病例06(2025):妊娠合并1型糖尿病并发严重肾病及视网膜病变1例  

Case 06(2025):A case of pregnancy complicated by type 1 diabetes with severe diabetic nephropathy and retinopathy

作　　者：黄红丽 杨慧霞[1] 宋耕[1] 王淑娴 冯烨[1] 魏玉梅[1] 孙瑜[1] 师素芳[3] 袁晓勇[4] 张婧[5] Huang Hongli;Yang Huixia;Song Geng;Wang Shuxian;Feng Ye;Wei Yumei;Sun Yu;Shi Sufang;Yuan Xiaoyong;Zhang Jing(Department of Obstetrics&Gynecology and Reproductive Medicine,Peking University First Hospital,Beijing 100034,China;Department of Obstetrics and Gynecology,Shenzhen Luohu Maternity and Child Health Hospital,Shenzhen 518019,China;Renal Division,Peking University First Hospital,Beijing 100034,China;Department of Endocrinology,Peking University First Hospital,Beijing 100034,China;Department of Ophthalmology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院妇产生殖医学中心,北京100034 [2]深圳市罗湖区妇幼保健院妇产科,深圳518019 [3]北京大学第一医院肾脏内科,北京100034 [4]北京大学第一医院内分泌科,北京100034 [5]北京大学第一医院眼科,北京100034

出　　处：《中华围产医学杂志》2025年第1期51-56,共6页Chinese Journal of Perinatal Medicine

摘　　要：本文报告了1例孕前合并严重糖尿病肾病、糖尿病视网膜病变、高血压及甲状腺功能减退症的1型糖尿病患者。患者孕前血糖控制不佳,并发症未规范诊治。本次为意外妊娠,孕前糖化血红蛋白7.8%,孕早期尿蛋白已达3.81~4.53 g/24 h。考虑患者孕前血糖未达标,合并肾病等多种并发症且未规范治疗,外院多学科会诊建议终止妊娠。但患者继续妊娠意愿强烈,遂转诊至北京大学第一医院。经严格综合管理控制血糖、监测血糖、评估并发症等综合管理,孕期血糖及血压均控制达标,定期监测尿蛋白、肾功能及眼底等相关指标。孕31周^(+4)开始,患者24 h尿蛋白定量明显升高,予促胎肺成熟后在孕34周+1剖宫产分娩,母儿结局良好。产后42 d随访,患者血糖及血压平稳,尿蛋白恢复到孕前水平,其婴儿一般情况良好。This paper reported a type 1 diabetes patient who had severe diabetic nephropathy,retinopathy,hypertension,and hypothyroidism before pregnancy.The patient's blood glucose control was poor before pregnancy,and the complications were not properly treated.This was an unintended pregnancy,with a pre-pregnancy glycated hemoglobin A1c of 7.8%and early pregnancy urine protein of 3.81-4.53 g/24 h.Considering the patient's poor blood glucose control before pregnancy and the lack of proper treatment for multiple complications including nephropathy,a multidisciplinary consultation at an external hospital recommended termination of the pregnancy.However,the patient was determined to continue the pregnancy and was referred to Peking University First Hospital.Through strict blood glucose control,monitoring and evaluation of complications,and comprehensive management,the patient's blood glucose and blood pressure were well controlled during pregnancy.Regular monitoring of urine protein,renal function,and ocular fundus was conducted.At 31 weeks and 4 days of gestation,the patient's 24-hour urine protein significantly increased.After promoting fetal lung maturity,a cesarean section was performed at 34 weeks and 1 day of gestation,resulting in a successful delivery with good maternal and neonatal outcomes.At the 42-day postpartum follow-up,the patient's blood glucose and blood pressure were stable,urine protein returned to pre-pregnancy levels,and the infant was in good general condition.

关 键 词：1型糖尿病 糖尿病肾病 糖尿病视网膜病变 高血压 妊娠 

分 类 号：R714.25[医药卫生—妇产科学]