妊娠期显性糖尿病与妊娠期糖尿病在妊娠晚期临床特点的比较

doi:10.3969/j.issn.1006-7795.2017.01.021

摘要/Abstract

摘要： 目的比较妊娠期初诊显性糖尿病与妊娠期糖尿病病人在妊娠晚期临床特点的差异。方法选取2015年1月至2016年2月于首都医科大学附属北京安贞医院临床营养科门诊就诊的处于妊娠晚期的妊娠期显性糖尿病（overt diabetes mellitus，ODM）病人25例和妊娠期糖尿病（gestational diabetes mellitus，GDM）病人30例作为研究对象，收集病人家族史、既往病史等相关信息及治疗情况，检测血压、糖化血红蛋白（hemoglobin A1c，HbA1c）、总蛋白（total protein，TP）、白蛋白（albumin，ALB）、前白蛋白（prealbumin，PALB）、尿素（urea nitrogen，BUN）、肌酐（serum creatinine，CREA）、血红蛋白（hemoglobin，HGB）等临床营养指标，给予动态血糖检测并记录血糖变化情况及各项检测指标数据，分析比较两组病人临床特点的差异。结果 ODM组HbA1c、空腹血糖值、日血糖平均值、早餐后2 h血糖值、晚餐后2 h血糖值、高血糖事件数和高血糖时间比均显著高于GDM组，两组比较差异有统计学意义（P<0.05），且ODM组建议使用胰岛素的病人数占32％（8/25），明显高于GDM组（0/30）（P<0.05）。ODM组有糖尿病家族史的病人数占48%（12/25），明显高于GDM组的10%（3/30）（P<0.05）。GDM组尿酮体阳性率明显高于ODM组（P<0.05），但尿微量白蛋白阳性率差异无统计学意义（P>0.05）。ODM组合并症子痫前期发作数（7/25）明显高于GDM组（P<0.05）。ODM组HGB浓度较对照组低（P<0.05）。结论妊娠晚期的妊娠期显性糖尿病病人有明显的家族史，HbA1c高，在空腹、早餐及晚餐进餐2 h后血糖浓度更高，日平均血糖值高，高血糖时间长，高血糖事件发生概率高，需要使用胰岛素对症治疗病人多，妊娠合并症多，HGB浓度相对低；而妊娠期糖尿病病人出现尿酮体阳性率更高。

关键词: 妊娠晚期, 妊娠期糖尿病, 妊娠期显性糖尿病, 临床特点

Abstract: Objective To explore the clinical characteristics of patients with overt diabetes mellitus and gestational diabetes mellitus at the late pregnancy. Methods Twenty-five cases of pregnancy overt diabetes and 30 cases of gestational diabetes mellitus from January 2015 to February 2016 who came to the Clinical Nutrition Department of Beijing Anzhen Hospital were randomly selected. We collected records of patients with a family history, past medical history and other related medical conditions and treatment, clinical nutrition indexes, blood pressure measurement, serous hemoglobin A1c(HbA1c), total protein(TP), albumin(ALB), prealbumin(PALB), urea nitrogen(BUN), serum creatinine(CREA), hemoglobin(HGB). We gave them dynamic blood glucose monitoring and record the changes of blood glucose and the test data. We statistically analyze the data of two groups. Results In the ODM, HbA1c, fasting blood glucose, average blood glucose values,two-hour blood glucose after breakfast, two-hour blood glucose after dinner, the number of hyperglycemic events and high blood glucose time ratio are significantly higher than that of GDM and two groups compared with statistical significance(P<0.05). It is recommended to use insulin patients in ODM accounted for 32%(8/25), significantly higher than GDM(0/30) (P<0.05). ODM has a family history of diabetes patients accounted for 48%(12/25),significantly higher than GDM 10%(3/30) (P<0.05). The urinary ketone positive rate in GDM was significantly higher than those in ODM(P<0.05), but urinary microalbumin abnormal rate was compared with no statistical difference (P>0.05). The number of preeclampsia in ODM(7/25) was significantly higher than that in GDM (P<0.05). The level of HGB in ODM was lower than that of GDM (P<0.05). Conclusion Late pregnancy ODM have obvious family history, high level of HbA1c, higher fasting glucose levels of breakfast, higher glucose levels of two-hour after breakfast and dinner,higher average blood glucose value, longer hypoglycemia time, higher probability of hyperglycemic events and greater opportunity to use insulin in the treatment of symptomatic patients, higher incidence of complications pregnancy complications than GDM, but HGB level is lower than GDM. GDM has higher positive rate of urine ketone than ODM.

