糖化血蛋白在妊娠期糖尿病筛查中的应用

目的:探讨血糖、糖化血红蛋白(HbA 1c )在妊娠期糖尿病(GDM)筛查中的作用,以及对具有高危因素孕妇早期糖筛查的意义.方法:用HbA 1c 、空腹血糖和糖负荷实验(GCT)三种方法对孕妇进行筛查,将孕妇分成三组.①正常妊娠组②妊娠糖尿病(GDM)组③健康女性对照组.结论:HbAle测定是一种简便、快捷、可靠的妊娠糖尿病筛查方法,可作为GDM诊断的筛查指标.在产科门诊开展对高危孕妇的HbAlc测定,加强对具有高危因素病人的筛查,对及早发现病人,及时控制病情,减少GDM并发症很有帮助     

农村居民2型糖尿病高危因素分析及护理对策

目的 调查夷陵区农村居民糖尿病的高危因素,并提出护理对策以加强对农村居民糖尿病的防治工作.方法 采取分层整群抽样的方式,对9 871名农村居民进行问卷调查及体检.结果 农村居民2型糖尿病的高危因素主要有缺乏体力活动、饮酒、膳食不均衡等不良生活方式,以及BMI、腰臀比异常及高血压、高血脂等临床指标异常.结论 农村居民对2...     

肾移植术后糖尿病的临床特性及高危因素

目的 研究肾移植术后糖尿病（ＰＴＤＭ）的临床特性及高危因素。方法 将５１２例肾移植患者分为２组,其中４８例ＰＴＤＭ患者为糖尿病组。其余４６４例患者为非糖尿病组。定期监测患者体重、用药情况、生化指标、病毒抗体,并用血清学方法及聚合酶链反应（ＰＣＲ）方法检测主要组织相容性抗原（ＨＬＡ）。结果 糖尿病组的平均年龄及术后６个月内激素的用量明显高于非糖尿病组。肾移植术后半年内易出现ＰＴＤＭ,且全部ＰＴＤＭ     

卵巢癌高危的主要影响因素与早期诊断治疗分析

目的探讨卵巢癌发病的高危因素。方法选取2010-04—2015-04收治的100例卵巢癌患者,将其临床资料与同期进行体检的100例健康人进行对比。结果单因素分析结果,卵巢癌危险性因初潮年龄早相对增加。卵巢癌与子宫内膜异位症也有一定关联。采取避孕措施、怀孕次数多、哺乳、产次多,均可使卵巢相对危险度减少。负性生活事件、抑郁情绪与卵巢癌发生呈正相关,哺乳、多产为保护因素。结论分析卵巢癌的高危因素,可对高危人群实施针对性支持干预提供依据,以延长其生存时间、提高其生存质量。     

妊娠期糖尿病对初次妊娠及再次妊娠骨密度的影响

目的研究妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇初次妊娠和再次妊娠的骨密度(body mineral density,BMD)情况。方法回顾性病例分析,入组单胎经产妇200人,其中100人初次妊娠诊断GDM,为GDM组,另100人初次妊娠血糖正常,为对照组。查询所有孕妇初次妊娠早孕期超声骨密度结果,产褥期骨密度情况,及再次妊娠早孕期骨密度情况。结果初次妊娠GDM组早孕期BMD与对照组无统计学差异(P0.05),产褥期BMD与对照组无统计学差异(P0.05),再次妊娠GDM组早孕期BMD与对照组无统计学差异(P0.05)。GDM产妇初次妊娠产褥期BMD与早孕期相比下降,差异有统计学意义(P0.05),而对照组初次妊娠产褥期BMD与早孕期相比无统计学差异(P0.05)。结论 GDM引起孕期骨密度下降,应加强管理,减少骨质疏松的发生。     

