妊娠糖尿病（GDM）患者焦虑状况相关影响因素调查

发布时间：2018-05-04 12:41

本文选题：妊娠糖尿病 + 焦虑　；参考：《安徽医科大学》2014年硕士论文

【摘要】：第一部分妊娠糖尿病(GDM)患者确诊后焦虑状况及相关影响因素调查目的调查了解孕妇确诊GDM后心理健康状况情况,并研究探讨影响GDM孕妇焦虑的相关因素,为对患者进行有针对性的心理干预提供临床依据。方法采用焦虑自评量表(SAS)和健康自我评分表对2012年6月至2013年6月在解放军第306医院产检,并于孕24～28周行75g OGTT,在确诊后1-2周内进行横断面调查,其中符合2011年ADA的标准的GDM孕妇105例,正常糖耐量孕妇103例,同时采集被调查孕妇的年龄,体重,身高等基本信息及孕妇的生化指标进行分析。结果GDM组与对照组相比,焦虑状态患病率(42.2%vs26.8%,p0.05)、孕前UBMI:(22.93±3.66vs20.29±2.32,p0.05) Kg/m2、收缩压(118.56±12.72vs110.88±10.81, p0.05) mmHg. SAS评分(41.05±9.02vs35.75±6.71,p0.05)、自我健康评分(72.62±10.65vs83.43±9.82,p0.05)有统计学差异。相关分析显示,SAS评分与空腹血糖(r=0.403,p0.05)、1h血糖(r=0.255,p0.05)、2h血糖(r=0.065, p0.05)、HbA1c (r=0.432,p0.05)、孕前BMI(r=0.338,p0.05)、收缩压(r=0.477,p0.05)、心率(r=0.458,p0.05)、运动令人伤脑筋(r=0.26,p0.05)、血糖监测痛苦(r＝0.39,p0.05)、血糖监测费钱(r=0.47,p0.05)均呈显著正相关。SAS评分与自我健康评分呈显著负相关(r=-0.751,p0.05)。Logistic回归显示,空腹血糖(OR=2.036,p=0.008)、孕前BMI (OR=1.185, p=0.007)、心率(OR=1.133,p=0.003)是GDM孕妇焦虑状态的危险因素。结论GDM患者确诊后存在较严重的焦虑状态,焦虑评分及焦虑状态患病率均比非妊娠糖尿病孕妇高。孕妇血糖水平,收缩压及孕前BMI与焦虑严重程度密切相关,孕前BMI、空腹血糖和心率是GDM确诊后焦虑的危险因素。第二部分 WHO与IADPSG诊断标准关于妊娠糖尿病(GDM)诊断率的比较目的：本研究通过对孕妇糖耐量试验结果与妊娠结局关系的回顾分析,比较WHO及IADPSG诊断标准对GDM诊断的异同,并对不同诊断标准下妊娠不良结局的比较。方法：回顾性分析2000年至2010年在解放军第306医院妇产科行孕检的初产单活胎产妇8943例,均在孕24-32周一步法行75克OGTT试验。比较两种诊断标准下GDM患病率及妊娠不良结局,探讨它们对不良妊娠结局风险评估的价值。结果：本研究共分为5组,正常糖耐量组(NGT)、符合WHO诊断标准组(w)、符合IAPDSG诊断标准组(I)、符合WHO而不符合IAPDSG组(W-I)、符合IAPDSG而不符合WHO组(I-W),各组OGTT孕周无显著差异。其中618例同时符合2种诊断标准,占任一诊断标准确诊患者之和的49.2%,符合2011年IADPSG的GDM诊断标准的835例,占总数的9.3%,符合WHO诊断标准的孕妇1039例,占总人数的11.6%,二者发病率比较有显著差异。其中217例(17.2%)仅符合IADPSG诊断标准,表现为空腹血糖水平在≥501-7.0mmol/l;或／和1小时血糖≥10.0mmol/1；421例(33.5%)仅符合WHO诊断标准,表现为2小时血糖≥7.8但8.5mmol/l。与NGT组相比,其余各组的孕妇年龄更大(P0.05),剖腹产率、巨大儿及低体重儿、新生儿窒息均显著升高(P均0.05)。结论：WHO诊断标准GDM发病率更高,但会漏诊17.2%符合IADPSG标准的患者；IADPSG则会漏诊33.5%2小时血糖异常的GDM患者。无论符合WHO还是IADPSG诊断标准的GDM患者,剖腹产及巨大儿发生率均显著高于NGT组。
[Abstract]:Part one
Investigation of anxiety status and related factors in patients with gestational diabetes mellitus (GDM) after diagnosis
Objective to investigate the mental health status of pregnant women after GDM diagnosis, and to explore the related factors affecting the anxiety of pregnant women in GDM, and to provide clinical basis for the psychological intervention of the patients.
Methods the self rating Anxiety Scale (SAS) and the health self rating scale were used to examine the birth of the 306th Hospital of PLA from June 2012 to June 2013. A cross-sectional study was performed at the 24~28 week of pregnancy. In 1-2 weeks after the diagnosis, a cross-sectional survey was conducted. Among them, 105 cases of GDM pregnant women who were in accordance with the standard of 2011 ADA, 103 cases of normal glucose tolerance pregnant women, and the pregnant women were collected at the same time. The basic information of age, weight, height and biochemical indicators of pregnant women were analyzed.
Results compared with the control group, the prevalence rate of anxiety (42.2%vs26.8%, P0.05), UBMI: (22.93 + 3.66vs20.29 + 2.32, P0.05) Kg/m2, systolic pressure (118.56 + 12.72vs110.88 + 10.81, P0.05) mmHg. SAS score (41.05 + 6.71, 6.71,) were compared with those in the control group. The correlation score was statistically different from that of my health score (72.62 + 9.82,). SAS score and fasting blood glucose (r=0.403, P0.05), 1H blood glucose (r=0.255, P0.05), 2h blood sugar (r=0.065, P0.05), HbA1c (r=0.432, P0.05), systolic blood pressure, blood sugar monitoring pain, blood glucose monitoring pain, blood sugar monitoring pain, and blood glucose monitoring cost Significant positive correlation.SAS score was negatively correlated with self-health score (r=-0.751, P0.05).Logistic regression showed that fasting blood glucose (OR=2.036, p=0.008), BMI (OR=1.185, p=0.007) before pregnancy, heart rate (OR=1.133, p=0.003) were risk factors for the anxiety state of GDM pregnant women.
