妊娠期糖尿病病人产后糖代谢转归及其相关因素分析
Analysis of the postpartum glucose metabolism outcome and its related factors in patients with gestational diabetes mellitus
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摘要: 目的：探讨妊娠期糖尿病（GDM）病人产后糖代谢转归及其影响因素，为预防GDM病人产后糖代谢异常提供参考。方法：选择GDM病人931例并收集临床资料，在产后6～12周跟踪糖代谢转归情况，对GDM病人产后糖代谢异常的相关因素进行分析。结果：931例病人产后6～12周出现糖代谢异常者占33.08％（308/931），其中糖尿病35例，空腹血糖调节受损14例，空腹血糖调节受损+葡萄糖耐量降低 7例，葡萄糖耐量降低 252例。GDM病人产后糖代谢异常组孕期口服葡萄糖耐量试验（OGTT） 中空腹血糖（FPG）、服糖2 h后血糖（2hPG）、服药3 h后血糖（3hPG）均高于正常组（P<0.01），新生儿体质量低于正常组（P<0.01）。单因素分析提示，OGTT FPG、2hPG、3hPG和新生儿体质量均是GDM病人产后糖代谢异常的影响因素。多因素分析显示，孕期OGTT 的FPG、2hPG、3hPG是产后糖代谢异常的独立危险因素。OGTT FPG（OR=3.528）、OGTT 2hPG（OR=1.579）和OGTT 3hPG（OR=1.655）越高，产后糖代谢异常的风险越高。结论：部分GDM病人产后会出现糖代谢异常，与孕期OGTT结果密切相关，应针对性做好随访管理和防控措施。Abstract: Objective:To explore the postpartum glucose metabolism outcome and its influencing factors in patients with gestational diabetes mellitus(GDM) for providing the reference to prevent the abnormal postpartum glucose metabolism.Methods:The clinical data of 931 patients with GDM were collected.The postpartum 6 to 12 weeks glucose metabolism information was investigated,and the related factors of abnormal postpartum glucose metabolism were analyzed.Results:Among 931 patients,308 cases(33.08%) with abnormal glucose metabolism were found after 6 to 12 weeks of delivery,which included 35 cases of diabetes mellitus,14 cases of impaired fasting glucose(IFG),7 cases of IFG complicated with impaired glucose tolerance(IGT) and 252 cases of impaired glucose tolerance(IGT).The levels of the gestational fasthg plasma glucose(FPG),2h plasma glucose(2hPG),and 3h plasma glucose(3hPG) in GDM patients with abnormal postpartum glucose metabolism were higher than those in normal group(P<0.01),but the neonatal body weight was lower than that in normal group(P<0.01).The univariate analysis showed the gestational FPG,2hPG,3hPG and neonatal body weight were the influencing factors of the GDM patients with abnormal postpartum glucose metabolism.The multivariate analysis showed that the gestational FPG,2hPG and 3hPG were the independent risk factor of abnormal postpartum glucose metabolism.The higher the value of FPG(OR=3.528),2hPG(OR=1.579) and 3hPG(OR=1.655) were,the higher the risk of abnormal postpartum glucose metabolism was.Conclusions:The postpartum abnormal glucose metabolism can be found in partial GDM patients,which is related to the result of OGTT.The pertinent following up administration and preventing measures should be developed.
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