2006-2008年安阳市部分孕妇糖尿病筛查结果分析

[目的]对妊娠期女性进行糖尿病筛查．做到早发现、早诊断、早治疗,确保母儿安全。[方法]对2006年1月至2008年3月到安阳市妇幼保健院产科门诊进行系统保健的孕妇进行血糖筛查及糖耐量试验。[结果]筛查3051人,检出妊娠期血糖升高者116例．检出率为3．61％,其中43例确诊为妊娠期糖尿病,患病率为1．41％。[结论]安阳市妊娠期女性妊娠期糖尿病患病率处于一般水平。     

Low rates of predominant breastfeeding in hospital after gestational diabetes,particularly among Indigenous women in Australia

Objectives: To investigate rates of ‘any’ and ‘predominant’ breastfeeding in hospital among Indigenous and non‐Indigenous women with and without gestational diabetes mellitus (GDM). Methods: A retrospective study of singleton infants born from July 2007 to December 2010 at Cairns Hospital, Australia, following GDM pregnancy, using linked hospital and birth data (n=617 infants), with a subsample of medical record reviews (n=365 infants). Aggregate data were used to compare to breastfeeding rates among infants born following non‐GDM pregnancy (n=7,894 infants). Results: More than 90% of all women reported any breastfeeding before hospital discharge. About 80% of women without GDM reported predominant breastfeeding. Despite significant increases over time (p<0.0001), women with GDM were less likely to predominantly breastfeed (OR 0.32, 95%CI 0.27–0.38, p<0.0001); with lower rates among Indigenous women (53%) compared with non‐Indigenous (60%) women (OR 0.78, 0.70–0.88, p<0.0001); and women having a caesarean birth or pre‐term infant. Conclusions: Rates of predominant in‐hospital breastfeeding were lower among women with GDM, particularly among Indigenous women and women having a caesarean or pre‐term birth. Implications: Strategies are needed to support predominant in‐hospital breastfeeding among women with GDM.     

Ⅱ型糖尿病患者血中抗氧化状态评价

分析Ⅱ型糖尿病患者血浆抗氧化维生素A、E,抗氧化酶SOD活性和一氧化氮(NO)含量变化,以探讨氧化和抗氧化系统与糖尿病的关系测定33例Ⅱ型糖尿病患者(男／女15∶18,年龄56.1±11.1岁)血浆抗氧化维生素A、E水平,抗氧化酶SOD活性和NO含量,并与33例正常对照(男／女16∶17,年龄56.0±10.5岁)进行比较。结果发现,糖尿病组与对照组相比,血浆抗氧化维生素A、E水平无显著性差异;SOD活性显著降低(P＜0.05);糖尿病组的血浆NO水平比正常对照组的显著增高(P＜0.01)。提示糖尿病患者抗氧化系统失衡,且可能参与糖尿病的病理过程。     

妊娠期糖尿病的合理管理与妊娠结局

为了解郑州地区妊娠期糖尿病的发病率及对妊娠期糖尿病合理管理后的妊娠结局 ,对定期进行围产保健的孕妇于孕 2 4～ 2 8w时行 50 g葡萄糖筛查 ,对糖筛查异常者行 75 g葡萄糖耐量试验 (OGTT) ,对 OGTT异常的病人实行合理管理。结果 :33例 (2 .95% )诊断为糖耐量受损 (GIGT) ,32例 (2 .95% )诊断为妊娠期糖尿病 (GDM) ,经过合理管理后均得到良好的妊娠结局     

妊娠期糖尿病的临床护理研究进展

妊娠期糖尿病(GDM)是妊娠期间首次发生或发现的糖耐量异常,为糖尿病的一种特殊类型,发病率呈逐年上升趋势.GDM在临床上属高危妊娠,如果孕妇病情未能得到很好的控制,会给母婴带来严重危害.多数患者产后糖代谢异常能恢复正常,但仍有40％～60％病例在5～10年后转变为2型糖尿病.因此,对GDM患者在孕期加强健康宣教,使其认...     