初诊2型糖尿病患者糖化血红蛋白影响因素分析

目的比较不同体重指数初诊患者糖化血红蛋白影响因素。方法将747例初诊T2DM患者按体重指数≥25kg/m2、BMI〈25kg/m2分为肥胖组（A组）和非肥胖组（B组）,比较两组年龄、HbA1c、收缩压、舒张压、空腹血糖、餐后2h血糖、胰岛素抵抗指数、甘油三酯、总胆固醇的差别;多元线性相关分析及多元逐步回归分析HbA1c与以上指标的关系。结果 A组HbA1c、DBP、FBG、PBG、HOMA-IR、TG、TC较B组增高（P〈0.05）。多元线性相关分析显示,A组HbAlc与BMI、FBG、HOMA-IR、TG正相关,B组HbA1c与TC、PBG呈正相关（P〈0.05）。以HbA1c为因变量、各代谢指标为自变量进行多元逐步回归分析,A组FBG、HOMA-IR进入回归方程（P〈0.01,R2=0.43）,B组PBG进入回归方程（P〈0.01,R2=0.29）。结论高空腹血糖、胰岛素抵抗是肥胖T2DM患者HbA1c升高的主要因素,餐后血糖升高是非肥胖T2DM患者HbA1c升高的主要因素。     

妊娠期糖尿病患者骨密度检测及影响因素分析

目的 探讨妊娠期糖尿病患者骨密度情况及影响因素。方法 选择2007年12月至2012年5月在孝感市中心医院产检和住院的孕妇,其中,正常孕妇160例为对照组,临床确诊为GDM的患者156例,应用超声骨密度测定仪测定孕妇右侧跟骨骨密度,检测空腹血糖（FPG）、糖化血红蛋白(HbA1C),并进行统计学分析。结果 妊娠期糖尿病组孕妇骨密度检测结果中BUA、SOS、SI均明显低于对照组(P<0.05);妊娠期糖尿病组骨量减少、骨质疏松比例分别为15.38%、5.13%,明显高于对照组(P<0.05);Pearson相关分析显示SI与年龄、孕周、FBS、HbA1C呈负相关（r=-0.160、-0.265、-0.160和-0.156,P<0.05）,与BMI呈正相关（r=0.069,P<0.05）。结论 妊娠期糖尿病患者骨量减少及骨质疏松发生率较正常孕妇明显升高;且跟骨超声骨密度SI与年龄、孕周、FBS、HbA1C呈负相关,与BMI呈正相关。     

妊娠期糖尿病孕妇心理弹性现况及影响因素研究

目的了解妊娠期糖尿病(GDM)孕妇的心理弹性现况并探讨其影响因素。方法应用Connor-Davidson心理弹性量表、自行构建的妊娠期糖尿病知信行调查问卷、一般资料调查表对上海市4所医院产科门诊及病房的359名GDM孕妇进行问卷调查。结果GDM孕妇的心理弹性量表得分为69.99±15.03,与知信行得分呈正相关(均P0.01);医院,孕周,是否使用胰岛素,知识、信念、行为得分是GDM孕妇心理弹性的影响因素(P0.05,P0.01),可共同解释总变异量的37.7%。结论 GDM孕妇的心理弹性水平处于中等水平,医院、孕周、是否使用胰岛素、疾病相关知识、信念、行为是其影响因素。应针对GDM孕妇开展规范化血糖管理,重视孕早期及孕晚期、使用胰岛素治疗孕妇的心理健康,提升孕妇疾病相关知识、促进其对疾病积极的信念、改善疾病管理行为,以提高GDM孕妇的心理弹性水平。     

2型糖尿病患者膀胱过度活动症患病现状及影响因素分析

目的了解2型糖尿病患者膀胱过度活动症(OAB)患病现状,并探讨影响因素。方法采用方便抽样法抽取1 103例2型糖尿病患者,使用一般资料调查表、OAB症状评分量表、Charlson合并症指数进行调查,并测量腰臀比及记录糖化血红蛋白水平。结果 2型糖尿病患者OAB患病率为13.6%。Logistic回归分析显示,年龄、性别、糖化血红蛋白、腰臀比、Charlson合并症指数是OAB的影响因素(P0.05,P0.01)。结论糖尿病患者是OAB的高危人群,尤其是血糖水平控制欠佳、年长、男性、肥胖、合并其他慢性病的患者。应加强对OAB预防知识的健康教育,并在糖尿病治疗过程中关注OAB患病情况,及早干预和治疗,以控制或延缓OAB病情进展。     

