探究巨大儿血糖及血脂水平的变化及临床意义

张　静， 李　洁，王丽丽，赵　彤

(1.日照市中医医院，山东 日照 276800；2.日照市人民医院，山东 日照 276800)



探究巨大儿血糖及血脂水平的变化及临床意义

张静1， 李洁2，王丽丽1，赵彤1

(1.日照市中医医院，山东 日照 276800；2.日照市人民医院，山东 日照 276800)

目的探讨妊娠期糖尿病母亲巨大儿与非妊娠期糖尿病巨大儿血糖及血脂水平的异同。方法选择日照市中医医院妇产科2012年12月至2014年12月收治的64例妊娠期糖尿病巨大儿产妇、62例健康巨大儿产妇及63例健康足月儿产妇为研究对象， 将妊娠期糖尿病巨大儿组(试验组)、健康巨大儿组(对照组A)、健康足月儿组(对照组B)采用回顾性分析的方法，研究三组患者的病历资料，分析各组患者相关指标。结果试验组与对照组A相比，血糖和HDL、ApoA、ApoB降低，新生儿低血糖发生率升高，且差异在组间均有统计学意义(t值分别为2.89、2.32、2.43、2.38、3.54，均P<0.05)；试验组的甘油三酯(TG)比对照组A升高，且差异在组间有统计学意义(t=2.02，P<0.05)。试验组与对照组B相比，血糖和HDL、ApoA、ApoB降低，且差异在组间均有统计学意义(t值分别为3.15、2.21、2.32、2.64，均P<0.05)；试验组的TG比对照组B升高，新生儿低血糖发生率也升高，且差异在组间均有统计学意义(t值分别为2.53、3.68，均P<0.05)。结论妊娠期糖尿病母亲生出的巨大儿，生后常表现为低血糖和/或脂质代谢异常，因此临床医生对孕妇要进行宣传和孕前及孕期的健康教育，通过干预减少巨大儿出生的比率。

妊娠期糖尿病；巨大儿；血糖；血脂

[Abstract]Objective To study the differences in blood glucose and blood lipid levels of macrosomia of mother with gestational diabetes mellitus (GDM) and those without GDM. Methods From December 2012 to December 2014 64 cases of GDM with macrosomia, 62 cases with healthy macrosomia and 63 cases with healthy term infant were selected in obstetrics and gynecology department of Rizhao City Hospital of Traditional Chinese Medicine. Retrospective analysis was conducted to analyze the clinical data of experimental group (GDM macrosomia group), control group A (healthy macrosomia group) and control group B (healthy full term group). Related indexes were analyzed for each group. Results Compared with control group A, blood glucose level, HDL, ApoA and ApoB declined but the incidence of neonatal hypoglycemia was higher in experimental group, and the differences were significant between groups (tvalue was 2.89, 2.32, 2.43, 2.38 and 3.54, respectively, allP<0.05). TG of experimental group was higher than control group A, and the difference between groups was statistically significant (t=2.02,P<0.05). Compared with control group B, blood glucose level, HDL ApoA and ApoB reduced in experimental group, and the differences between groups were significant (tvalue was 3.15, 2.21, 2.32 and 2.64, respectively, allP<0.05). TG of experimental group was higher than that of control group B, and the incidence of neonatal hypoglycemia was also higher with significant difference (tvalue was 2.53 and 3.68, respectively, bothP<0.05). Conclusion Macrosomia of pregnant women with GDM always have hypoglycemia and (or) lipid metabolic abnormalities. Therefore, clinicians must carry on propaganda for pregnant woman and pregnant and prenatal health education to reduce the ratio of macrosomia through intervention.

[Key words]gestational diabetes mellitus (GDM); macrosomia; blood glucose; blood lipid

妊娠期间的糖尿病包括两种类型，其一是在妊娠前诊断为糖尿病的情况为糖尿病合并妊娠；第二种类型是妊娠期糖尿病(gestationaldiabetesmellitus，GDM)，表现为妊娠前糖代谢正常或仅出现糖耐量减退，而在妊娠期间才诊断为糖尿病[1]。患有糖尿病的孕妇大部分为GDM，约占80%。GDM在我国的发生率约为3%，据报道这一数据有明显上升的趋势。GDM可表现为多饮、多食、多尿，易出现生殖系统假丝酵母菌感染，孕期体重明显增加，妊娠期间伴有羊水过多、巨大胎儿(出生体重大于4 000g)[2]。GDM的孕妇病情较复杂，母儿都有危害，应该受到充分的重视，现将本院研究结果报告如下。……