孕早期中医体质和胰岛素抵抗指数与妊娠期糖尿病的相关性

发布时间：2019-01-18 18:36

【摘要】：目的:探讨中医体质类型和胰岛素抵抗指数(Insulin resistance index,IRI)与妊娠期糖尿病(gestational diabetes mellitus,GDM)的相关性,为临床GDM的早期预测、通过体质干预从而预防GDM的发生提供一定的借鉴和理论基础。方法:本课题采用横断面调查的研究方法,对2015年4月~2016年2月在河南中医药大学第一附属医院定期进行检查的孕妇进行抽样调查,剔除资料不全者,从收回的348份有效问卷中,选取105例GDM孕妇作为病例组,并采用单纯随机抽样法,从243例同期健康孕妇中选取105例作为对照组。采用GDM流行病学调查表(见附录1),对调查对象进行现场问卷式调查,调查所得结果录入SPSS并建立数据库。对两组对象的计数资料采用χ2检验分析,计量资料采用t检验进行分析;对两组体质类型构成的比较采用Fisher精确概率法分析,对多因素研究采用logistic回归分析。结果:(1)GDM孕妇组与正常孕妇组的体质总体构成共同点为:均以平和质为主要体质之一,其中平和体质为正常孕妇组总体体质构成的主要体质,平和质占正常孕妇总人数的61.9%,说明平和质是健康女性人群的主要体质;(2)GDM孕妇组与正常孕妇组体质辨识存在明显差异,统计分析提示差异具有统计学意义,中医体质辨识中GDM组主要的偏颇体质类型为痰湿质,正常孕妇组主要偏颇体质为阳虚质;(3)病例组和对照组胰岛素抵抗指数具有显著统计学差异(P0.05);(4)GDM痰湿体质孕妇的胰岛素抵抗指数(IRI)水平最高,与非痰湿体质比较,差异均有统计学意义(P0.05);(5)多因素Logistic回归分析提示:孕前体质指数,糖尿病家族史,痰湿体质,IRI四个危险因素均进入回归模型,各影响回归系数分别为0.168,1.207,1.449,1.267。结论:(1)痰湿体质为GDM的易感偏颇体质;(2)胰岛素抵抗指数与GDM的发病呈正相关性,对GDM有一定的早期预测作用;(3)多因素Logistic回归结果显示:孕前体重指数,糖尿病家族史,痰湿体质是GDM的独立危险因素。
[Abstract]:Objective: to investigate the correlation between TCM physique type and insulin resistance index (Insulin resistance index,IRI) and gestational diabetes mellitus (gestational diabetes mellitus,GDM) in order to predict early clinical GDM. Physical intervention to prevent the occurrence of GDM provides a certain reference and theoretical basis. Methods: a cross-sectional survey was conducted on pregnant women in the first affiliated Hospital of Henan University of traditional Chinese Medicine from April 2015 to February 2016. From 348 valid questionnaires, 105 pregnant women with GDM were selected as case group, and 105 healthy pregnant women were selected as control group. GDM epidemiological questionnaire (see Appendix 1) was used to investigate the subjects in the field. The results were recorded in SPSS and the database was established. The count data of the two groups were analyzed by 蠂 2 test and t test, the constitution of the two groups was analyzed by Fisher accurate probability method, and the multiple factors were analyzed by logistic regression analysis. Results: (1) the general constitution of GDM pregnant women group and normal pregnant women group were as follows: one of the main constitutions was calmness and quality, and the peaceful constitution was the main constitution of normal pregnant women. Peaceful quality accounted for 61.9% of the total number of normal pregnant women, indicating that peaceful quality is the main body mass of healthy women. (2) there was significant difference in physique identification between GDM pregnant women and normal pregnant women. Statistical analysis showed that the difference was statistically significant. The main biased physique type of GDM group in TCM physique identification was phlegm and dampness. In normal pregnant women, the main physical bias was yang deficiency; (3) there was significant difference in insulin resistance index between the case group and the control group (P0.05). (4) the insulin resistance index (IRI) of pregnant women with GDM phlegm dampness constitution was the highest, compared with that of non-phlegm dampness constitution, the difference was statistically significant (P0.05); (5) the multivariate Logistic regression analysis showed that four risk factors, including pre-pregnancy BMI, family history of diabetes, phlegm dampness and IRI, all entered the regression model, and the regression coefficients were 0.168 / 1.207 / 1.449 / 1.267respectively. Conclusion: (1) phlegm dampness constitution is the susceptible and biased constitution of GDM, (2) the insulin resistance index is positively correlated with the incidence of GDM, which has a certain early predictive effect on GDM. (3) the results of multivariate Logistic regression showed that body mass index before pregnancy, family history of diabetes and phlegm dampness were independent risk factors of GDM.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R271.9

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