妊娠与分娩期痔病的高危因素

痔是指肛垫的异常移位或血管丛及动静脉吻合支发生的病理改变,是一种常见病。其原因并不完全明了,一般有肛垫下移学说、静脉曲张学说及认为其与遗传、饮食及地理环境等有关的理论。妊娠期女性腹内压力增加及激素水平升高,故孕妇易患痔病。国外文献报道,有25％～30％的孕妇患有痔病,到妊娠后期甚至有高达85％孕妇受此困扰。     

炎症因子用于早期预测妊娠期糖尿病的研究进展

妊娠期糖尿病(gestational diabetes mellitus,GDM)是指在妊娠期发生或首次发现的不同程度的糖耐量异常或糖尿病,对母亲及胎儿的危害很大,早期发现其危险因子,并进行早期诊断和干预,来预防、减少GDM及其并发症的发生值得关注和研究。炎症因子在GDM发生中的作用一直是研究的热点之一,本文将综述用炎症因子指标对GDM进行早期预测的研究进展。     

妊娠期糖尿病分子遗传学研究进展

妊娠期糖尿病（GDM）是指妇女在妊娠期发生或首次发现的不同程度的糖耐量异常.与妊娠相关的胰岛素抵抗程度超过了胰岛β细胞功能代偿的极限是目前较为公认的GDM发病原因,但其具体的发病机制尚不完全清楚.近年的研究表明,遗传因素在GDM的发生发展中起重要作用,一些基因的多态性可能影响到个体GDM易感性的差异.现就近年的关GDM基因多态性方面的研究做一综述.     

100g口服葡萄糖耐量试验与妊娠糖尿病

目的探讨妊娠糖尿病(GDM)孕妇100g口服糖耐量试验(OGTT)的血糖水平并评价能否将抽血4次减为3次。方法回顾性分析2003年1月至2004年12月本院妇产科出院的、经50g OGTT阳性(服糖后1h血糖≥7.8mmol/L)后行100g OGTT、按照美国国家糖尿病数据组(NDDG)标准诊断的115例GDM患者的100 g OGTT血糖水平。结果如果不取空腹血糖值,将有2例(1.7%)GDM孕妇被漏诊;分别略去餐后1、2和3h的血糖值,依次有42例(36.5%)、63例(54.8%)和36例(31.3%)孕妇被漏诊。结论省略餐后1、2或3h任何一个时点的血糖值都将出现较高的GDM漏诊率。目前资料显示,不论采用75 g或100g OGTT,尚不能将试验时间由3h简化为2h;而诊断标准是沿用NDDG还是采用美国糖尿病学会(ADA)的标准,有待进一步行大规模的前瞻性研究。     

Current progress in metabolomics of gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders of pregnancy and can cause short- and long-term adverse effects in both pregnant women and their offspring. However, the etiology and pathogenesis of GDM are still unclear. As a metabolic disease, GDM is well suited to metabolomics study, which can monitor the changes in small molecular metabolites induced by maternal stimuli or perturbations in real time. The application of metabolomics in GDM can be used to discover diagnostic biomarkers, evaluate the prognosis of the disease, guide the application of diet or drugs, evaluate the curative effect, and explore the mechanism. This review provides comprehensive documentation of metabolomics research methods and techniques as well as the current progress in GDM research. We anticipate that the review will contribute to identifying gaps in the current knowledge or metabolomics technology, provide evidence-based information, and inform future research directions in GDM.     

