王晓琴,杨志慧,阳运康
WANG Xiaoqin,YANG Zhihui,YANG Yunkang

• 1:广汉市人民医院妇产科
• 2:西南医科大学附属医院

摘要(Abstract)：

目的:探讨个体化医学营养疗法(IMNT)对妊娠期糖尿病(GDM)初产妇剖宫产术后糖脂代谢的影响。方法:将246例接受剖宫产并成功随访的GDM初产妇分为观察组(n=101)及对照组(n=145),观察组接受IMNT干预治疗,对照组采用GDM相关教育等指导常规治疗;比较2组患者生产后12周及1年的体质量、体质量指数(BMI)、腰臀比(WHR)及产妇产后滞留体质量,比较2组患者产前、产后12周及1年时的空腹血糖(FPG)、餐后2 h血糖(2hPG)、稳态模型胰岛β细胞功能(HOMA-β)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C);比较2组患者生产后12周及1年的糖脂代谢异常率。结果:观察组患者产后12周及1年的BMI、WHR、产后滞留体质量及体脂率均显著低于对照组,同组产后1年BMI、WHR、产后滞留体质量及体脂率均显著低于产后12周(P<0.05); 2组患者产后12周及1年的HDL-C显著高于同组产前水平,FPG、2hPG、HOMA-β、TC、TG及LDL-C显著低于产前水平,观察组同时点变化更显著(P<0.05);产后12周及1年时,观察组患者糖代谢异常率、高TG血症、高TC血症及低HDL-C血症异常率均低于对照组(P<0.05);产后1年,2组患者的糖代谢异常率、高TG血症和低HDL-C血症异常率显著高于同组产后12周时,观察组显著低于对照组(P<0.05),观察组患者高LDL-C血症异常率显著低于同组产后12周,对照组患者高LDL-C血症异常率显著高于于同组产后12周(P<0.05)。结论:IMNT可改善GDM初产妇剖宫产术后近远期糖脂代谢转归,降低糖脂代谢异常发生率。
Objective: To discass the effect of individualized medical nutrition therapy on glucose and lipid metabolism after caesarean section in pregnant women with diabetes mellitus. Methods: The GDM primiparas of 246 cases were divided into observation group(n=101) and control group(n=145). The observation group received IMNT intervention treatment, and the control group used GDM related education to guide routine treatment. The body mass, body mass index(BMI), waist-hip ratio(WHR) and postpartum hysteretic mass were compared after 12 weeks and 1 year. Fasting glucose(FPG), postprandial 2 h blood glucose(2 hPG), islet beta-cell function(HOMA-β), total cholesterol(TC), triglycerides(TG), high-density lipoprotein cholesterol(HDL-C) and low-density lipoprotein cholesterol(LDL-C) were compared in two groups after prenatal and postnatal 12 weeks and 1 year. The abnormal rates of glycolipid metabolism were compared between 12 weeks and 1 year after production in 2 groups. Results: The BMI, WHR, body mass and body fat rate were significantly lower in the observation group than in the control group after 12 weeks and 1 year postpartum, and in the same group, one year postpartum BMI, WHR, body mass and body fat rate were significantly lower than 12 weeks postpartum(P<0.05). HDL-C was significantly higher in the 2 groups than in the same group after 12 weeks and 1 year postpartum. FPG, 2 hPG, HOMA-β, TC, TG and LDL-C were significantly lower than prenatal levels, and the simultaneous change of observation group was more significant(P<0.05). The abnormal rates of glucose metabolism, high TG mass formed by blood stasis, high TC mass formed by blood stasis and low HDL-C mass formed by blood stasis in the observation group were lower than those in the control group at 12 weeks and 1 year postpartum(P<0.05). The abnormal rate of high LDL-C in the observation group was significantly lower than that in the same group at 12 weeks postpartum, and the abnormal rate of high LDL-C in the control group was significantly higher than that in the same group at 12 weeks postpartum(P<0.05). Conclusion: IMNT can improve the long-term glycolipid metabolic outcome and reduce the incidence of abnormal glycolipid metabolism in GDM primipara after cesarean section.

关键词(KeyWords)： 妊娠期糖尿病;初产妇;个体化医学营养疗法;剖宫产;糖脂代谢
gestational diabetes mellitus;primipara;individualized medical nutrition therapy;cesarean section;glycolipid metabolism

Abstract:

Keywords:

基金项目(Foundation): 四川省科技厅基金项目(zc14006)

作者(Author): 王晓琴,杨志慧,阳运康
WANG Xiaoqin,YANG Zhihui,YANG Yunkang

DOI: 10.19367/j.cnki.1000-2707.2020.01.014

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