糖尿病家属史对GDM血糖和血脂影响及围产结局分析

发布时间：2018-01-04 18:02

  本文关键词：糖尿病家属史对GDM血糖和血脂影响及围产结局分析　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 妊娠期糖尿病 糖尿病家族史 围产结局

【摘要】：研究背景:妊娠期糖尿病(GDM)是指妊娠期首次发生或发现的糖尿病,是常见的产科并发症之一,与一系列不良围产结局有关。目前,GDM在全球范围内的发病率为1.8～24.5%,中国GDM的发病率为17.5%,随着GDM发病率的上升,GDM已经成为全球性健康难题。已有大量研究表明,糖尿病家族史(FHD)是妊娠期糖尿病的危险因子,危险因素模式包括遗传易感基因与生活习惯两方面。糖尿病人数的激增,将进一步提高GDM的发病率,危害母婴健康。但是FHD对GDM孕妇血糖、血脂水平的影响及与不良围产结局研究文献较少,而且结论不一。本文旨在探究FHD对GDM孕妇血糖、血脂的影响及可能干预方式,为临床改善糖尿病家族史GDM孕妇的围产结局提供帮助。方法:本研究纳入2014年1月1日～12月31日于浙江大学医学院附属妇产科医院产科门诊进行孕中期首次产检并于本院分娩的所有单胎妊娠GDM孕妇;根据FHD,分为FHD组和无FHD组。根据OGTT血糖异常值分类,仅空腹血糖异常为OGTT-A,仅服糖后血糖异常为OGTT-B,空腹血糖与服糖后血糖均异常为OGTT-C。观察指标包括年龄、孕次、孕前体质量指数(BMI)、孕期增加体重(GWG)、75g-OGTT血糖值以及异常指标项数、孕中晚期血脂水平(包括甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL))以及妊娠结局(包括大于胎龄儿(LGA)、小于胎龄儿(SGA)、剖宫产、子痫前期、早产、胎儿窘迫、产后出血)。经统计分析所有计量资料非正态分布,结果用中位数M(四分位数间距Q)表示,组间比较用秩和检验;计数资料结果用频数和率表示,组间比较采用卡方检验,不符合卡方检验条件的用Fisher检验;独立相关性研究采用二元logistic回归分析,以P0.05为差异有统计学意义。结果:1.FHD组孕妇LGA[24.8%,63/254]、子痫前期[3.5%,9/254]以及剖宫产[50.8%,129/254]的发生率均显著高于无FHD组[分别为(19.5%,312/1603),(1.6%,25/1603),(43.8%,702/1603),P值均0.05]。2.孕晚期FHD组TG水平明显高于无FHD组[3.53(1.74)比3.27(1.77)nmol/L,P0.05]。3.FHD组空腹血糖、服糖1h血糖、服糖2h血糖及糖化血红蛋白水平均明显高于无FHD组[分别为4.81(0.80)比4.66(0.76),10.39(2.01)比 10.1(1.5),8.86(1.55)比8.52(1.75),5.1(0.40)比5.0(0.40)mmol/L,P值均0.05]。且FHD孕妇OGTT血糖三项、两项异常率均明显高于无FHD组,一项异常率则明显低于无FHD组[分别为(15.3%,39/254)比(4.3%,70/1603),(39.8%,101/254)比(26.1%,418/1603),(44.9%,114/254)比(69.6%,1115/1603),P值均0.001]。FHD组孕妇中OGTT-B类比例明显低于无FHD组,而OGTT-C类比例则明显高于无FHD组[分别为(64.2%,163/254)比(73.6%,1180/1603),(24%,61/254)比(10.1%,162/1603),P值均0.05]。4.所有研究对象孕中期OGTT三项指标均异常的孕妇,较一项、两项异常组,LGA[(36.7%,40/108)比(19.4%,239/1231)比(18.5%,96/518)]、子痫前期[(7.3%,8/108)比(1.5%,19/1231)比(1.3%,7/518)]、剖宫产[(62.4%,68/108)比(43.1%,530/1231)比(44.9%,233/518)]发生率均呈上升趋势,且有显著性差异(P0.01)。OGTT-C组孕妇与A组和B组相比,子痫前期[(4.9%,11/224)比(1.0%,3/299)比(1.5%,20/1334)]、剖宫产[(59.2%,132/224)比(46.7%,136/299)比(41.9%,563/1334)]的发生率明显升高,同时与B组相比,LGA[(34.5%,77/224)比(16.3%,219/1334)]、产后出血[(2.7%,6/224)比(0.7%,10/1334)]的发生率均明显升高,且有统计学差异(P0.01)。OGTT-A组孕妇与B组相比,LGA[(27.1%,79/299)比(16.3,219/1334)]、胎儿窘迫[(8.9%,26/299)比(4.9%,67/1334)]的发生率均显著升高(P0.01)5.通过二元logistic回归分析发现,对LGA而言,孕前BMI、孕期增加体重、FBG及TG是其独立正相关因素,OR值分别为1.15(95%CI 1.10～1.20)、1.13(95%CI 1.10～1.17)、1.37(95%CI 1.12～1.67)、1.21(95%CI 1.14-1.28);对剖宫产而言,孕前BMI、孕期增加体重及FBG是其正相关因素,OR值分别为1.14(95%CI1.11～1.19)、1.04(95%CI 1.02～1.07)、1.30(95%CI 1.13～1.59);对子痫前期而言,孕前BMI、孕期增加体重、2h-OGTT及TG均是其独立影响因素,OR值分别为1.33(95%CI 1.23～1.48)、1.16(95%CI 1.08～1.26)、1.38(95%CI 1.09～1.79)、1.15(95%CI 1.00～1.30)。结论:1.对于FHD组GDM孕妇,在孕早期即应接受医学营养和运动治疗,必要时胰岛素提前干预,严格控制血糖水平;2.FHD组GDM孕妇孕晚期TG水平与不良妊娠结局有关,需要密切监测与干预。3.为改善FHD组孕妇妊娠结局,建议孕前适当控制体重。