Key words: late pregnancy, gestational diabetes mellitus, overt diabetes mellitus, clinical characteristics

中图分类号:

R714.25

王蕤, 徐品颖, 肖利. 妊娠期显性糖尿病与妊娠期糖尿病在妊娠晚期临床特点的比较[J]. 首都医科大学学报, 2017, 38(1): 103-107.

Wang Rui, Xu Pinying, Xiao Li. A clinical characteristic study of the patients with overt diabetes mellitus and gestational diabetes mellitus[J]. Journal of Capital Medical University, 2017, 38(1): 103-107.

参考文献

[1] Frigeri H R, Martins L T, Auwerter N C, et al. The polymorphism rs2268574 in Glucokinase gene is associated with gestational diabetes mellitus[J]. Clin Biochem,2014,4(3):346-348.
[2] Tang I P, Shashinder S, Kuljit S, et al. Outcome of patients presenting with preauricular sinus in a tertiary centre-a five year experience[J]. Med J Malaysia,2007,62(1):53-55.
[3] 孙翀,刘淑霞.妊娠期糖尿病病人血糖控制效果对母婴结局影响的观察[J].中国糖尿病杂志,2014,22(5):401-403.
[4] Gunderson E P, Hurston S R, Ning X, et al. Lactation and progression to type 2 diabetes mellitus after gestational diabetes mellitus:a prospective cohort study[J].Ann Intern Med,2015,163(12):889-898.
[5] 李秀琴.妊娠中期初诊显性糖尿病与妊娠期糖尿病动态血糖对照研究[J].中国实验诊断学杂志,2016,20(5):771-774.
[6] 韦红霞.妊娠期糖尿病发病机制及治疗进展[J].世界最新医学信息文摘,2016,16(8):65-69.
[7] Fu S, Li F, Zhou J, et al. The relationship between body iron status, iron intake and gestational diabetes:a systematic review and Meta-analysis[J].Medicine,2016,95(2):e2383.
[8] Ascherio A, Rimm E B, Giovannucci E,et al. Blood donations and risk of coronary heart disease in men[J].Circulation,2001, 103(1):52-57.
[9] Afkhami-Ardekani M, Rashidi M. Iron status in women with and without gestational diabetes mellitus[J].J Diabetes Complications,2009,23(3):194-198.
[10] Jung E J, Jung E J, Min S Y,et al.Fibroblast growth factor receptor 2 gene amplification status and its clinicopathologic significance in gastric carcinoma[J].Hum Pathol,2012,43(10):1559-1566.
[11] Sugiyama T,Saito M, Nishigori H, et al.Comparison of pregnancy outcomes between women with gestational diabetes and overt diabetes first diagnosed in pregnancy:a retrospective multi-institutional study in Japan[J]. Diabetes Res Clin Pract,2014,103(1):20-25.
[12] 周俏苗.妊娠期显性糖尿病与妊娠期糖尿病临床特征比较[J].海南医学,2014,25(20):3083-3085.
[13] 谢诺. 妊娠期糖尿病危险因素的分析[J]. 中国医科大学学报,2016,45(5):476-477.
[14] 王影, 刘伟,王景. 门冬胰岛素联合生物合成人胰岛素治疗妊娠期糖尿病临床观察[J]. 解放军医药杂志,2016,28(1):96-100.
[15] 胡寒冰. 妊娠期糖尿病59例临床分析[J]. 中国煤炭工业医学杂志,2014,17(1):39-40.