Attenuating type 2 diabetes with postpartum interventions following gestational diabetes mellitus

Women with a history of gestational diabetes should be screened during and after the postpartum period because of a high risk for developing type 2 diabetes mellitus. Although differences exist between guidelines practiced throughout various parts of the world, all recommend the use of cutoffs for fasting and/or post-load plasma glucose to diagnose diabetes or pre-diabetes. The use of these glycemic parameters could be optimized when a trend is observed, rather than considering them as isolated values at various time points. As the presence of insulin resistance and beta-cell dysfunction start before glycemic changes are evident, the estimation of insulin sensitivity and beta-cell function by Homeostatic Model Assessment is suggested for women who have additional risk factors for diabetes, such as obesity. Disease-modifying lifestyle intervention should be the first-line strategy to prevent or delay the onset of diabetes in women with a history of gestational diabetes mellitus. Intensive lifestyle interventions are designed to decrease caloric intake and increase physical activity in order to reduce body weight and fat, which will in turn reduce insulin resistance. This article also reviews unique problems of postpartum women, which should be considered when designing and implementing an intervention. Innovative “out of the box” thinking is appreciated, as continued adherence to a program is a challenge to both the women and the health care personnel who deal with them.     

Effect of resveratrol in gestational diabetes mellitus and its complications

The incidence rate of diabetes in pregnancy is about 20%, and diabetes in pregnancy will have a long-term impact on the metabolic health of mothers and their offspring. Mothers may have elevated blood glucose, which may lead to blood pressure disease, kidney disease, decreased resistance and secondary infection during pregnancy. The offspring may suffer from abnormal embryonic development, intrauterine growth restriction, obesity, autism, and other adverse consequences. Resveratrol (RSV) is a natural polyphenol compound, which is found in more than 70 plant species and their products, such as Polygonum cuspidatum, seeds of grapes, peanuts, blueberries, bilberries, and cranberries. Previous studies have shown that RSV has a potential beneficial effect on complex pregnancy, including improving the indicators of diabetes and pregnancy diabetes syndrome. This article has reviewed the molecular targets and signaling pathways of RSV, including AMP-activated protein kinase, mitogen-activated protein kinases, silent information regulator sirtuin 1, miR-23a-3p, reactive oxygen species, potassium channels and CX3C chemokine ligand 1, and the effect of RSV on gestational diabetes mellitus (GDM) and its complications. RSV improves the indicators of GDM by improving glucose metabolism and insulin tolerance, regulating blood lipids and plasma adipokines, and modulating embryonic oxidative stress and apoptosis. Furthermore, RSV can ameliorate the GDM complications by reducing oxidative stress, reducing the effects on placentation, reducing the adverse effects on embryonic development, reducing offspring's healthy risk, and so on. Thus, this review is of great significance for providing more options and possibilities for further research on medication of gestational diabetes.     

KCNQ1基因单核苷酸多态性与妊娠期糖尿病相关性研究

目的探讨KCNQ1基因单核苷酸多态性(SNP)位点rs2237892、rs2237895及rs2237896与妊娠期糖尿病(GDM)的相关性。方法本研究共纳入1436例孕妇,其中GDM 520例,糖耐量正常(NGT) 641例以及50 g葡萄糖激发试验阴性[GCT(-)]275例,后两组设为对照。采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)的方法检测KCNQ1基因的多态性。并以稳态模型评估指数(HOMA)评估其胰岛β细胞功能及胰岛素抵抗。结果(1)SNP rs2237896的三种基因型(AA、AG、GG)在GDM组及对照组分布频率分别为8.8%、46.7%、44.4%和13.1%、47.5%、39.4%,两组的基因型分布频率差异显著(P=0.011)。该位点在其隐性模型中(AA vs AG+GG),两组差异仍显著(P=0.016)。rs2237896等位基因A、G的分布频率在GDM组和对照组分别为32.2%、67.8%和36.8%、63.2%,GDM组中G等位基因分布频率高于对照组,差异有显著性[P=0.012,OR 1.228(95%CI 1.045～1.442)]。(2) SNP rs2237895的三种基因型(AA、AC、CC)在GDM组及对照组分布频率分别为39%、53.3%、7.7%和48.1%、43.0%、8.8%,两组的基因型分布频率差异显著(P=0.022)。该位点在其显性模型中(CC+AC vs AA),两组差异仍显著(P=0.001)。其等位基因A、C的分布频率在GDM组和对照组分别为65.7%、34.3%和69.7%、30.3%,GDM组中C等位基因分布频率高于对照组,差异有显著性[P=0.028,OR 1.200(1.020～1.411)]。(3)将受试者按SNP rs2237895基因型AA、AC、CC分类,其HOMA-B值分别为(158.15±99.66)、(141.72±132.62)和(131.54±189.85),差异具有显著性(P=0.021),基因型CC的孕妇具有最小的HOMA-B值。同时,该位点在显性模型中,差异也有显著性(P=0.005)[HOMA-B值为(140.25±142.15)(AC+CC)vs(158.15±99.66)(AA)]。结论在中国人群中KCNQ1基因SNP与GDM具有一定相关性,可能与具有风险基因的个体其胰岛β细胞功能更易受到损伤有关。     