Ⅱ型糖尿病并发脑梗死患者检测同型半胱氨酸临床意义的荟萃分析

目的:通过Meta分析探讨Ⅱ型糖尿病脑梗死患者与同型半胱氨酸的关系。方法:使用电脑检索中国知网(1979-2011.05)、维普数据库(1989-2011.05)和万方数据库(1998-2011.05)相关论文,采用RevMan 4.2软件对入选试验进行Meta分析。结果:共9篇研究符合要求,纳入分析。结论:HCY是Ⅱ型糖尿病脑梗死的重要危险因素。     

叶酸与维生素B12对2型糖尿病大鼠心肌组织凋亡 相关蛋白表达的影响

摘要:目的　观察2型糖尿病大鼠心肌凋亡相关蛋白Bax、Bcl-2和Caspase-3的表达变化及叶酸、维生素B12的干预作用。方法　6周龄SD大鼠60只,糖尿病造模成功后,随机分为对照组（A组）、模型组（B组）、叶酸和维生素B12干预组（C组）。12周后取血检测各组同型半胱氨酸（Hcy）、叶酸、维生素B12的水平;取大鼠心肌组织,免疫组化法检测Bax,Bcl-2,Caspase-3的表达,并用计算机图像分析系统测平均灰密度值。结果　12周后B组Hcy明显增高,与A组和C组比较,差异均有统计学意义（P＜0.01）,C组叶酸、维生素B12与A组和B组比较,差异均有统计学意义（P＜0.01）;心肌组织中,B组Bax、Caspase-3的表达明显高于A组（P＜0.01）,Bcl-2的表达明显低于A组（P＜0.01）;C组Bax、Caspase-3的表达较B组明显下降（P＜0.01）,Bcl-2的表达明显高于B组（P＜0.01）;A组与C组Bax、Caspase-3、Bcl-2的表达差异无统计学意义（P＞0.05）。结论　2型糖尿病大鼠血液中Hcy的升高,可能在促进心肌细胞凋亡过程中发挥重要作用,而叶酸、维生素B12的干预可以有效缓解病变进程。     

妊娠期糖代谢异常162例母儿预后分析

目的:探讨妊娠期糖代谢异常对母儿预后的影响。方法:2003年6月~2007年8月在大同市第一人民医院诊断为妊娠期糖代谢异常的孕妇162例,其中妊娠期糖尿病(GDM)组58例,妊娠期糖耐量减低(G IGT)组104例,另选择150例血糖值正常孕妇作为血糖正常(GNGT)组,比较3组的母儿预后。结果:GDM组孕妇产后即时出血、剖宫产、妊娠期高血压疾病、羊水过多、巨大儿、早产儿和新生儿低血糖的发生率均显著高于GNGT组(P<0.05);G IGT组剖宫产、羊水过多、巨大儿的发生率显著高于GNGT组(P<0.05)。结论:妊娠期糖代谢异常对孕产妇和围生儿的预后有不良影响,应对妊娠期糖代谢异常的孕产妇进行积极干预。     

Relationship between Serum Osteocalcin Level and Gestational Diabetes Mellitus: A Case-Control Study

BackgroundOsteocalcin (OC) is the most common noncollagenous protein in bone matrix, which is synthesized only in bone tissue and by osteoblasts. The potential role of osteocalcin on glucose and fat metabolism has been previously reported. The aim of this study was to compare the serum OC level in pregnant women with and without gestational diabetes mellitus (GDM).MethodsIn the present case-control study, all pregnant women who were referred to a obstetrics and gynecology clinic in Sari, Iran, and met the inclusion criteria underwent an overall screening with a 75-g glucose tolerance test (GTT) at week 24 to 28 of gestation. The study was conducted between September 2018 and February 2019. Based on criteria, the pregnant women with confirmed GDM were matched with pregnant women without GDM in terms of baseline characteristics such as chronological age and BMI. The serum OC levels were also measured if vitamin D and calcium levels were normal. All data were analyzed using SPSS 21.ResultsThe two groups with and without GDM had no significant difference in terms of age, BMI and OC level. There was no significant correlation between age and BMI with OC level in healthy pregnant women, respectively (P=0.49 and P=0.58). The correlation between BMI and age with OC level in GTT-positive pregnant women was 0.05 and -0.172, respectively, which was not significant (P=0.77 and P=0.36).ConclusionAccording to the results of this study, there is no significant difference of serum OC levels in pregnant women with GDM compared to healthy pregnancy. Given that the levels of serum insulin or insulin resistance have not been assessed, these indices are recommended to be evaluated in future studies.     

