天津市部分城区3906名妊娠期糖尿病筛查结果分析

妊娠期糖尿病(GDM)是一种多基因遗传的内分泌代谢疾病,是指在妊娠期首次发生或发现的不同程度的糖代谢异常。GDM是妊娠期常见的并发症之一,其发病率并不一致,一般为1%～4%,并有逐年升高的趋势,在国内外产科界正受到越来越多的关注[1]。而临床上绝大多数GDM的孕妇都无任何症状和体征,一旦出现症状则对母婴损害已形成。本文分析了四年来对本院非糖尿病孕妇进行GDM的筛查和结果,以期了解孕妇GDM的发病情况,并为临床医生提供参考依据,现报道如下。     

妊娠期糖代谢异常血液检测临床意义

妊娠期糖尿病（GDM）是指妊娠期为适应孕期糖代谢增加的需求,促进胰岛分泌胰岛素,若胰岛功能不良,在孕期首次出现糖耐量异常（GIGT）,称GDM。因此本文着重介绍孕妇GDM的血液相关指标：糖耐量实验（OGTT）、血清胰岛素、血清C反应蛋白（CRP）的检测及其临床意义。     

妊娠期糖尿病的早期预防、治疗对妊娠结局的影响

目的探讨通过妊娠期糖尿病（GDM）的筛查并予早期心理、饮食、运动及药物干预措施对降低GDM母儿并发症的作用。方法对2008年1月至2009年1月在徐州市妇幼保健院进行产前检查并分娩的孕前健康,无合并症的4850例孕妇资料进行回顾性分析,将不同孕周筛查出GDM分为3组（早期干预组、中期干预组、晚期干预及未治组）进行母儿并发症的比较。结果 GDM的发病率为5.2%,糖耐量异常的发病率为4.2%,未经干预,糖耐量异常最终发展为GDM者为10.8%。早期及中期干预组较晚期干预及未治组GDM母儿并发症明显降低,差异有显著性意义（P〈0.05）。晚期干预及未治组应用胰岛素治疗的孕妇较早期及中期干预组明显增加,差异有显著性意义（P〈0.05）。结论对GDM进行早期心理、饮食、运动及药物干预可降低妊娠期糖尿病的并发症及新生儿患病率,减少胰岛素的使用率。     

妊娠糖尿病患者血清中性粒细胞明胶酶相关脂质运载蛋白水平变化

目的:探讨糖代谢异常孕妇血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平变化的临床意义。方法:74例糖代谢异常孕妇及66例正常孕妇(NGT组)纳入研究。根据糖耐量试验(OGTT)将糖代谢异常孕妇分为妊娠期糖尿病组(GDM组,n=26)和妊娠期糖耐量受损组(GIGT组,n=48)。测定三组空腹血糖(FBG)、胰岛素(FINS)、NGAL及肿瘤坏死因子-α(TNF-α)浓度,计算胰岛素抵抗指数(HOMA-IR),并比较三组妊娠结局。结果:GDM组FBG、HOMA-IR、FINS、NGAL及TNF-α较GIGT组和NGT组显著升高(P<0.01);GIGT组仅HOMA-IR及NGAL高于NGT组(P<0.05)。所有患者血清NGAL与HOMA-IR呈显著正相关(r=0.886,P<0.01);GDM组血清NGAL还与FINS、TNF-α呈显著正相关(r=0.874,r=0.867,P均<0.01)。GDM组妊娠结局较GIGT组和NGT组差。结论:NGAL可能是一个敏感的GDM诊断指标;妊娠糖尿病中的高胰岛素抵抗状态可能是引起NGAL升高的因素。     

瘦素、脂联素与妊娠期糖尿病胰岛素抵抗关系的研究

目的探讨瘦素、脂联素与妊娠期糖尿病胰岛素抵抗的关系。方法采用稳态模型评估法评估正常糖耐量孕妇（NGT）糖耐量减低孕妇（GIGT）和妊娠期糖尿病孕妇（GDM）的胰岛素抵抗指数,采用放射免疫分析方法检测其血浆瘦素、脂联素、血糖及胰岛素水平。结果 GDM组和GIGT组HOMA-IR显著高于NGT组,GDM组HOMA-IR显著高于GIGT组。血清瘦素水平由NGT组到GIGT组和GDM组呈显著增高,瘦素与空腹胰岛素、孕晚期体重指数、HOMA-IR呈显著正相关;血清脂联素由NGT组到GIGT组和GDM组呈显著下降,脂联素与空腹胰岛素、孕晚期体重指数、HOMA-IR呈显著负相关。结论瘦素、脂联素水平与GDM患者IR程度密切相关,其水平可作为预测妊娠期糖尿病胰岛素敏感性的指标,将来可能是治疗妊娠期糖尿病的新靶点。     

