妊娠期糖尿病妇女产后1年糖代谢转归及其影响因素研究

发布时间：2018-03-18 05:13

本文选题：妊娠期糖尿病　切入点：产后　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究旨在了解妊娠期糖尿病(GDM)妇女产后1年糖代谢转归情况,分析糖代谢转归异常的可能影响因素,探寻GDM妇女产后转变为2型糖尿病(T2DM)及糖代谢异常的危险因素,为预防GDM妇女产后转变为2型糖尿病提供理论依据。资料与方法:选取2014年5月至2015年5月在铜陵市某妇幼保健院妇产科门诊进行产检并且在孕24-28周之间进行75g葡萄糖耐量试验(OGTT)被诊断为GDM的妇女作为研究对象,于2015年7月至2016年5月进行产后1年随访。收集研究对象产后1年时的体重、血压、体成分、母乳喂养情况、体力活动情况等信息。同时复查OGTT,并检测空腹血糖、餐后2h血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、瘦素、C-反应蛋白、脂联素、白介素-6水平。了解GDM妇女产后1年T2DM及糖代谢异常发病率,采用Logistic回归分析探寻影响糖代谢转归的危险因素。结果:(1)经过纳入排除标准,确定孕中期OGTT试验诊断出的204名GDM妇女作为研究对象,最终于产后1年随访到166名GDM妇女,失访率为18.6%。经过产后1年OGTT试验,诊断出3例2型糖尿病患者,24例空腹血糖受损患者(IFT),9例餐后2h血糖受损者(IGT),4例空腹血糖受损合并餐后两小时血糖受损者(IFT合并IGT),产后1年GDM妇女T2DM发病率为1.81%,糖代谢异常发病率为24.1%。(2)产后1年糖代谢转归异常的GDM妇女与糖代谢转归正常的妇女相比,孕前及产后1年BMI较高,孕早、中、晚期及产后一年空腹血糖水平较高,孕中期餐后1h血糖水平较高,产后1年餐后2h血糖水平较高,产后1年空腹胰岛素及胰岛素抵抗水平较高,孕早期、孕中期及产后1年甘油三酯水平较高,孕晚期高密低脂蛋白水平较低(P0.05)。此外糖代谢转归异常的GDM妇女产后1年有着更高的腰围、肱三头肌皮褶厚度、肩胛下皮褶厚度、腹部皮褶厚度、体脂肪含量、体脂百分比及收缩压(P0.05)。(3)C-反应蛋白水平与产后1年空腹血糖、空腹胰岛素及HOMA-IR水平呈现正相关趋势(P0.05),瘦素水平与产后1年空腹胰岛素及HOMA-IR水平呈现正相关趋势(P0.05)。(4)Logistic回归分析结果显示产后1年BMI、孕中期-产后1年空腹血糖值差异、孕中期-产后1年餐后2h血糖值差异、产后1年体脂百分比及产后一年内脏脂肪含量等级是GDM妇女产后糖代谢异常发生的危险因素(OR=1.679,95%CI[1.085~2.596];OR=5.857,95%CI[1.957~17.529];OR=1.568,95%CI[1.130~2.176];OR=1.481,95%CI[1.042~2.105];OR=0.366,95%CI[0.182~0.732])。结论:(1)孕前及产后1年BMI,孕期及产后血脂水平,产后1年腰围、体脂百分比及内脏脂肪含量都与GDM妇女产后糖代谢转归密切相关,其中产后1年BMI、孕中期-产后1年空腹血糖值差异、孕中期-产后1年餐后2h血糖值差异、产后1年体脂百分比及产后一年内脏脂肪含量等级均为GDM妇女产后发生糖代谢异常的危险因素。(2)患有妊娠期糖尿病的妇女产后易发生T2DM和糖代谢异常,因此对妊娠期糖尿病妇女进行产后随访十分必要,对预防和延迟将来发生T2DM有重要意义。
[Abstract]:Objective: This study aimed to understand the gestational diabetes mellitus (GDM) women 1 years postpartum glucose metabolism conditions, factors that may affect the outcome of abnormal glucose metabolism, to explore the transformation of GDM postpartum women for type 2 diabetes (T2DM) and the risk factors of abnormal glucose metabolism, for the prevention of postpartum GDM transformation provides a theoretical basis for type 2 diabetes materials and methods: from May 2014 to May 2015 in the Department of Obstetrics and gynecology clinic in Tongling city a hospital for production inspection and glucose tolerance test 75g in 24-28 weeks of pregnancy (OGTT) women diagnosed with GDM as the research object, followed up for 1 years from July 2015 to May 2016. After collected 1 years postpartum the body weight, blood pressure, body composition, breastfeeding, physical activity and other information. At the same time to review the OGTT and fasting blood glucose, 2h postprandial blood glucose, triglyceride, total cholesterol, high density lipoprotein , low density lipoprotein, leptin, adiponectin, C- reactive protein, interleukin -6 level. 