妊娠期糖尿病患者产后代谢指标变化及影响因素研究  

Postpartum Changes of Metabolic Parameters and Its Influencing Factors in Patients with Gestational Diabetes

作　　者：苏娜[1] 王光亚[1] 付冬霞[1] 王霖霞[1] 郭宁宁[1] 邢宝恒[2] 

机构地区：[1]河北省沧州市中心医院内分泌二科,061000 [2]河北省沧州市中心医院产二科,061000

出　　处：《中国全科医学》2014年第8期898-902,共5页Chinese General Practice

摘　　要：目的探讨妊娠期糖尿病(GDM)患者产后1年代谢指标的变化及相关影响因素。方法选取2009年1月—2012年6月于沧州市中心医院产检、孕中期行口服葡萄糖耐量试验(OGTT)诊断为GDM者126例为GDM组,选取同期在本院产检、孕中期行OGTT显示糖代谢正常者114例为对照组,两组均在本院分娩,并于产后1年回访。于孕中期采血检测OGTT各点血糖值、空腹胰岛素、空腹血脂,留置血清冰冻后测定超敏C反应蛋白(hs-CRP),测量身高和体质量;同时询问孕前体质量、糖尿病家族史、既往妊娠史。产后1年随访时测量身高、体质量、腰围、血压,检测血脂、空腹血糖(FBG)及餐后2 h血糖。结果 GDM组有糖尿病家族史者29例(23.0%),对照组有糖尿病家族史者14例(12.3%),两组间差异有统计学意义(χ2=4.690,P=0.022)。孕中期GDM组体质量增加值、胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、hs-CRP均较对照组升高(P<0.05)。产后1年,GDM组腰围>80 cm、FBG≥5.6 mmol/L、TG≥1.70 mmol/L及舒张压(DBP)≥85 mm Hg(1 mm Hg=0.133 kPa)的发生率均高于对照组(P<0.05);GDM组与对照组糖代谢异常发生率分别为22.2%和1.8%,两组间差异有统计学意义(χ2=22.924,P=0.000);GDM组与对照组脂代谢异常发生率分别为30.2%和20.2%,两组间差异无统计学意义(χ2=3.147,P=0.052);GDM组与对照组MS发生率为17.5%和7.9%,两组间差异有统计学意义(χ2=4.869,P=0.021)。多因素Logistic回归分析显示,孕中期FBG、孕前BMI、孕中期hs-CRP及诊断GDM时年龄是产后发生MS的影响因素,OR值分别为9.645、1.632、1.466、1.442。结论 GDM患者产后糖脂代谢异常发生率及MS发生率较对照组明显升高,孕中期FBG、孕前BMI、孕中期hs-CRP及诊断GDM时年龄是产后发生MS的影响因素。Objective To explore the changes of metabolic parameters in patients with gestational diabetes mellitus（GDM） 1 year after partum and its influencing factors.Methods One hundred and twenty-six pregnancy women who had antenatal care and diagnosed as GDM by oral glucose tolerance test（OGTT） in this hospital from January 2009 to June 2012 were enrolled as GDM group,another 114 healthy pregnancy women with normal glycometabolism as control group.Follow-ups were made 1 year after partum.Mid-gestation blood was collected to detect blood glucose（BG） level at varying points of OGTT,fasting insulin（FI）,fasting plasma lipid（FPL）,high sensitivity C-reactive protein（hs-CRP） was measured after serum frozen;height and body mass（BM） measured;pregnancy women were asked about their pre-pregnancy BM,family history of diabetes,history of pregnancy.Height,BM,abdominal circumference,blood pressure（BP）,fasting blood glucose（FBG）,postprandial 2 h glucose were determined in the follow-ups 1 year after partum.Results There were 29 pregnancy women having family history of diabetes in GDM group（23.0%）,and 14 in control group（12.3%）,the difference was significant（χ2=4.690,P=0.022）.The increase value of BM,insulin resistance index（HOMA-IR）,triglyceride（TG）,low density lipoprotein cholesterol（LDL-C）,hs-CRP were higher in GDM group than in control group（P＜0.05）.The incidences of WC〉80 cm,FBG≥5.6 mmol/L,TG≥1.70 mmol/L,DBP≥85 mm Hg were higher in GDM group than in control group（P＜0.05）.The incidences of abnormal glycometabolic indexes of groups GDM and control were 22.2%,1.8%,respectively,the difference was significant（χ2=22.924,P=0.000）,those of abnormal lipid metabolic indexes were 30.2%,20.2%,respectively,the difference was significant（χ2=3.147,P=0.052）,those MS were 17.5%,7.9%,respectively,the difference was significant（χ2=4.869,P=0.021）.By multivariate Logistic regression analysis,pregnancy FBG,pre-pregnanct BMI,pregnancy hs-CRP and gestational ag

关 键 词：糖尿病 妊娠 血糖指数 脂代谢障碍 代谢综合征X C反应蛋白质 

分 类 号：R587.1[医药卫生—内分泌] R714.147[医药卫生—内科学]