妊娠期糖代谢异常妊娠结局分析

目的分析妊娠期糖代谢异常（GDM和GIGT）与妊娠结局的关系。方法前瞻性收集我院2007年9月-12月，糖代谢异常单胎妊娠孕妇242例作为研究组，其中GDM5例，GIGT12例；选择同期糖代谢正常的单胎孕妇225例为对照组，比较其孕妇、围生儿的最终结局。结果GDM组及GIGT组孕妇及胎婴儿的患病率均明显高于糖代谢正常组。结论应对全部孕妇进行糖尿病筛查及确诊，对糖耐量异常者应给予及时治疗和监测。     

妊娠糖尿病孕妇血浆抵抗素水平与胰岛素和血糖的分析

目的分析妊娠期糖尿病(GDM)孕妇血浆抵抗素水平与胰岛素和血糖的关系。方法采用酶联免疫吸附法(ELISA)检测53例妊娠期糖尿病GDM组孕妇和50例正常孕妇空腹血浆抵抗素水平;采用葡萄糖氧化酶法测定两组孕妇空腹血糖水平;采用发光免疫法测定两组孕妇的空腹血浆胰岛素水平。结果 GDM组孕妇空腹血浆抵抗素水平为(18.14±5.37)μg/L,正常妊娠组孕妇为(13.25±2.27)μg/L两组比较,差异有极显著性(t=5.96,P0.05);GDM组孕妇空腹血浆胰岛素、血糖水平分别为(12.64±4.35)mIU/L、(8.83±2.13)mmol/L,正常妊娠组孕妇分别为(10.21±4.22)mIU/L、(5.38±1.47)mmol/L,两组比较差异有极显著性(t=2.87和t=9.51,P0.05)。结论 GDM孕妇血浆抵抗素水平升高,其抵抗素水平与空腹血浆胰岛素及血糖水平有关。     

妊娠期糖尿病患者与年龄关系的临床分析

目的探讨妊娠期糖尿病（GDM）与孕妇各年龄组的关系。方法对在我院分娩的12205例孕妇，按年龄分甲组（25岁以下）、乙组（25—29岁）、丙组（30-34岁）、丁组（35岁及以上），行75g葡萄糖耐药量试验（OGTY），确诊为GDM病例219例，分析各组GDM的发者生率。结果GDM发病率为1．79％，其中甲组0．84％、乙组1．7％、丙组2．0％、丁组4．3％。结论GDM发生率随孕妇年龄的增加而明显增加。建议25岁以下孕妇无任何糖尿病高危因素存在时，可不行孕期糖尿病筛查，25岁以上的孕妇应作常规GDM筛查，而35岁以上孕妇需在整个妊娠期定期检查空腹及餐后血糖，以及早发现和治疗糖尿病。     

准妈妈:妊娠期糖尿病不可怕

正1妊娠期糖尿病主要是指怀孕前没有,而怀孕后才发生的糖尿病,它是由于妊娠期一系列生理变化造成糖代谢异常而引起的。在我国,该病在孕妇中的发生率为1%~5%。近年,随着女性妊娠年龄的推迟,妊娠期糖尿病有明显增高的趋势。那么,为什么孕前不是糖尿病,怀孕后就变成糖尿病患者了呢?这是由于从孕24-28周开始,     

2196例妊娠期糖尿病筛查结果分析

目的了解开封市妊娠期糖尿病(GDM)的发病率及分布情况。方法采用回顾性分析方法,对2009年11月1日-2010年10月30日在开封市妇产医院进行产前检查行糖尿病筛查的2196例孕妇进行临床资料分析。结果开封市妊娠期糖尿病发病率为2.73%;糖筛异常率为10.15%;GDM的发病率随年龄的增长而增加,28岁以上组的发病率明显高于28岁以下组,两组差异有显著性(P<0.05);脑力劳动者GDM的发病率高于体力劳动者,两组差异有显著性(P<0.05);孕前体重指数(BMI)≥25kg/m2者GDM的发病率明显高于(BMI)<25kg/m2者,两组差异有显著性(P<0.05)。结论对育龄妇女首先要进行健康教育,孕前肥胖者建议体重降至正常后再受孕,生育年龄不易过晚,孕期提倡均衡合理饮食及适当运动,降低GDM的发病率。     

