个性化营养干预对妊娠期糖尿病的治疗作用

目的探讨个性化营养干预对妊娠期糖尿病的疗效。方法选取2012年在兰州军区乌鲁木齐总医院门诊治疗的73例妊娠期糖尿病(gestational diabetes mellitus GDM)患者为研究对象。自愿接受个性化营养治疗的38例患者为干预组,只接受常规营养指导不愿接受个性化营养管理的35例患者为对照组,分析两组孕妇血糖水平变化及妊娠结局。结果个性化营养治疗前,两组空腹血糖及餐后血糖比较差异无统计学意义(P0.05);干预组患者治疗10周后,空腹及餐后2 h血糖均较对照组下降明显(P0.05);干预组患者妊娠期高血压疾病、羊水过多、剖宫产、巨大儿、低体重儿、新生儿低血糖等母婴并发症发生率明显低于对照组(P0.05)。结论个性化营养治疗能有效控制孕期血糖,防止母婴并发症的发生,促进母婴健康。     

Comparison of the guideline development processes used for type 2 diabetes dietetic practice guidelines

Objective: To compare procedures used for the development of three sets of dietetic practice guidelines for type 2 diabetes: the Queensland Best Practice Guidelines (Queensland Guidelines), New Zealand Standards of Care (New Zealand Guidelines) (unpublished, 2003) and American Nutrition Practice Guidelines (American Guidelines) against National Health and Medical Research Council (NHMRC) standards for development of clinical practice guidelines. Design: The Queensland, New Zealand and American guidelines were audited against a checklist based on the NHMRC clinical practice guideline development standards, accounting for the recommended tasks and the order in which they should be completed. Additional information regarding the development processes was obtained from development coordinators of the existing dietetic practice guidelines for type 2 diabetes. Results: The American guidelines addressed more of the components of development recommended by the NHMRC than the Queensland and New Zealand guidelines. Most importantly the American guidelines were tested for clinical and cost effectiveness. Conclusion or application: The data presented show that the American Guidelines came closest to meeting the NHMRC criteria. These results suggest that the American Guidelines may best suit Australian requirements.     

孕期营养及糖尿病筛查对妊娠期糖尿病发病的预测

目的:探讨孕期膳食及体重增长情况对妊娠期糖尿病发病的影响和糖尿病筛查试验对妊娠期糖尿病发病的预测价值。方法:于2007年4月～2010年6月,在厦门市妇幼保健院营养门诊收集265例妊娠期糖尿病患者,并收集同期就诊的正常孕妇571例作为对照组。调查两组孕妇的膳食情况,动态监测孕期体重增长,探讨孕期膳食及体重增长情况对妊娠期糖尿病发病的影响和糖尿病筛查试验对妊娠期糖尿病发病的预测价值。结果:①两组孕妇的一般资料具有可比性。②GDM组孕妇能量、碳水化合物、脂肪的摄入水平均高于对照组孕妇(P<0.05),并且饱和脂肪酸占能量的百分比高于对照组,单/多不饱和脂肪酸占能量的百分比低于对照组,差异均有统计学意义(P<0.01)。③GDM组孕妇硒的摄入量低于对照组,维生素E的摄入量高于对照组(P<0.01)。④对年龄进行分层后,分析孕期体重增长对妊娠期糖尿病发病的影响,发现除25岁前的孕妇外,GDM组的孕期体重总增长值高于对照组(P<0.05)。⑤糖尿病筛查用于预测空腹血糖水平有统计学意义(P=0.000),即糖尿病筛查值越高,空腹血糖水平高的可能性越大,面积的95%可信区间为0.767～0.878。结论:①孕期总能量和脂肪的摄入及孕期体重增长对妊娠期糖尿病的发病有影响,孕妇应当合理的控制饮食,维持体重的平稳增长。②糖尿病筛查高值提示空腹血糖高值,当糖尿病筛查结果超过10.9 mmol/L时孕妇应当先行空腹血糖测定。③加强孕期营养健康教育及围产期保健,及早进行妊娠期糖尿病筛查及系统管理,对提高母婴健康水平至关重要。     

炎症因子与妊娠期糖尿病

近年来炎症反应在妊娠期糖尿病的发生发展中的作用越来越受到人们的重视。许多的炎症因子如C反应蛋白、肿瘤坏死因子、脂联素、血浆纤溶酶原激活物抑制因子1、瘦素、白介素等与妊娠期糖尿病有一定的联系。前瞻性研究表明这些炎症因子高的人群有较高的妊娠期糖尿病发病率。该文对某些炎症因子与妊娠期糖尿病之间关系的研究进行综述,为临床寻找更有效的诊断、预防和治疗手段提供参考。     

