發(fā)布時(shí)間：2019-01-18 18:36

【摘要】：目的:探討中醫(yī)體質(zhì)類型和胰島素抵抗指數(shù)(Insulin resistance index,IRI)與妊娠期糖尿病(gestational diabetes mellitus,GDM)的相關(guān)性,為臨床GDM的早期預(yù)測(cè)、通過體質(zhì)干預(yù)從而預(yù)防GDM的發(fā)生提供一定的借鑒和理論基礎(chǔ)。方法:本課題采用橫斷面調(diào)查的研究方法,對(duì)2015年4月~2016年2月在河南中醫(yī)藥大學(xué)第一附屬醫(yī)院定期進(jìn)行檢查的孕婦進(jìn)行抽樣調(diào)查,剔除資料不全者,從收回的348份有效問卷中,選取105例GDM孕婦作為病例組,并采用單純隨機(jī)抽樣法,從243例同期健康孕婦中選取105例作為對(duì)照組。采用GDM流行病學(xué)調(diào)查表(見附錄1),對(duì)調(diào)查對(duì)象進(jìn)行現(xiàn)場(chǎng)問卷式調(diào)查,調(diào)查所得結(jié)果錄入SPSS并建立數(shù)據(jù)庫。對(duì)兩組對(duì)象的計(jì)數(shù)資料采用χ2檢驗(yàn)分析,計(jì)量資料采用t檢驗(yàn)進(jìn)行分析;對(duì)兩組體質(zhì)類型構(gòu)成的比較采用Fisher精確概率法分析,對(duì)多因素研究采用logistic回歸分析。結(jié)果:(1)GDM孕婦組與正常孕婦組的體質(zhì)總體構(gòu)成共同點(diǎn)為:均以平和質(zhì)為主要體質(zhì)之一,其中平和體質(zhì)為正常孕婦組總體體質(zhì)構(gòu)成的主要體質(zhì),平和質(zhì)占正常孕婦總?cè)藬?shù)的61.9%,說明平和質(zhì)是健康女性人群的主要體質(zhì);(2)GDM孕婦組與正常孕婦組體質(zhì)辨識(shí)存在明顯差異,統(tǒng)計(jì)分析提示差異具有統(tǒng)計(jì)學(xué)意義,中醫(yī)體質(zhì)辨識(shí)中GDM組主要的偏頗體質(zhì)類型為痰濕質(zhì),正常孕婦組主要偏頗體質(zhì)為陽虛質(zhì);(3)病例組和對(duì)照組胰島素抵抗指數(shù)具有顯著統(tǒng)計(jì)學(xué)差異(P0.05);(4)GDM痰濕體質(zhì)孕婦的胰島素抵抗指數(shù)(IRI)水平最高,與非痰濕體質(zhì)比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);(5)多因素Logistic回歸分析提示:孕前體質(zhì)指數(shù),糖尿病家族史,痰濕體質(zhì),IRI四個(gè)危險(xiǎn)因素均進(jìn)入回歸模型,各影響回歸系數(shù)分別為0.168,1.207,1.449,1.267。結(jié)論:(1)痰濕體質(zhì)為GDM的易感偏頗體質(zhì);(2)胰島素抵抗指數(shù)與GDM的發(fā)病呈正相關(guān)性,對(duì)GDM有一定的早期預(yù)測(cè)作用;(3)多因素Logistic回歸結(jié)果顯示:孕前體重指數(shù),糖尿病家族史,痰濕體質(zhì)是GDM的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to investigate the correlation between TCM physique type and insulin resistance index (Insulin resistance index,IRI) and gestational diabetes mellitus (gestational diabetes mellitus,GDM) in order to predict early clinical GDM. Physical intervention to prevent the occurrence of GDM provides a certain reference and theoretical basis. Methods: a cross-sectional survey was conducted on pregnant women in the first affiliated Hospital of Henan University of traditional Chinese Medicine from April 2015 to February 2016. From 348 valid questionnaires, 105 pregnant women with GDM were selected as case group, and 105 healthy pregnant women were selected as control group. GDM epidemiological questionnaire (see Appendix 1) was used to investigate the subjects in the field. The results were recorded in SPSS and the database was established. The count data of the two groups were analyzed by 蠂 2 test and t test, the constitution of the two groups was analyzed by Fisher accurate probability method, and the multiple factors were analyzed by logistic regression analysis. Results: (1) the general constitution of GDM pregnant women group and normal pregnant women group were as follows: one of the main constitutions was calmness and quality, and the peaceful constitution was the main constitution of normal pregnant women. Peaceful quality accounted for 61.9% of the total number of normal pregnant women, indicating that peaceful quality is the main body mass of healthy women. (2) there was significant difference in physique identification between GDM pregnant women and normal pregnant women. Statistical analysis showed that the difference was statistically significant. The main biased physique type of GDM group in TCM physique identification was phlegm and dampness. In normal pregnant women, the main physical bias was yang deficiency; (3) there was significant difference in insulin resistance index between the case group and the control group (P0.05). (4) the insulin resistance index (IRI) of pregnant women with GDM phlegm dampness constitution was the highest, compared with that of non-phlegm dampness constitution, the difference was statistically significant (P0.05); (5) the multivariate Logistic regression analysis showed that four risk factors, including pre-pregnancy BMI, family history of diabetes, phlegm dampness and IRI, all entered the regression model, and the regression coefficients were 0.168 / 1.207 / 1.449 / 1.267respectively. Conclusion: (1) phlegm dampness constitution is the susceptible and biased constitution of GDM, (2) the insulin resistance index is positively correlated with the incidence of GDM, which has a certain early predictive effect on GDM. (3) the results of multivariate Logistic regression showed that body mass index before pregnancy, family history of diabetes and phlegm dampness were independent risk factors of GDM.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R271.9

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