1 year incidence of abnormal T2DM and GDM postpartum glucose metabolism rate, Logistic regression analysis was used to explore the risk factors of glucose metabolism outcome. Results: (1) through the inclusion and exclusion criteria, determine the second trimester OGTT diagnosis test the 204 women with GDM as the research object, in the final 1 years postpartum follow-up to 166 women with GDM, the dropout rate was 18.6%. after 1 years postpartum OGTT test, diagnosed 3 cases of patients with type 2 diabetes, 24 cases of patients with impaired fasting glucose (IFT), 9 cases of impaired 2h postprandial blood sugar (IGT) two hours, 4 cases of impaired impaired fasting glucose and postprandial glucose (IFT and IGT), 1 years postpartum women GDM incidence rate of T2DM was 1.81%, the incidence rate of abnormal glucose metabolism in 24.1%. (2) 1 years postpartum glucose metabolism outcome GDM women with abnormal glucose metabolism outcome of normal pregnant and postpartum women compared to 1 BMI High, early, late pregnancy, and postpartum a fasting glucose level is higher, the second trimester 1H postprandial blood glucose level is high, high 2H blood glucose levels 1 years postpartum postpartum 1 years after the meal, fasting insulin and insulin resistance in high level, early pregnancy, pregnancy and postpartum 1 years higher triglyceride levels in late pregnancy, low fat and high density the protein level was low (P0.05). In addition the outcome of glucose metabolism abnormal GDM postpartum women 1 years have a higher waist circumference, triceps skinfold thickness, subscapular skinfold, abdominal skinfold thickness, body fat, body fat percentage and systolic blood pressure (P0.05). (3) the levels of C-reactive protein and C- after 1 years of fasting blood glucose, fasting insulin and HOMA-IR levels showed positive correlation (P0.05), leptin and 1 year postpartum fasting insulin and HOMA-IR levels showed positive correlation (P0.05). (4) Logistic regression analysis results showed that 1 years postpartum BMI, mid pregnancy - 1 years postpartum The fasting blood glucose level difference, the second trimester - 1 years postpartum 2h postprandial blood glucose values, 1 year postpartum body fat percentage and a year postpartum visceral fat content rating is a risk factor for abnormal postpartum glucose metabolism in women with GDM (OR=1.679,95%CI[1.085~2.596] OR=5.857,95%CI[1.957~17.529]; OR=; 1.568,95%CI[1.130~2.176]; OR=1.481,95%CI[1.042~2.105]; OR=0.366,95%CI[0.182~0.732]). Conclusion: (1) before pregnancy and postpartum 1 years BMI, blood lipid levels during pregnancy and postpartum, 1 years postpartum waist circumference, percentage of body fat and visceral fat content and outcome of postpartum glucose metabolism of women is closely related to GDM, including 1 years postpartum BMI, mid pregnancy - 1 years postpartum fasting blood glucose values, second trimester - 1 years postpartum 2h postprandial blood glucose value differences. After 1 years the percentage of body fat and visceral fat level a year postpartum were risk factors of abnormal glucose metabolism in GDM. (2) postpartum women with gestational diabetes mellitus Postpartum women are prone to have abnormal T2DM and glucose metabolism. Therefore, postpartum follow-up is very necessary for women with gestational diabetes mellitus, which is significant for preventing and delaying the occurrence of T2DM in the future.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256

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