营养干预对妊娠糖尿病患者血糖控制的研究进展

通过检索并总结对妊娠糖尿病(gestational diabetes mellitus,GDM)患者进行营养干预从而改善患者代谢和母婴结局的相关文献,归纳目前关于营养干预GDM患者主流策略的研究进展。由于GDM患病率以及母婴并发症发生率升高,且单纯地通过胰岛素和口服降糖药物的效果和远期副作用有待进一步的论证,目前GDM的治疗正在趋于非药物化。越来越多的证据表明,对GDM患者或GDM高风险妇女的早期发现、早期监测和全程营养干预可以极大地改善母婴结局。通过检索近十年涉及妊娠糖尿病、营养干预、母婴结局的相关文献,综合分析后,得出结论:科学的营养干预、血糖监测和个性化健康教育相结合,使患者代谢水平和母婴结局显著改善。今后在这一领域的干预研究应侧重于系统规范地对GDM患者进行早诊断和早干预,并给出个性化干预方案。     

妊娠期糖尿病孕足月引产的临床研究

目的探讨足月引产对妊娠期糖尿病(gestational diabetes mellitus,GDM)母儿结局的影响。方法选择苏州市立医院本部产科2014年10月至2015年5月收治的孕足月GDM孕妇414例,根据是否自然临产和实施干预分为自然临产组和引产组,自然临产组234例,引产组180例,其中普贝生引产52例,水囊引产13例,人工破膜+催产素静滴引产86例,自然破膜+催产素静滴引产29例。分别对两组孕妇的一般情况、分娩方式、新生儿窒息率等临床资料进行回顾性分析。结果 1引产组的阴道分娩率(77.8%)明显低于自然临产组(95.3%),(P0.05)。2引产组及自然临产组的总产程分别为(6.99±3.86)h和(7.55±3.41)h,羊水III度污染发生率为2.8%(5/180)和2.6%(6/234)、新生儿窒息率为1.7%(3/180)和1.3%(3/234),差异均无统计学意义(P0.05)。3 4种引产方法在产后出血量及阴道分娩率方面,差异有统计学意义(P0.05);阴道分娩率由高至低依次为:人工破膜+催产素静滴组(84.88%)、普贝生组(80.77%)、自然破膜+催产素静滴组(62.07%)、水囊组(53.85%)。4种引产方式剖宫产指征的构成比差异无统计学意义(P0.05)。结论引产增加了孕足月GDM患者的剖宫产率,同时并没有降低新生儿窒息率,故有必要对GDM孕妇的引产采用个体化的治疗,选择合适的引产时机及引产方式。     

妊娠期糖尿病干预管理对妊娠结局影响分析

目的探讨妊娠期糖尿病干预管理对孕妇妊娠结局的影响。方法选取近年来福建医科大学附属第一医院收治的妊娠期糖尿病孕妇中的100例作为研究对象,分为观察组和对照组（各50例）。对照组孕妇为妊娠期未作监测,分娩前确诊为糖尿病,妊娠期间没有进行相关治疗;观察组孕妇为定期体检,并于妊娠28周内确诊为糖尿病,经规范化治疗干预。对比分析两组孕妇妊娠结局。结果观察组患者分娩前血糖值低于对照组,妊娠并发症和妊娠结局改善情况均优于对照组;均具有显著差异（P〈0.05）。结论妊娠期糖尿病干预管理对于妊娠结局有明显的改善,能够减少产妇妊娠并发症。     

饮食运动管理对妊娠期糖尿病的应用研究

目的 探讨饮食控制和运动管理在妊娠期糖尿病(GDM)中的应用效果.方法 选取青岛市胶州中心医院产科自2014年7月至2015年7月间收治的114例确诊为妊娠期糖尿病的患者进行实验研究,按照数字随机原则将其分成三组,即对照组A患者38例未采取任何干预,对照组B38例仅采用常规护理干预,观察组(38例)在常规护理基础上行饮食控制和运动管理干预,测定三组孕妇干预前后的血糖含量变化;同时记录母婴并发症情况、剖宫产率、新生儿转儿科率.结果 对照组A患者干预前后空腹血糖(FBG)、餐后2h血糖(2hPG)均无显著性差异(t值分别为0.543、2.164,均P＞0.05),对照组B患者干预后血FBG、2hPG均显著下降(t值分别为4.812、5.198,均P＜0.05),且均显著低于对照组A干预后(t值分别为2.346、2.879,均P＜0.05),观察组患者干预后血FBG、2hPG均显著下降(t值分别为9.166、10.336,均P＜0.05),且均显著低于对照组A和对照组B干预后(t值分别为3.908、4.568、2.065、2.978,均P＜0.05).观察组产妇并发症、新生儿并发症发生率均显著低于对照组A组(x2值分别为5.330、4.659,均P＜0.05),且产妇并发症显著低于对照组B(x2=3.439,P＜0.05),但新生儿并发症发生率无显著性差异(x2=1.401,P＞0.05).观察组产妇剖宫产率、新生儿转儿科率均显著低于对照组A(x2值分别为4.070、4.145,均P＜0.05),但和对照组B比较均无显著性差异(x2值分别为0.957、2.235,均P＞0.05).结论 妊娠期糖尿病孕妇治疗过程中加强对饮食运动的管理干预,能够降低和避免孕妇、新生儿并发症发生率,避免不良妊娠结局的发生,值得推广.     