Changing trends in management of gestational diabetes mellitus

Gestational diabetes mellitus(GDM)is on the rise globally.In view of the increasing prevalence of GDM and fetal and neonatal complications associated with it,there is a splurge of research in this field and management of GDM is undergoing a sea change.Trends are changing in prevention,screening,diagnosis,treatment and future follow up.There is emerging evidence regarding use of moderate exercise,probiotics and vitamin D in the prevention of GDM.Regarding treatment,newer insulin analogs like aspart,lispro and detemir are associated with better glycemic control than older insulins.Continuous glucose monitoring systems and continuous subcutaneous insulin systems may play a role in those who require higher doses of insulin for sugar control.Evidence exists that favors metformin as a safer alternative to insulin in view of good glycemic control and better perinatal outcomes.As the risk of developing GDM in subsequent pregnancies and also the risk of overt diabetes in later life is high,regular assessment of these women is required in future.Lifestyle interventions or metformin should be offered to women with a history of GDM who develop pre-diabetes.Further studies are required in the field of prevention of GDM for optimizing obstetric outcome.     

Long-term effects of metformin use in gestational diabetes mellitus on offspring health

Metformin is the first-line drug for the treatment of type 2 diabetes mellitus, but its role in gestational diabetes mellitus (GDM) management is not clear. Recent evidence suggests a certain beneficial effect of metformin in the treatment of GDM, but a high treatment failure rate leads to the initiation of additional medications, such as insulin. Moreover, since metformin crosses the placental barrier and reaches a significant level in the fetus, it is likely to influence the fetal metabolic milieu. The evidence indicates the long-term safety in children exposed to metformin in utero except for mild adverse anthropometric profiles. Diligent follow-up of metformin-exposed offspring is warranted from the clinician’s point of view.     

Improving nutrition for the prevention of gestational diabetes: Current status and perspectives

Gestational diabetes mellitus (GDM) is a common complication of pregnancy and a serious public health problem. It carries significant risks of short-term and long-term adverse health effects for both mothers and their children. Risk factors, especially modifiable risk factors, must be considered to prevent GDM and its consequences. Observational studies have identified several nutritional and lifestyle factors associated with the risk of GDM. The results of intervention studies examining the effects of diet and lifestyle on the prevention of GDM are contradictory. Differences in the study populations, types and intensity of intervention, time frame of the intervention, and diagnostic criteria for GDM may explain the heterogeneity in the results of intervention studies. This review provides an overview of new diets and other factors that may help prevent GDM. The main results of epidemiological studies assessing the risk factors for GDM, as well as the results and methodological problems of intervention studies on the prevention of GDM and their meta-analyses, are discussed. In addition, the evidence that gene and lifestyle interactions influence the development of GDM, as well as prospects for increasing the effectiveness of interventions designed to prevent GDM, including new data on the possible uses of personalized diet therapy, are highlighted.