亚临床甲状腺功能减退合并妊娠期糖尿病 对妊娠结局的影响

摘要:目的　探讨亚临床甲状腺功能减退（Subclinical Hypothyroidism,SCH）合并妊娠期糖尿病（Gestational Diabetes Mellitus,GDM）对妊娠结局的影响。方法　选取2014年1月-2014年12月在邢台市人民医院建档,经甲状腺功能筛查诊断为SCH单胎妊娠妇女285例,同期正常单胎妊娠妇女2181例为对照,依据妊娠24～28周行75 g葡萄糖耐量试验（Oral Glucose Tolerance Test OGTT）结果将其分为四组（对照组1909例、SCH组201例、GDM组272例及SCH+GDM组84例）,对四组的新生儿体重及妊娠结局进行比较。结果　GDM组新生儿体重大于SCH组（t＝2.264,P＝0.032）及对照组（t＝2.586,P＝0.011）。4组在妊娠期高血压（χ2＝49.588,P＜0.001）、剖宫产（χ2＝30.7736,P＜0.001）、新生儿窒息（χ2＝9.759,P＝0.021）、早产流产（χ2＝9.240,P＝0.026）总体上有显著差异,组间两两比发现SCH+GDM组在妊娠期高血压发病高于GDM组（χ2＝11.197,P＝0.001）、SCH组（χ2＝25.543,P＜0.001）及对照组（χ2＝41.480,P＜0.001）;SCH+GDM组在剖宫产比例高于GDM组（χ2＝8.902,P＝0.003）、SCH组（χ2＝12.170,P＜0.001）及对照组（χ2＝26.989,P＜0.001）;SCH+GDM组在新生儿窒息高于SCH组（χ2＝4.118,P＝0.042）、GDM组（χ2＝6.464,P＝0.031）及对照组（χ2＝9.662,P＝0.002）。SCH+GDM组在早产、流产高于SCH组（χ2＝8.350,P＝0.004）、GDM组（χ2＝7.044,P＝0.008）及对照组（χ2＝11.696,P＝0.001）。而4组在胎膜早破（χ2＝4.939,P＝0.176）、胎盘早剥（χ2＝7.485,P＝0.058）、产后出血（χ2＝6.973,P＝0.073）发病差异无统计学意义。结论　SCH合并GDM增加妊娠不良结局的风险,应注重SCH妊娠妇女血糖监测及控制。     

CRP和IL-12与妊娠期糖尿病胰岛素抵抗的相关性研究

目的 探讨炎性介质C反应蛋白(CRP)和白介素12(IL-12)在妊娠期糖尿病(GDM)发病机制中的作用.方法 选择我院诊治的孕妇,妊娠中期服50 g葡萄糖筛查阴性为对照组,50例;50 g葡萄糖筛查阳性、并经75 g葡萄糖耐量试验诊断为GDM孕妇作为GDM组,40例.分別检测两组孕妇血清中CRP、IL-12、胰岛素及空腹血糖(FBS)的水平.结果 GDM组空腹血糖、空腹胰岛素、胰岛素抵抗指数(IRI)、CRP、IL-12均高于对照组[(4.95±0.76) mmol/L比(4.57±0.58) mmol/L、(13.65±1.74)uIU/ml比(8.78±1.65) uIU/ml、(2.91±1.05)比(1.72±0.87)、(5.56±1.24) mg/L比(3.25±1.13) mg/L、(71.47±4.35) pg/ml比(56.03±4.06) pg/ml,P＜0.05],单因素分析结果CRP与IRI呈正相关(r=0.865,P＜ 0.05),IL-12与IRI呈正相关(r=0.913,P＜0.05).结论 CRP及IL-12与IRI呈正相关,可能参与了GDM的发病,促进高血糖发生.     

