新诊断标准下GDM危险因素调查及CRP与GDM的相关性

发布时间：2018-08-03 13:08

【摘要】：目的：探讨新诊断标准下妊娠期糖尿病(gestational diabetes mellitus,GDM)发病的危险因素及炎症因子C反应蛋白(C-reactive protein,CRP)与GDM发病的相关性，为临床通过对GDM的危险因素进行早期干预，以预防GDM及远期并发症提供一定的循证学依据，顺应中医“治未病”理念，为创建具有中医特色的围产保健模式提供参考。方法：本课题采用横断面调查的研究方法，对2013年4月～2014年2月在河南中医学院第一附属医院建卡并定期行围产保健检查的孕28周内的单胎孕妇进行抽样调查。选出符合GDM诊断标准的孕妇91例作为观察组，并采用单纯随机抽样法从179份完整问卷中选出同期围产保健的健康孕妇91例作为对照组。对调查对象采用GDM流行病学调查表(见附录1)进行调查，将调查结果录入SPSS并建立数据库。采用SPSS18.0统计软件用χ2检验对计数资料进行分析，采用t检验对计量资料进行分析，对于计量资料首先进行正态分布检验，采用单样本k-s检验法，若为正态分布，则进行两独立样本的t检验法进行分析，反之则进行两独立样本的非参数检验法进行分析。对于多因素的研究采用Logistic回归分析法。结果：①观察组和对照组在饮食偏嗜，孕前体重指数，本次妊娠年龄，初次妊娠年龄，OGTT时体重增幅，糖尿病家族史，GDM史，不良孕产史，妊娠次数，巨大儿或羊水过多分娩史，多囊卵巢综合征病史，本次妊娠胎儿大于孕周或羊水过多等方面存在有显著性统计学差异(P＜0.05)。②观察组和对照组CRP水平具有显著性统计学差异(P＜0.05)。③观察组与对照组在职业，教育文化程度，产次，分娩方式，乙肝病毒表面抗原携带，反复性假丝酵母菌感染史等方面的组间比较中差异无统计学意义(P＞0.05)。④经多因素Logistic回归分析，孕前体重指数，本次妊娠年龄，妊娠次数，不良孕产史，巨大儿或羊水过多分娩史，多囊卵巢综合征病史，CRP七个危险因素均进入回归模型，各影响回归系数分别为1.334,0.520,-0.813,1.580,1.709,1.513,0.262。结论：①多因素Logistic回归结果显示：孕前体重指数，妊娠年龄，不良孕产史，，巨大儿或羊水过多分娩史，多囊卵巢综合征病史是新诊断标准下GDM的独立危险因素。②CRP水平与新诊断标准下GDM的发病呈正相关性，有一定的早期预测作用。③饮食偏嗜，初次妊娠年龄，GDM史，糖尿病家族史，本次妊娠胎儿大于孕周或羊水过多等因素未能进入回归模型，可能是GDM的混杂因素。
[Abstract]:Objective: to investigate the risk factors of (gestational diabetes mellitusus in gestational diabetes mellitus (GDM) under the new diagnostic criteria, and the correlation between C-reactive and GDM, so as to provide early intervention for the risk factors of GDM. In order to prevent GDM and long-term complications to provide a certain evidence-based basis, comply with the concept of "cure disease", for the establishment of traditional Chinese medicine characteristics of perinatal health care model to provide a reference. Methods: a cross-sectional investigation was carried out on pregnant women with single pregnancy during 28 weeks of pregnancy during the first affiliated Hospital of Henan College of traditional Chinese Medicine from April 2013 to February 2014, with regular perinatal health care examination. 91 pregnant women who met the diagnostic criteria of GDM were selected as observation group, and 91 healthy pregnant women in the same period of perinatal care were selected as control group from 179 complete questionnaires. The subjects were investigated by GDM epidemiological questionnaire (see Appendix 1). The results were recorded in SPSS and database was established. SPSS18.0 statistical software was used to analyze the counting data by 蠂 2 test, the measurement data was analyzed by t test, the normal distribution test was carried out for the measurement data, and the single sample k-s test method was used, if it was normal distribution, Then the t-test method of two independent samples and the non-parametric test method of two independent samples are carried out. Logistic regression analysis was used to study the multiple factors. Results in the observation group and control group, the diet preference, body mass index (BMI) before pregnancy, age of pregnancy, weight increase of OGTT at the first gestational age, family history of diabetes mellitus (GDM), history of bad pregnancy and delivery, pregnancy times, macrosomia or amniotic fluid excess delivery history were observed in the observation group and the control group. History of polycystic ovary syndrome, There was significant difference in CRP level between the observation group and the control group (P < 0. 05). 3 there was significant difference between the observation group and the control group in the level of occupation, education and culture, and there was significant difference between the pregnancy group and the control group in the aspects of fetal excess or amniotic fluid excess (P < 0. 05). There was no significant difference in delivery times, delivery mode, HBV surface antigen carrying, history of repeated Candida cerevisiae infection among groups (P > 0. 05). 4. By multivariate Logistic regression analysis, the body mass index before pregnancy, gestational age, and so on were not significantly different (P > 0. 05). Seven risk factors, including the frequency of pregnancy, the history of bad pregnancy and labor, the history of macrosomia or amniotic fluid, and the history of polycystic ovary syndrome (PCOS) were all included in the regression model, and the regression coefficients were 1.334n0.520- 0.8131.580- 1.709U 1.513130.262. Conclusion the results of multivariate Logistic regression showed that: body mass index (BMI), age of pregnancy, history of bad pregnancy and labor, history of macrosomia or amniotic fluid overproduction. The history of polycystic ovary syndrome (PCOS) is an independent risk factor of GDM under the new diagnostic criteria. The level of CRP is positively correlated with the onset of GDM under the new diagnostic criteria. In the family history of diabetes, the factors such as gestational excess or amniotic fluid were not included in the regression model, which may be the mixed factor of GDM.
【学位授予单位】：河南中医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.256

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