广东地区12000例妊娠期糖尿病筛查结果

目的探讨广东地区50g葡萄糖负荷试验（GCT）筛查妊娠期糖尿病（GDM）的阈值、孕妇年龄对GDM发生的影响以及广东地区GDM的检出率。方法采用回顾性研究,对本院2005年1月至2007年12月全部孕妇实施50g葡萄糖负荷试验,异常者再行75g口服葡萄糖耐量（OGTT）实验,依据美国糖尿病资料小组（NDDG）的诊断标准诊断妊娠期糖尿病和糖耐量受损（IGT）。结果12000例孕妇GCT1h平均血糖水平为（7.37±1.75）mmol/L;以7.80mmol/L为切点,GCT血糖异常率为35.3%;IGT的检出率为6.9%,GDM的检出率为5.4%。GCT1h血糖≥11.1mmol/L者中,GDM的发生率为74.7%（195/261）,其中36.8%（96/261）根据空腹血糖水平可以作出诊断。24岁以下孕妇GDM的发生率为0.83%,显著低于年龄≥24岁的孕妇,GCT的异常率和IGT及GDM的发生率随年龄的增加呈上升趋势。196例GCT1h血糖〈7.8mmol/L存在高危因素的孕妇复行GCT和OGTT后,诊断为IGT和GDM的患者分别为23、17例,分别占总检出率的2.8%（23/824）和2.6%（17/648）。结论广东地区GCT筛查GDM以7.80mmol/L为切点是合理的,但1次GCT1h血糖正常的高危孕妇,复行GCT及OGTT是有必要的;GCT≥11.1mmol/L,仍有部分孕妇必须通过OGTT才能确诊;孕妇年龄与GDM发生密切相关,应加强高龄孕妇血糖的监测及GDM管理。     

妊娠期糖尿病患者胎盘中PPARγ的表达和作用的研究进展

妊娠期糖尿病(gestational diabetes mellitus,GDM)是一组多基因遗传所致的异质性疾病,其发病机制涉及到糖代谢机制的每一个环节.过氧化物酶体增殖物激活受体γ(per-oxisome proliferater activated receptorγ,PPARγ)是生物体重要的代谢转录因子和脂肪生成的关键因子,在糖脂代谢中发挥着重要的调控作用,其激动剂(噻唑烷二酮类药物)广泛应用于糖尿病的治疗,但目前关于PPARγ在GDM中的研究尚少.本文将对PPARγ在GDM患者的胎盘中的表达和作用进行全面的综述,并简要提及近来的一些有关GDM患者其他组织细胞中PPARγ的表达和作用的研究,以期为PPARγ作为治疗GDM的潜在靶点的临床研究奠定理论基础.     

妊娠期糖尿病筛查3280例结果分析

目的初步了解本地妊娠期糖尿病（GDM）和妊娠期糖耐量受损（GIGT）的患病率;探讨糖筛查试验和空腹血糖两种方法对妊娠期糖尿病筛查的意义。方法对3280例孕24～28周孕妇进行口服50g葡萄糖负荷试验（GCT）,对1h静脉血糖≥7.8mmol/L者做75g口服葡萄糖糖耐量试验（OGTT）。结果本地GDM患病率为2.16%;GIGT的患病率为4.82%;GCT异常率为28.23%;空腹血糖作为筛查方法的漏诊率为22.53%,敏感性差。结论本地GDM和GIGT有一定的患病率,应重视和加强筛查工作。糖筛查试验应作为妊娠期产前检查的常规项目,对临床早期诊断妊娠期糖尿病具有重要意义。     

The role of genetics and epigenetics in the pathogenesis of gestational diabetes mellitus

Diabetes mellitus (DM) is a heterogeneous group of disorders whose common trait is chronic hyperglycemia. Gestational diabetes mellitus (GDM) is one of the subtypes of DM that manifests during pregnancy. It is believed that 2%–5% of pregnancies worldwide are complicated with GDM, with the prevalence having significantly increased over the last decade. While the pathogenesis of the disease remains largely unknown, GDM is believed to be a result of interactions between genetic, epigenetic, and environmental factors. Linkage and association studies, including those that are genome-wide, have allowed us to identify complex genetic and epigenetic mechanisms that lead to the development of GDM. Multiple common variants in candidate genes such as potassium inwardly rectifying channel subfamily J, member 11 (KCNJ11), glucokinase (GCK), or hepatocyte nuclear factor 1α (HNF1A) have been found to increase the disease risk. In this review, we provide a detailed overview of the current knowledge concerning the influence of genetics and epigenetics on the development of GDM.     

妊娠糖尿病的治疗进展

妊娠糖尿病的治疗涉及到改善本次妊娠结局和预防将来成人胎源性疾病发生两个方面,要求为母亲和胎儿提供一个适合的孕期体内代谢环境。与普通糖尿病相比,妊娠糖尿病的治疗有着许多自身不同的特点。本综述从妊娠糖尿病治疗的获益、营养治疗、血糖及尿酮体的监测、运动治疗、药物治疗等几方面论述近年来在妊娠糖尿病治疗方面所取得的进展。     

Prevalence of diabetes in acromegaly and Cushing syndrome

In a retrospective study glucose metabolism was investigated in 206 patients with acromegaly and 131 patients with Cushing's disease. 40.5% of the patients with hypersomatotropism and 32.0% of the patients with hypercortisolism suffered from overt diabetes mellitus. Impaired glucose tolerance was present prior to therapy in 28.2% and 30.6% of the patients, respectively. In acromegaly the incidence of overt diabetes mellitus was higher in women than in men, but no difference existed in the distribution of impaired glucose tolerance between both sexes. No correlation was found between growth hormone levels and occurrence of diabetes. In acromegaly and Cushing's disease overt diabetes increased with advanced age. Diabetes mellitus occurred independently from the etiology of hypercortisolism.     