饮食习惯和体力活动对妊娠期糖尿病的影响

目的 探讨饮食习惯和体力活动对妊娠期糖尿病发病的影响。方法 选择产科门诊确诊妊娠期糖尿病孕妇942列（GDM组）及其配对对照组作为调查对象,以问卷方式,对膳食史、饮食习惯和体力活动等情况进行回顾性调查。结果 GDM组每日膳食总热能、脂肪供热比、动物比脂肪百分比均显高于对照组（P＜0．05）;GDM组长期饱餐和喜甜食的比例显高于对照组（P＜0．05）;而GDM组平均体力活动量低于对照组（P＜0．05）。结论 孕期高热能、高脂肪的膳食,喜饱餐和喜甜食和较少的体力活动是诱使发生妊娠期糖尿病的重要影响因素。     

妊娠期糖尿病98例临床分析

目的 探讨妊娠期糖尿病的及时诊断、规范化管理与妊娠结局的关系.方法 回顾性分析98例在笔者所在医院分娩的妊娠期糖尿病（GDM组）与随机选择同期正常的孕妇100例（对照组）患者的母婴预后情况.结果 GDM组98例患者中,64例（65.3%）无糖尿病典型临床表现但有糖尿病高危因素存在或因妊娠高血压综合征重复检查而确诊,50 g葡萄糖负荷试验、75 g葡萄糖耐量试验是筛选、诊断妊娠期糖尿病的主要手段 经治疗和监测,妊娠期糖尿病的并发症中除早产、羊水过多明显高于对照组（P〈0.05）,巨大儿发生率低于对照组（P〈0.05）外,余并发症与对照组相比差异无统计学意义.结论 及时诊断、积极治疗可明显改善母婴预后.     

Association of Homocysteine Levels With Blood Lead Levels and Micronutrients in the US General Population

Objectives

Even though several epidemiological studies have observed positive associations between blood lead levels and homocysteine, no study has examined whether this association differs by the levels of micronutrients, such as folate, vitamin B6, and vitamin B12, which are involved in the metabolism of homocysteine. In this study, we examined the interactions between micronutrients and blood lead on homocysteine levels.

Methods

This study was performed with 4089 adults aged ≥20 years old in the US general population using the National Health and Nutrition Examination Survey 2003-2004.

Results

There were significant or marginally significant interactions between micronutrients and blood lead levels on mean homocysteine levels. Positive associations between blood lead and homocysteine were clearly observed among subjects with low levels of folate or low vitamin B6 (p-trend <0.01, respectively). However, in the case of vitamin B12, there was a stronger positive association between blood lead and homocysteine among subjects with high levels of vitamin B12, compared to those with low levels of vitamin B12. In fact, the levels of homocysteine were already high among subjects low in vitamin B12, irrespective of blood lead levels. When we used hyperhomocysteinemia (homocysteine>15 µmol/L) as the outcome, there were similar patterns of interaction, though p-values for each interaction failed to reach statistical significance.

Conclusions

In the current study, the association between blood lead and homocysteine differed based on the levels of folate, vitamin B6, or vitamin B12 present in the blood. It may be important to keep sufficient levels of these micronutrients to prevent the possible harmful effects of lead exposure on homocysteine levels.     

