基于稳态模型评估法2胰岛素敏感指数差异评价妊娠期糖尿病患者不同孕周血糖血脂变化及非药物干预效果  

The evaluation of blood glucose and blood lipid changes and non-pharmacological intervention effects in gestational diabetes mellitus patients at different gestational weeks based on insulin sensitivity index differences of homeostasis model assessment 2

作　　者：周霞 梁茹英 赵青云 柏智 王志坚[5] 牟纯玮 Zhou Xia;Liang Ruying;Zhao Qingyun;Bai Zhi;Wang Zhijian;Mou Chunwei(Department of Gynecology and Obstetrics,Shijing People′s Hospital in Baiyun District,Guangzhou 510430,China;Department of Obstetrics,Yunfu City People′s Hospital,Yunfu 527300,China;Department of Obstetrics,Dongguan Fenggang People′s Hospital,Dongguan 523686,China;Department of Obstetrics,Dongguan First Hospital Affiliated to Guangdong Medical University,Dongguan 523710,China;Department of Gynecology and Obstetrics,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China;Department of Department of Gynecology and Obstetrics,Baiyun Branch of Nanfang Hospital of Southern Medical University,Guangzhou 510420,China)

机构地区：[1]广州市白云区石井人民医院妇产科,广州510430 [2]云浮市人民医院产科,云浮527300 [3]东莞市凤岗人民医院产科,东莞523686 [4]广东医科大学附属东莞第一医院产科,东莞523710 [5]广州医科大学附属第三医院妇产科,广州510150 [6]南方医科大学南方医院白云分院妇产科,广州510420

出　　处：《中国医师进修杂志》2024年第10期898-903,共6页Chinese Journal of Postgraduates of Medicine

基　　金：广东省自然科学基金(2023A1515010207)。

摘　　要：目的探讨胰岛素敏感性不同的妊娠期糖尿病(GDM)患者各孕期血糖、血脂变化和非药物干预效果。方法回顾性收集2023年7月1日至9月1日广州市白云区石井人民医院等六家医院门诊同期产检孕36周GDM患者及健康孕妇孕期资料各240例。利用稳态模型评估法2(HOMA2)模型计算两组孕妇早孕期胰岛素敏感指数(ISI),根据正常孕妇ISI的第25百分位数将GDM患者分为胰岛素敏感组(A组)和胰岛素敏感缺陷组(B组),根据36周血糖控制情况将A组和B组分为血糖控制良好组(A1组和B1组)及血糖控制不良组(A2组和B2组)。比较各组年龄、孕前体质量指数(BMI)、早孕期空腹血糖(FPG)、血脂指标、糖化血红蛋白(HbA 1c);中孕期各组血糖和血脂指标;孕28、32、36周的A1、A2、B1、B2组病例数变化、血糖和血脂指标及非药物干预方式。结果A、B组分别有166例和74例。各组早孕期血糖、血脂指标均正常。中孕期A、B组间血糖指标比较差异无统计学意义(P>0.05),血脂指标均较早孕期明显升高,以三酰甘油(TG)和低密度脂蛋白胆固醇(LDL-C)升高显著。孕晚期A1组孕妇数量明显多于A2组(P=0.01),随孕周增加两组孕妇数量无明显变化;28周B1组孕妇数量多于B2组(51例比23例)(P=0.01)。32周B1组和B2组孕妇数量相似(P=0.31)。36周B1组孕妇数量明显低于B2组(15例比59例)(P=0.01)。孕晚期B2组各血糖指标均高于A2组(P<0.05)。A2组和B2组TG、LDL-C均分别高于A1组和B1组,高密度脂蛋白胆固醇(HDL-C)分别低于A1组和B1组(P<0.05);28周和32周A2组TC与A1组比较差异无统计学意义(P>0.05),但36周明显升高(P=0.01)。孕晚期A组以单纯饮食控制为主(分别为91.7%、87.7%、81.6%)(P>0.05)。B1组在28周和32周单纯饮食控制和饮食联合运动干预比例相似(52.9%比47.1%,45.7%比54.3%)(P=0.072、0.113)。36周以饮食联合运动干预为主(73.3%)。B2组以饮食干预为主(69.6%、71.8%、69.5%),可能是血糖控制不�Objective To investigate the changes of blood glucose and blood lipid in gestational diabetes mellitus(GDM)patients with different insulin sensitivity during pregnancy and the effect of non-drug intervention.Methods Data of 240 pregnant women with GDM and 240 healthy pregnant women were collected from July 1 to September 1,2023 in Shijing People′s Hospital in Baiyun District and other five hospital.The insulin sensitivity index(ISI)was calculated by homeostasis model assessment 2(HOMA2)model,according to the 25th percentile of ISI of normal pregnant women,GDM patients were divided into insulin sensitive group(group A)and insulin sensitive deficiency group(group B),and group A and group B were divided into two groups according to 36-week blood glucose control:group A1 with good blood glucose control(group A1 and group B1)and group A2 with bad blood glucose control(group A2 and group B2).The age,body mass index(BMI)before pregnancy,fasting plasma glucose(FPG),blood lipids and blood glycated hemoglobin(HbA 1c)in the first trimester,blood glucose and blood lipids in the second trimester were compared at the 28th,32nd and 36th weeks of gestation,the number of cases,blood glucose,blood lipids and non-drug intervention were measured.Results There were 166 cases in group A and 74 cases in group B.Blood glucose and blood lipid were normal in early pregnancy.There was no significant difference in blood glucose between group A and group B during the second trimester.The levels of blood lipids were significantly higher than those during the first trimester,and the levels of triglyceride(TG)and low-density lipoprotein cholesterol(LDL-C)were significantly higher than those during the first trimester.The number of pregnant women in group A1 was significantly more than that in group A2 in the third trimester(P=0.01),and the number of pregnant women in group B1 was more than that in group B2 at 28 weeks(P=0.01).At 32 weeks,the number of pregnant women in group B1 and group B2 was similar(P=0.31).At 36 weeks,the number of pregna

关 键 词：妊娠期糖尿病 胰岛素抵抗 胰岛素敏感指数 血糖 血脂 非药物干预 

分 类 号：R714.256[医药卫生—妇产科学]