糖化血红蛋白联合糖化清蛋白测定在妊娠期糖尿病筛查中的应用价值

目的 探讨糖化血红蛋白(HbA1c)联合糖化清蛋白(GA)测定在妊娠期糖尿病筛查中的应用价值.方法 对2015年3月至2016年3月在荆州市中心医院产科做产前检查的GDM孕妇(GDM组)和健康妊娠孕妇(对照组),进行外周血HbA1c、GA检测并分析两组受试者上述指标的差异.结果 GDM组HbA1c、GA阳性检出率均高于对照组,差异具有显著统计学意义(均P＜0.01);且GDM组中HbA1c与GA呈显著性正相关(r=0.958,P＜0.01).结论 HbA1c联合GA检测有助于妊娠期糖尿病的临床诊断和治疗,具有较高的应用价值.     

Postpartum Glucose Testing Rates Following Gestational Diabetes Mellitus and Factors Affecting Testing Non-compliance from Four Tertiary Centers in Korea

The purpose of this study was to investigate postpartum glucose testing rates in patients with gestational diabetes mellitus (GDM) and to determine factors affecting testing non-compliance in the Korean population. This was a retrospective study of 1,686 patients with GDM from 4 tertiary centers in Korea and data were obtained from medical records. Postpartum glucose testing was conducted using a 2-hr 75-g oral glucose tolerance, fasting glucose, or hemoglobin A1C test. Test results were categorized as normal, prediabetic, and diabetic. The postpartum glucose testing rate was 44.9% (757/1,686 patients); and of 757 patients, 44.1% and 18.4% had pre-diabetes and diabetes, respectively. According to the multivariate analysis, patients with a high parity, larger weight gain during pregnancy, and referral from private clinics due to reasons other than GDM treatment were less likely to receive postpartum glucose testing. However, patients who had pharmacotherapy for GDM were more likely to be screened. In this study, 55.1% of patients with GDM failed to complete postpartum glucose testing. Considering the high prevalence of diabetes (18.4%) at postpartum, clinicians should emphasize the importance of postpartum diabetes screening to patients with factors affecting testing noncompliance.     

妊娠糖尿病对母婴影响的分析

目的探讨妊娠糖尿病（GDM）对母婴影响。方法观察妊娠糖尿病患者36例及健康孕妇36例,分析其妊娠结局。结果GDM组妊娠期高血压疾病、早产、巨大儿及剖宫产发生率分别为41.7%、27.7%、25%及58.3%,明显高于对照组16.7%、8.3%、5.5%及27.7%,差异有显著性（P〈0.05）。结论GDM是危害孕产妇和围产儿的妊娠并发症,早期诊断GDM及控制血糖是减少母婴并发症的关键。     

Maternal and fetal outcome of gestational diabetes mellitus in Mulago Hospital, Uganda

Objective

To determine the maternal and foetal outcomes in mothers with gestational diabetes mellitus attending antenatal clinics in Mulago Hospital Kampala Uganda.

Design

This was a cohort study.

Setting

Mulago Hospital antenatal clinics.

Participants

Ninety mothers with gestational ages between 24–32 weeks were recruited from April to September 2001.They were followed up to the time of delivery. The WHO criterion for the diagnosis of gestational diabetes was used. Thirty mothers with a 2 hrs post prandial capillary blood sugar more than 140 mg/dl were the exposed group and 60 mothers with less than 140 mg/dl were the unexposed group. Blood sugar was measured using a one touch glucometer.

Outcome variables

Socio demographic characteristics, maternal complications, mode of delivery and the foetal outcomes.

Results

The mean age of mothers in both groups was similar: 28.6 years vs 27.5 years. Both groups had similar body mass index more than 26. The mothers with gestational diabetes mellitus (GDM) were four times more likely to have hypertensive disease(p=0.04) and nine times more likely to have vaginal candidiasis(p=0.002).The modes of delivery were similar in both groups but genital injuries were more common among mothers with GDM. The indications of Caesarian section in mothers with GDM were two times more likely to be due to big babies and obstructed labour. The babies for mothers with GDM were more likely to be macrocosmic, still born, and have shoulder dystocia than those of normal mothers.

Conclusion

Gestational diabetes mellitus exists in Uganda and is associated with adverse maternal and foetal outcomes. There is need to routinely screen mothers for gestational diabetes in this environment.