口服葡萄糖耐量试验中空腹血糖水平升高妊娠期糖尿病患者的妊娠结局分析

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摘要目的探讨75 g 葡萄糖耐量试验（OGTT）中空腹血糖升高妊娠期糖尿病（GDM）患者的妊娠结局。方法选取2015年1月～2018年2月在我院规范产前检查并分娩的450 例空腹血糖升高GDM 孕妇作为研究组。根据OGTT空腹、服糖后1 h 及服糖后2 h 时间点血糖结果分组，其中仅空腹血糖升高为GDMⅠ组、空腹合并其他任一时间点血糖升高为GDMⅡ组，三点均升高者为GDMⅢ组。选取同期在该院检查的健康孕妇450 例为对照组，比较两组的妊娠结局。采用Spearman 相关分析不同时相血糖指标与新生儿体重的关系。结果研究组早产、大于胎龄儿、剖宫产、妊娠期高血压疾病发生率高于对照组，差异均有统计学意义（P＜0.05）；三组大于胎龄儿、胰岛素使用及剖宫产比较，差异有统计学意义（P＜0.05），即随着血糖异常数目的增多并发症呈逐步增多趋势；而三组早产、妊娠期高血压比较，差异无统计学意义（P＞0.05）；GDMⅢ组大于胎龄儿发生率高于GDMⅠ组，差异有统计学意义（P＜0.05）），与GDMⅡ组比较，差异无统计学意义（P＞0.05）。GDMⅢ组胰岛素使用率高于GDMⅠ组，差异有统计学意义（P＜0.05））；Spearman 相关分析结果显示，空腹血糖与新生儿体重成正相关（r=0.122，P＜0.01），随着空腹血糖升高，新生儿体重呈上升趋势。结论 OGTT 血糖多点异常GDM 患者，其不良妊娠结局发生率增加，空腹血糖值对妊娠结局及新生儿体重的预测有重要意义。临床上应根据OGTT 异常情况个体化管理。

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关键词 ：妊娠期糖尿病, 口服葡萄糖耐量试验, 妊娠结局, 出生体重

Abstract：Objective To analyze of pregnancy outcome of gestational diabetes mellitus (GDM) patients with increased fasting blood glucose level in 75 g oral glucose tolerance test OGTT. Methods A total of 450 cases of pregnant women with increased fasting blood glucose of GDM who were received standard prenatal examination and delivered in our hospital from January 2015 to January 2018 were selected, and grouped according to the results of fasting, 1 and 2 hours after taking the glucose in OGTT test, only fasting blood glucase increased to GDM group Ⅰ, the fasting combined with elevalted blood glucose at any other time point as the GDM group Ⅱ, all three time points were elevated as GDM group Ⅲ. A total of 450 healthy pregnant women who were examined at the same time were selected for a control group, the pregnancy outcomes of the two groups were compared. Spearman correlation was used to analyze the relationship between different phase blood glucose and neonatal weight. Results The incidences of premature delivery,large for gestational age (LGA), cesarean section, and hypertensive disorder complicating pregnancy in the study group were higher than those in the control group (P＜0.05)； there were significant differences in the comparison of LGA, insulin usage and cesarean section (P＜0.05), that was the complications increased with the growing abnormal blood glucose levels. There were no differences in premature delivery and hypertensive discorders comlicating pregnancy in the three groups (P＞0.05). The incidence of LGA in GDM group Ⅲwas higher than that of GDM group Ⅰ, and the difference was statistically significant (P＜0.05). There was no significant difference compared with GDM group Ⅱ(P＞0.05).Comparison of insulin usage rate, GDM group Ⅲwas higher than that of GDM groupⅠ, and the difference was statistically significant (P＜0.05). Spearman correlation analysis result showed that fasting plasma glucose was positively correlated with neonatal weight (r=0.122, P＜0.01), that neonatal weight was on the rise with the increase of fasting blood glucose. Conclusion The incidence of adverse pregnancy outcome is significantly increased in GDM patients with OGTT multipoint abnormal blood glucose. The fasting blood glucose level is important for the prediction of pregnancy outcome and neonatal weight. Clinical management should be individualized based on OGTT abnormalities status .

Key words： Gestational diabetes mellitus Oral glucose tolerance test Pregnant outcome Birth weight

基金资助:广东省深圳市龙岗区经济与科技发展专项资金医疗卫生科技计划项目（LGKCYLW2018000086）

引用本文:

刘继群；董晨；简洁英. 口服葡萄糖耐量试验中空腹血糖水平升高妊娠期糖尿病患者的妊娠结局分析[J]. 中国当代医药, 2020, 27(16): 120-123.
LIU Ji-qun； DONG Chen； JIAN Jie-ying. Analysis of pregnancy outcome of gestational diabetes mellitus patients with increased fasting blood glucose level in oral glucose tolerance test. 中国当代医药, 2020, 27(16): 120-123.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2020/V27/I16/120

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