Participant attrition and perinatal outcomes in prenatal vitamin D-supplemented gestational diabetes mellitus patients in Asia: A meta-analysis

BACKGROUNDThe role of vitamin D supplementation in gestational diabetes mellitus (GDM) patients is unclear.AIMTo determine the burden and risk of post-randomization GDM patient attrition from vitamin D-supplemented arms of randomized controlled trials (RCTs). The auxiliary aim was to compare the effects of nutritional supplements on their fasting blood glucose (FPG) levels and perinatal outcomes.METHODSRCTs were searched in the PubMed, Embase, and Scopus databases. Random-effect prevalence and pairwise meta-analysis were performed for the primary objective. The auxiliary aim was to compare the effects of nutritional supplements on their fasting blood glucose (FPG) levels and perinatal outcomes. Fixed-effect network meta-analyses were undertaken for the secondary goals. All analyses were performed using Stata software, and statistical significance was determined at P < 0.05.RESULTSThirteen RCTs from Iran and China were reviewed. The participant attrition burden in vitamin D recipients was 6% [95% confidence interval (CI): 0.03, 0.10], and its risk did not vary from non-recipients. Vitamin D and calcium co-supplementation reduced the cesarean section incidence in GDM patients [risk ratio (RR): 0.37; 95%CI: 0.18, 0.74]. The hyperbilirubinemia or hospitalization risk in their newborns decreased with vitamin D supplementation (RR: 0.47; 95%CI: 0.27, 0.83) and co-supplementation with calcium (RR: 0.35; 95%CI: 0.16, 0.77) or omega-3 fatty acids (RR: 0.25; 95%CI: 0.08, 0.77). Vitamin D and probiotics co-supplementation decreased newborn hyperbilirubinemia risk (RR: 0.28; 95%CI: 0.09, 0.91). FPG levels and macrosomia risk did not vary across interventions.CONCLUSIONIn RCTs, vitamin D supplementation or co-supplementation in GDM patients showed a low participant attrition burden and low risk of cesarean section, newborn hyperbilirubinemia, and newborn hospitalization.     

Determinants and distributions of plasma total homocysteine concentrations among school children in Taiwan

Background: Plasma total homocysteine (tHcy) level is an independent risk factor for cardiovascular disease (CVD) even among children. The purpose of this study is to evaluate the determinants and distributions of plasma tHcy levels and the relationship between plasma tHcy, folate and vitamin B12 levels among school children in Taipei. Methods: After multi-stage sampling, we randomly selected 1234 school children (609 boys and 625 girls) with the mean age of 13 years (from 12 to 15 years) in this study. Fasting plasma tHcy levels were measured using an ABBOTT IMx analyzer (Axis Biochemicals ASA, Oslo, Norway). Plasma folate and vitamin B12 levels were measured by ACS:180 automated chemiluminescence analyzer (Bayer, Tarrytown, NY, USA). Results: The distribution of plasma tHcy levels were skewed to the right with the mean values of 10.50 and 8.95 mol/l and medians of 9.67 and 8.474 mol/l for boys and girls, respectively. Plasma tHcy concentrations were lower in younger children and progressively increased with increasing age. Boys had significantly higher plasma tHcy levels than girls (10.50 ± 4.134 vs. 8.95 ± 2.61 mol/l, p < 0.01) and lower plasma folate levels (6.05 ± 2.85 vs. 6.39 ± 2.58 nmol/l, p < 0.01), and vitamin B12 levels (444.8 ± 158.4 vs. 495.0 ± 181.5 pmol/l, p < 0.001). Plasma tHcy levels were significantly positively associated with anthropometric measures in boys; but these characteristics attenuated and became insignificant after adjusting for other potential confounders in girls. Plasma tHcy levels were negatively associated with plasma folate and vitamin B12 levels even after adjusting for BMI and other potential confounders in both genders. Conclusions: From this study, the distributions of tHcy levels were skewed to the right and the boys had higher plasma tHcy levels than girls. Plasma tHcy levels were significantly positively associated with BMI among boys. Further studies are needed to evaluate the relationship between tHcy and CVD risk factors among children for the better prevention of heart disease in early life.     