Conclusion there is a serious anxiety state in GDM patients. The anxiety score and the prevalence of anxiety are higher than those of non gestational diabetes. The blood glucose level, systolic pressure and pre pregnancy BMI are closely related to the severity of anxiety. BMI before pregnancy, fasting blood glucose and heart rate are the risk factors for the anxiety after GDM.
The second part
Comparison of diagnostic rate between WHO and IADPSG diagnostic criteria for gestational diabetes mellitus (GDM)
Objective: To compare the differences of WHO and IADPSG diagnostic criteria for GDM diagnosis by retrospective analysis of the relationship between the results of pregnant women's glucose tolerance test and the pregnancy outcome, and compare the adverse outcome of pregnancy under different diagnostic criteria.
Methods: a retrospective analysis was made of 8943 primiparas born in the 306th Hospital of the 306th Hospital of the PLA from 2000 to 2010. 75 g OGTT test was performed on the 24-32 Monday of pregnancy. The incidence of GDM and the adverse outcome of pregnancy were compared under the two diagnostic criteria, and the value of their risk assessment for bad pregnancy was discussed.
Results: the study was divided into 5 groups. The normal glucose tolerance group (NGT) conforms to the WHO diagnostic standard group (W), conforms to the IAPDSG diagnostic standard group (I), conforms to WHO and does not conform to the IAPDSG group (W-I). It conforms to IAPDSG but does not conform to the WHO group (I-W). There are no significant differences in OGTT gestational weeks in each group. The 618 of them conforms to 2 diagnostic criteria, accounting for any diagnostic standard of the patient. 49.2%, in accordance with the GDM diagnostic criteria of IADPSG in 2011, 835 cases, accounting for 9.3% of the total, 1039 cases of pregnant women, accounting for 11.6% of the total number of pregnant women, and 11.6% of the total, two of them have significant differences. 217 cases (17.2%) only conform to the diagnostic criteria of IADPSG, showing that the level of fasting blood glucose is more than 501-7.0mmol/l, or / and 1 hours of blood glucose more than 10.0mmol/1. 421 cases (33.5%) were only in accordance with the WHO diagnostic criteria, showing 2 hours of blood glucose more than 7.8, but compared with the group NGT, the other groups were older (P0.05), the Caesarean birth rate, the large and low weight infants, and the neonatal asphyxia significantly increased (P 0.05).
Conclusion: the incidence of WHO diagnostic standard GDM is higher, but 17.2% patients with IADPSG standard are missed, and IADPSG will miss the GDM patients with abnormal 33.5%2 hours blood glucose. The caesarean section and the incidence of macrosomia are significantly higher than those of the NGT group, regardless of WHO or IADPSG diagnostic criteria.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.256

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