Weighing the evidence of low glycemic index dietary intervention for the management of gestational diabetes mellitus: an Asian perspective

This review aims to evaluate the effectiveness of low glycemic index (GI) dietary intervention for the treatment of gestational diabetes mellitus (GDM), specifically from the Asian perspective. A systematic review of the literature using multiple databases without time restriction was conducted. Three studies were retrieved based upon a priori inclusion criteria. While there was a trend towards improvement, no significant differences were observed in overall glycemic control and pregnancy outcomes in GDM women. However, a tendency for lower birth weight and birth centile if the intervention began earlier was noted. Low GI diets were well accepted and had identical macro-micronutrient compositions as the control diets. However, due to genetic, environment and especially food pattern discrepancies between Western countries and Asians, these results may not be contributed to Asian context. Clearly, there are limited studies focusing on the effect of low GI dietary intervention in women with GDM, particularly in Asia.     

妊娠糖尿病的发病机理和治疗研究进展

妊娠糖尿病是妊娠妇女较常见的围产期并发症之一,其发病机制涉及遗传易感、胰岛素抵抗和分泌缺陷、慢性炎症反应、代谢紊乱等。妊娠糖尿病的诊断方法和标准尚未统一,临床上以两步法诊断和美国国家糖尿病数据组及WHO的诊断标准应用尤为广泛。胰岛素治疗是妊娠糖尿病药物治疗的首选,近年的研究显示超短效胰岛素类似物同样具有安全、有效的治疗作用。另外,虽然有报道优降糖等口服降糖药物治疗妊娠糖尿病较为安全,但其有效性和安全性尚待进一步证实。     

Nutritional management of cystic fibrosis in Australia and New Zealand

Aim:  To document current practice in the nutritional management of cystic fibrosis in Australia and New Zealand and to examine changes in practice since 1996.
Methods:  Thirty-four cystic fibrosis services in Australia and New Zealand responded to a survey that examined current nutritional management practices and dietetic staffing levels. The questionnaire was based on a previous survey conducted in 1996.
Results:  Cystic fibrosis dietetic staffing levels were low. No service met the staffing level recommended by the UK Cystic Fibrosis Trust. Minor practice variations existed in nutrition assessment and monitoring: nutrition support and vitamin supplementation. Changes in the management of pancreatic enzyme replacement therapy and cystic fibrosis-related diabetes were reported since 1996.
Conclusion:  This survey highlights that improvements in consistency of nutrition management have been achieved since 1996 and reflect adherence to available clinical guidelines for pancreatic enzyme replacement therapy. While there are many areas of agreement in nutrition care for people with cystic fibrosis around Australia and New Zealand, there are still practice differences, implying that Australian- and New Zealand-specific clinical guidelines are warranted. The implementation of the Australasian Clinical Practice Guidelines for Nutrition in Cystic Fibrosis will be important in standardising and improving cystic fibrosis care.     

妊娠期糖尿病与母婴结局的回顾性对照研究

目的:探讨妊娠期糖尿病(GDM)与母婴结局的关系及相关的处理措施。方法:回顾性收集2007年1月～2010年12月在广西医科大学第一附属医院产科住院分娩的GDM单胎孕产妇病案资料232例作为GDM组,随机选择同期分娩的非GDM单胎孕产妇243例作为对照组,对两组相关资料进行对照分析。结果:GDM组孕产妇剖宫产、妊娠期高血压疾病、产后出血的发生率均高于对照组,两组比较差异有统计学意义(P<0.01);GDM组巨大儿、胎儿生长受限、新生儿低血糖、新生儿高胆红素血症的发生率和新生儿转新生儿科治疗率均高于对照组,两组比较差异有统计学意义(P<0.05);GDM组新生儿窒息发生率高于对照组,但两组比较差异无统计学意义(P>0.05)。结论:及时发现GDM并对GDM孕妇进行合理治疗,有利于降低剖宫产率,减少母婴并发症。