运动、饮食综合干预对妊娠期糖尿病合并妊娠期高血压孕妇影响观察

目的 探究运动、饮食综合干预对妊娠期糖尿病合并妊高症（GDM-PIH）孕妇母子结局及临床疗效的影响。方法 选取我院2016年1月到2017年9月间收治的152例妊娠期糖尿病合并妊高症患者，随机分为对照组和观察组，每组各76例。对照组进行常规降糖降压治疗，观察组采用运动、饮食综合干预。比较两组患者血糖血压控制情况、Mg2+、内脂素水平、缺血缺氧损伤指标、血管新生因子水平和两组母子结局。结果 治疗前，对照组和观察组收缩压、舒张压、平均动脉压、空腹血糖、口服葡萄糖耐量试验（OGGT2h）血糖、Mg2+、内脂素水平差异无统计学意义（P>0.05）。治疗后，与对照组比较，观察组收缩压［136.74±11.26比148.62±11.56 mmHg］、舒张压［86.45±8.31比92.44±8.52 mmHg］、平均动脉压［100.24±9.13比110.28±9.36 mmHg］、空腹血糖、OGGT2h血糖、内脂素［18.22±4.37比23.25±4.88 μg/L］、缺氧诱导因子-1α（hypoxia inducible factor-1α，HIF-1α）［40.26±5.89比84.25±9.46 pg/L］、一氧化氮、内皮素-1、丙二醛、Caspase-3蛋白［5.58±1.87比12.46±2.32 pg/L］、Bax［9.42±1.25 比24.25±3.56 pg/L］、可溶性人血管内皮细胞生长因子(vascular endothelial growth factor，VEGF)受体（sFlt-1）［（51.24±6.25比82.34±9.26） pg/L］水平降低；Mg2+、碱性成纤维生长因子、转化生长因子β1（transforming growth factor-β，TGFβ1）［110.12±11.13 比74.44±9.25 μg/L］、促血管生长素-2（angiogenin -2，Ang-2）［68.65±7.21 比45.97±6.33 pg/L］、肝细胞生长因子（Hepatocyte Growth Factor ，HGF）［80.12±8.32 比56.98±5.99 mg/L］、VEGF［207.61±24.15比115.54±15.22 mg/L］水平升高，不良妊娠结局［（15.79% 比42.11%）］、不良胎儿结局［（26.32% 比50.00%）］降低，差异有统计学意义（P<0.05）。结论 运动、饮食综合干预能有效控制患者病情，平衡患者缺血缺氧损伤指标、降低血管新生因子水平，从而改善GDM-PIH患者的母子结局，值得临床推广。

Comprehensive exercise and diet intervention on pregnant women with gestational diabetes mellitus complicated with gestational hypertension

To explore the effect of combined exercise and diet intervention on maternal and child outcomes and clinical efficacy of pregnant women with gestational diabetes mellitus(GDM-PIH). Methods 152 patients with gestational diabetes mellitus complicated with preeclampsia who admitted to our hospital from January 2016 to September 2017 were randomly divided into control group and observation group, with 76 cases in each group. The control group received routine hypoglycemic and hypertensive therapy, while the observation group received comprehensive exercise and diet intervention. Blood glucose and blood pressure control, Mg2+, lactone level, ischemia and hypoxia injury index, angiogenesis factor level and parent-child outcome were compared between the two groups. Results Before treatment, there was no significant difference in systolic blood pressure, diastolic blood pressure, mean arterial pressure, fasting blood glucose, oral glucose tolerance test(OGGT2 h) blood glucose, Mg2+, and visfatin levels between the control group and the observation group(P>0.05). After treatment, compared with the control group, some indexes of the observation group were lower: the systolic blood pressure 136.74±11.26 vs 148.62±11.56 mmHg], diastolic blood pressure 86.45±8.31 vs 92.44±8.52 mmHg], mean arterial pressure 100.24±9.13 vs 110.28±9.36 mmHg], fasting blood glucose, OGGT2 h blood glucose, visfatin 18.22±4.37 vs 23.25±4.88 μg/L], hypoxia-inducible factor-1α(HIF-1α) 40.26±5.89 vs 84.25±9.46 pg/L], nitric oxide, endothelin-1, malondialdehyde, Caspase-3 protein 5.58±1.87 vs. 12.46±2.32 pg/L], bax 9.42±1.25 vs. 24.25±3.56 pg/L] and soluble human vascular endothelial growth factor(VEGF). The level of receptor(sFlt-1) (51.24±6.25 vs. 82.34±9.26) pg/L] was significantly decreased; Mg2+, basic fibroblast growth factor, transforming growth factor β1(TGFβ1) 110.12±11.13 vs 74.44±9.25 μg/L], angiotensin-2(Ang-2) 68.65±7.21 vs. 45.97±6.33 pg/L], hepatocyte growth factor(HGF) 80.12±8.32 vs. 56.98±5.99 mg/L], VEGF 207.61±24.15] was significantly higher than that of 115.54±15.22 mg/L. The adverse pregnancy outcome (15.79% vs. 42.11%)] and the adverse fetal outcome (26.32% vs. 50.00%)] were significantly lower(all P<0.05). Conclusion The comprehensive intervention of exercise and diet can effectively control the condition of patients, balance the indicators of ischemia and hypoxia injury in patients and reduce the level of angiogenesis factor, and thus improve the mother-child outcome of GDM-PIH patients, which is worthy of clinical promotion.