改良食物交换系统在妊娠期糖尿病合并非酒精性脂肪肝中的应用  

Application of improved food exchange system in pregnancy with diabetes mellitus combined with nonalcoholic fatty liver

作　　者：薛俊[1] 华玉蓉 管崟 王宏星[4] XUE Jun, HUA Yurong, GUAN Yin, WANG Hongxing.(Department of Endocrinology, Wuxi Third People ＇ s Hospital , Wuxi 214041, Jiangsu , Chin)

机构地区：[1]无锡市第三人民医院内分泌科,江苏无锡214041 [2]无锡市第三人民医院妇产科,江苏无锡214041 [3]无锡市第三人民医院临床营养科,江苏无锡214041 [4]南通市妇幼保健院消化内科

出　　处：《上海医学》2018年第1期14-18,共5页Shanghai Medical Journal

基　　金：江苏省营养学会营养与健康研究项目(JYX201303);无锡市卫生局适宜卫生技术推广项目(T201308);无锡市卫生局妇幼保健项目(FYKY201402)

摘　　要：目的探讨基于血糖负荷概念的改良食物交换系统在妊娠期糖尿病(GDM)合并非酒精性脂肪肝(NAFLD)营养治疗中的应用效果。方法选择2014年5月—2015年3月无锡市第三人民医院收治的GDM合并NAFLD患者作为研究对象,共纳入患者65例,采用随机数字表法按就诊先后顺序将其随机分为研究组(34例,采用改良食物交换份法营养干预)和对照组(31例,采用传统食物交换份法营养干预)。均由专人统一按照两种不同方法通过门诊定期随访、讲课、现场示范与指导等形式进行营养治疗。比较两组间的年龄、孕次、首诊孕程、孕前体重,以及干预前与产后42d(产后)的肝功能、血糖、血脂指标和B超检查结果。分娩时,记录两组巨大儿、胎儿宫内窘迫、新生儿低血糖发生率,以及剖宫产率。结果干预结束时,研究组脱落6例,对照组脱落3例。两组间的年龄、孕次、首诊孕程、孕前体重,干预前轻度和中度脂肪肝患者比例,以及干预前丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)水平的差异均无统计学意义(P值均>0.05)。两组产后的轻度脂肪肝患者比例均显著高于同组干预前(P值均<0.05),中度脂肪肝患者比例均显著低于同组干预前(P值均<0.05);研究组产后的轻度脂肪肝患者比例显著高于对照组同时间(P<0.05),中度脂肪肝患者比例显著低于对照组同时间(P<0.05)。两组患者产后的ALT、AST、2hPG、HbA1c、TG、LDL-C均显著低于同组干预前(P值均<0.05),HDL-C均显著高于同组干预前(P值均<0.05);研究组产后的ALT、AST、2hPG、HbA1c、TG、LDL-C水平均显著低于对照组同时间(P值均<0.05),HDL-C显著高于对照组同时间(P<0.05)。研究组的巨大儿、胎儿宫内窘迫、新生儿低血糖发生率,以及剖宫�Objective To investigate the application of improved food exchange system based on glycemic load in pregnant women with gestational diabetes mellitus （GDM） combined with nonalcoholic fatty liver disease （NAFLD）. Methods A total of 65 pregnant women with GDM and NAFLD treated in the Wuxi Third People＇s Hospital between May 2014 and March 2015 were randomly divided into two groups： study group （n = 34, treated with improved food exchange system） and control group （n = 31, treated with normal food exchange system）. A specially-assigned person carried out the nutrition treatment according to the two food exchange systems with regular outpatient service, lecture, live demonstration and instruction. The age, pregnancy, first diagnosis and weight before pregnancy were compared between the two groups. The liver function, serum glucose, serum lipide, and liver B ultrasound were monitored before nutrition treatment and 42 days after delivery. During childbirth, the macrosomia, fetal distress, neonatal hypoglycemia, and cesarean section rate were recorded. Results Six persons in study group and three persons in control group withdrew from the study. There were no significant differences in age, pregnancy time, first diagnosis, gestational weight, prevalence of mild or moderate fatty liver before treatment, or the levels of alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, glutamyl transpeptidase （GGT）, 2 h postprandial blood glucose （2hPG）, glycosylated hemoglobin （HbAlc）, total cholesterol （TO）, triglyceride （TG）, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C） between the two groups （all P〉0. 05）. The prevalence of gestational mild fatty liver was higher than that before nutrition treatment （both P〈0. 05）, while the prevalence of gestational moderate fatty liver was lower than that before nutrition treatment in both groups （both P 〈 0. 05）. The prevalence of gestational mild fatty liver in th

关 键 词：糖尿病 妊娠 非酒精性脂肪肝 营养治疗 血糖负荷 食物交换份法 

分 类 号：R714.25[医药卫生—妇产科学]