不同孕周、不同血糖状态的妊娠妇女血脂代谢分析

发布时间：2018-06-08 08:20

本文选题：妊娠糖尿病 + 血脂代谢　；参考：《宁夏医科大学》2014年硕士论文

【摘要】：目的通过对不同孕周、不同血糖状态的妊娠妇女血脂谱的变化状况分析，了解妊娠期孕妇的血脂谱波动的状态，同时观察妊娠完成后母体血脂谱的变化状况。方法连续收集2013年1月至2013年12月在宁夏医科大学总医院就诊患者433例，按照美国ADA标准分为正常孕妇(NGRG)组315例，妊娠糖尿病孕妇（GDM）组118例，需排除孕前患有糖耐量异常、糖尿病、高血压和其他内分泌代谢性疾病者，排除有烟酒嗜好者。依据筛查及诊断标准进行排除后即可入组。两组孕妇均进行问卷调查和基本实验室检查，监测血脂谱、空腹血糖、餐后血糖1小时、餐后2小时、餐后3小时、血压、血肌酐、尿素氮、白蛋白并做统计学分析。结果1.正常妊娠组（NGRG组）与妊娠糖尿病组（GDM组）两组一般临床资料相比较：妊娠糖尿病组中孕妇的年龄、孕前BMI、妊娠过程中孕妇的体重增加情况均明显高于正常妊娠组，两组比较有显著差异，两组间一般临床资料比较具有统计学意义（P0.05）。2.两组间研究对象的一般临床特征：GDM组收缩压值明显高于NGRG组，具有统计学意义（P0.05）；GDM组白蛋白水平明显低于NGRG组，具有统计学意义。而两组间舒张压、血肌酐、尿素氮水平比较无明显差异，，不具有统计学差异（P0.05）。3.两组间血糖值对比得出：可得出GDM组空腹血糖、餐后1小时、餐后2小时血糖值水平均明显高于NGRG组，有明显差异，具有统计学差异（P0.05）。餐后3小时血糖值GDM组明显低于NGRG组，具有统计学差异（P0.05）。4.两组间血脂谱分析：在妊娠28周及产后42天后分别监测血脂代谢指标，得出表一下结果：妊娠糖尿病组中的甘油三酯、胆固醇、低密度脂蛋白、载脂蛋白-A水平均明显高于正常妊娠组，有明显差异，具有明显统计学意义（P0.05），而妊娠糖尿病组的高密度脂蛋白水平明显低于正常妊娠组，具有统计学差异（P0.05）。5.血脂代谢相关因素分析：妊娠过程中孕妇体重增加状况、基础体重指数、餐后1小时血糖可升高血浆胆固醇及甘油三酯水平，而餐后2小时血糖还可升高血浆胆固醇。结论1.GDM孕妇空腹血糖、餐后1小时及2小时血糖升高，餐后3小时血糖降低，应监测餐后3小时血糖，以防孕期低血糖的发生。2.GDM孕妇存在甘油三酯、胆固醇、低密度脂蛋白、载脂蛋白-A的升高，且存在高密度脂蛋白水平降低，即使在生产后仍难以恢复，其血脂水平的升高与孕妇基础指数、孕期体重增加状况有关。3.孕期监测血糖、血脂、血压等指标尤其重要，孕期调整饮食结构、改善生活习惯、适当运动等可有效减少妊娠不良结局的发生。
[Abstract]:Objective to analyze the changes of serum lipids in pregnant women with different gestational weeks and different blood glucose status, and to understand the fluctuating state of blood lipids in pregnant women. Methods from January 2013 to December 2013, 433 patients in the General Hospital of Ningxia Medical University were collected and divided into normal pregnant women group (315 cases) and normal pregnant women group (NGRG) according to American ADA standard. In the GDM group 118 patients with gestational diabetes should be excluded from impaired glucose tolerance diabetes hypertension and other endocrine and metabolic diseases. According to the screening and diagnostic criteria for exclusion can be added to the group. The blood lipid profile, fasting blood glucose, postprandial blood glucose 1 hour, postprandial 2 hours, postprandial 3 hours, blood pressure, serum creatinine, urea nitrogen, albumin and statistical analysis were performed in both groups. Normal pregnancy group (NGRG group) and gestational diabetes group (GDM group) the general clinical data of the two groups were as follows: the age of pregnant women in gestational diabetes group, pre-pregnancy BMIs and weight gain during pregnancy were significantly higher than those in normal pregnancy group. There is a significant difference between the two groups, the general clinical data between the two groups have statistical significance (P 0.05). 2. The general clinical features of the two groups were as follows: the systolic blood pressure of the two groups was significantly higher than that of the NGRG group, and the albumin level in the GDM group was significantly lower than that in the NGRG group. However, there was no significant difference in diastolic blood pressure, serum creatinine and urea nitrogen levels between the two groups. The results showed that fasting blood glucose, 1 hour after meal and 2 hours after meal in GDM group were significantly higher than those in NGRG group (P 0.05). 3 hours postprandial blood glucose level in GDM group was significantly lower than that in NGRG group (P 0.05. 4). Blood lipid spectrum analysis between the two groups: blood lipid metabolism indexes were monitored at 28 weeks of pregnancy and 42 days after delivery, and the following results were obtained: triglyceride, cholesterol, low density lipoprotein in gestational diabetes mellitus group, The level of apolipoprotein A was significantly higher than that of normal pregnancy group (P 0.05), while the level of high density lipoprotein in gestational diabetes group was significantly lower than that in normal pregnancy group (P 0.05. 5). Factors related to blood lipid metabolism: maternal weight gain, basal body mass index and 1 hour postprandial blood glucose increased plasma cholesterol and triglyceride levels during pregnancy. Conclusion 1. The fasting blood glucose of GDM pregnant women increased at 1 hour and 2 hours postprandial, but decreased at 3 hours postprandial, so the blood glucose of 3 hours after meal should be monitored. To prevent hypoglycemia during pregnancy. 2. GDM pregnant women have elevated triglycerides, cholesterol, low density lipoprotein, apolipoprotein A, and reduced high density lipoprotein levels, which are difficult to recover even after childbirth. The increase of serum lipids was related to the basic index of pregnant women and the weight gain during pregnancy. It is very important to monitor blood sugar, blood lipid and blood pressure during pregnancy. Adjusting diet structure, improving living habits and proper exercise during pregnancy can effectively reduce the occurrence of adverse outcome of pregnancy.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.256

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