血浆同型半胱氨酸与急性脑梗死关系的临床研究

目的探讨血浆同型半胱氨酸（Hcy）与急性脑梗死的关系及其临床意义。方法86例急性脑梗死患者（急性脑梗死组）和同期66例体检正常的健康者（对照组）采用荧光偏振免疫分析法测定血浆Hcy，采用化学发光法测定叶酸和维生素B12，并将结果进行比较。结果急性脑梗死组血浆Hcy为（20．08±8．72）μmol／L，对照组为（12．50±2．20）μmol／L，两组比较差异有统计学意义（P〈0．01）；急性脑梗死组血浆叶酸为（4．98±5．01）μg／L，对照组为（7．68±2．02）μg／L，两组比较差异有统计学意义（P〈0．01）；急性脑梗死组血浆维生素B12为（227．39±127．89）pmol／L，对照组为（311．64±152．15）pmol／L，两组比较差异有统计学意义（P〈0．01）。结论急性脑梗死患者血浆Hcy是升高的，而血浆叶酸和维生素B12呈下降趋势，Hcy是急性脑梗死的独立危险因素。     

54例妊娠期糖尿病孕妇的妊娠结局分析

目的研究54妊娠期糖尿病(Gestational Diabetes Mellitus,GDM)孕妇的妊娠结局。方法回顾性分析2011年1月～2011年12月在我院建卡分娩的54例GDM孕妇。根据孕前体重指数分为四组,比较各组的产前体重指数、糖筛查值和空腹血糖值;再根据孕期体重增长情况分为孕期体重增长适宜组(28例)和不适宜组(26例),比较两组孕妇的妊娠结局。结果 GDM孕妇孕前体重指数与产前指数、空腹血糖值呈正相关(p<0.05),但孕前体重指数与GCT值无相关性(p>0.05)。54例GDM孕妇中,体重增加不适宜组的剖宫产率以及发生羊水粪染、产后出血及新生儿并发症的几率高于适宜组(p<0.05)。结论孕前肥胖是导致GDM孕妇血糖增加的重要因素;GDM孕期体重增长过多可增加发生不良妊娠结局的危险。     

2型糖尿病患者骨密度与相关因素分析

目的 探讨2型糖尿病患者骨质疏松的相关因素。方法 采用双能X射线骨密度仪测定120例2型糖尿病患者正位腰椎(L_1-4)、左侧股骨颈、左侧股骨粗隆及左侧股骨干骨密度,根据骨密度值分为骨量正常组、骨量减少组及骨质疏松组,观察各组年龄、病程、体质指数(BMI)、血清骨代谢及相关生化指标的变化,并对上述指标进行对比分析。结果 骨质疏松组在年龄、病程、BMI、血碱性磷酸酶(ALP)、Ⅰ型胶原氨基末端肽(SNTX)及血清25-羟维生素D (25-VitD)水平与正常组比较差异均有统计学意义(P < 0.05),骨量减少组与正常组比较仅年龄的差异有统计学意义(P < 0.05),其他指标无统计学差异(P > 0.05)。直线相关分析显示年龄、BMI及25-VitD与各部位骨密度均相关(P < 0.01或P < 0.05),病程与除腰椎外的其他部位骨密度呈负相关(P < 0.01),ALP与除股骨干之外的各部位骨密度呈负相关(P < 0.05),SCTX、SNTX分别与腰椎、股骨干骨密度呈负相关(P < 0.05)。结论 年龄、病程及低BMI是2型糖尿病患者骨质疏松的危险因素,检测血清25-VitD、ALP、SNTX和SCTX水平在一定程度上有助于判断个体是否易患骨质疏松。     

吡格列酮对2型糖尿病患者血清髓过氧化物酶的影响

目的探讨吡格列酮对2型糖尿病患者血清髓过氧化物酶(Myeloperoxidase,MPO)及胰岛素抵抗等指标的影响。方法30名2型糖尿病患者加用吡格列酮15mg/d治疗12周,测定治疗前后的空腹血糖、空腹胰岛素、糖化血红蛋白、血脂、血清髓过氧化物酶,计算胰岛素抵抗指数。结果吡格列酮干预后的空腹血糖、血清髓过氧化物酶、胰岛素抵抗指数均显著下降(P0.05),糖化血红蛋白有下降趋势(P=0.07),血脂各项指标均无显著变化。结论吡格列酮能显著降低2型糖尿病患者的血清髓过氧化物酶水平及胰岛素抵抗程度,提示其可用于预防2型糖尿病患者的动脉粥样硬化。