[Abstract]:Background: gestational diabetes mellitus (GDM) during pregnancy for the first time refers to the occurrence or discovery of diabetes, is one of the common complications of pregnancy, and a series of adverse perinatal outcome. At present, the incidence of GDM in the global scope of the rate is 1.8 ~ 24.5%, China incidence rate of GDM was 17.5%, with the rising incidence of GDM the GDM has become a global health problem. There are a large number of studies show that family history of diabetes (FHD) is a risk factor for gestational diabetes mellitus, patterns of risk factors including genetic susceptibility gene and two habits. In diabetes, will further increase the incidence of GDM, but the harm to the maternal and child health for pregnant women with GDM FHD. The blood glucose, and few studies and adverse perinatal outcome affects blood lipid levels, and not a conclusion. This paper aims to explore the FHD of pregnant women with GDM blood glucose, blood lipid and effect of intervention, clinical improvement of diabetes Help GDM family history of pregnant women and perinatal outcome. Methods: This study included in the January 1, 2014 to December 31st in the affiliated obstetrics and Gynecology Hospital of Zhejiang University Medical College of Obstetrics outpatient examination and first trimester in our hospital during all singleton pregnancy GDM pregnant women; according to FHD, divided into FHD group and non FHD group according to the classification of abnormal values. OGTT blood glucose, only impaired fasting glucose OGTT-A, postprandial blood glucose abnormalities only OGTT-B, fasting blood glucose and postprandial blood glucose were abnormal for OGTT-C. observation indexes including age, pregnancy, pre pregnancy body mass index (BMI), pregnancy weight gain (GWG), 75g-OGTT blood glucose levels and abnormal blood lipid level index number, late pregnancy (including triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL)) and pregnancy outcomes (including large for gestational age (LGA), gestational age (SGA), cesarean section, preeclampsia, preterm birth, fetal Fetal distress, postpartum hemorrhage). Through the statistical analysis of all the non normal distribution of measurement data, the median (four percentile interval M Q) said, compared with the rank sum test results; count data by frequency and rate of said groups were compared by chi square test, chi square test does not meet the conditions Fisher test; independent association studies using two logistic regression analysis, with P0.05 as the difference was statistically significant. Results: 1.FHD group LGA[24.8%, 63/254], 9/254] and [3.5% in preeclampsia and cesarean section [50.8%, the incidence rate of 129/254] was significantly higher than that of non FHD Group [respectively (19.5%, 312/1603), (1.6%. 25/1603), (43.8%, 702/1603), P value was 0.05].2. in late pregnancy group FHD TG was significantly higher than that of non FHD group ([3.53 1.74) 3.27 (1.77) nmol/L, P0.05].3.FHD group, fasting blood glucose, oral glucose 1H blood glucose, blood glucose and glycosylated hemoglobin levels take sugar 2h were significantly higher than those without FHD group. 涓，

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