目的 评价应用妊娠期糖尿病(gestational diabetes mellitus,GDM)新诊断标准后患者的母儿结局及一日门诊的效果. 方法 回顾性分析在北京大学第一医院妇产科2011年7月1日至2012年6月30日分娩的GDM孕妇(GDM组)841例和糖代谢正常孕妇3 043例(糖代谢正常组)的临床资料,探讨GDM孕妇参加一日门诊(研究组605例)和未参加一日门诊(对照组236例)的母儿结局差异.采用成组t检验或x2检验对数据进行统计学分析. 结果 (1) GDM组孕妇平均年龄(31.5±4.2)岁,稍高于糖代谢正常组的(30.0±3.7)岁(t=9.13,P＜0.01).研究组的平均年龄为(31.7±4.2)岁,与对照组平均年龄[(31.7±4.9)岁]相比,差异无统计学意义(t=2.32,P＞0.05).研究组口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)空腹血糖水平为(5.2±0.5) mmol/L,稍低于对照组的(5.3±0.8) mmol/L,差异有统计学意义(t=2.48,P＜0.05).2组OGTT服糖后l和2h血糖水平差异无统计学意义(P值均＞0.05).(2) GDM组和糖代谢正常组孕妇巨大儿的发生率分别为6.5％(55/841)和5.9％(182/3 043),差异无统计学意义(x2=0.36,P＞0.05).GDM组孕妇早产率明显高于糖代谢正常组[10.1％(83/841)与7.4％(225/3 043),x2=5.56;P＜0.05],妊娠期高血压和轻度子痫前期的发生率亦明显高于糖代谢正常组[妊娠期高血压:4.2％ (35/841)与2.6％(82/3 043),x2=4.85;轻度子痫前期:1.7％(14/841)与0.9％(26/3 043),x2=4.24;P值均＜0.05],而2组重度子痫前期的发生率[分别为2.4％(20/841)与1.6％(49/3 043)]差异无统计学意义(x2=2.22,P＞0.05).(3)GDM组孕妇妊娠期胰岛素使用率为9.3％(78/841).其中研究组胰岛素使用率为7.9％(48/605),对照组为11.9％(28/236),差异无统计学意义(x2=3.54,P＞0.05).2组巨大儿和妊娠期高血压疾病的发生率相似[巨大儿:6.9％(42/605)与5.3％(13/236),x2=0.57;妊娠期高血压疾病:7.4％(45/605)与9.9％(24/236),x2=1.68;尸值均＞0.05].研究组早产率明显低于对照组[7.2％ (44/605)与16.0％(38/236),x2=15.04,P＜0.05].研究组足月分娩561例中,分娩巨大儿42例.分娩巨大儿与非巨大儿孕妇的平均年龄、妊娠前体重指数、妊娠期体重增长和参加一日门诊的孕周差异无统计学意义[平均年龄:(31.4±3.9)岁与(31.7±4.2)岁,t=4.27;妊娠前体重指数:(23.5±3.9)与(22.6±3.2),t=1.58;妊娠期体重增长:(16.1±5.6) kg与(15.7±11.4)kg,t=0.22;参加一日门诊的孕周:(27.5±4.3)周与(28.1±2.8)周,t=0.86;P值均＞0.05].分娩巨大儿者妊娠中晚期糖化血红蛋白水平高于分娩非巨大儿者[(5.6±0.4)％与(5.4±0.4)％,t=2.13,P＜0.05]. 结论 通过一日门诊综合管理可以降低GDM孕妇的早产率和巨大儿发生率.一日门诊是目前应对医疗资源不足的一种群体式管理模式,尚需改进和完善.
目的 評價應用妊娠期糖尿病(gestational diabetes mellitus,GDM)新診斷標準後患者的母兒結跼及一日門診的效果. 方法 迴顧性分析在北京大學第一醫院婦產科2011年7月1日至2012年6月30日分娩的GDM孕婦(GDM組)841例和糖代謝正常孕婦3 043例(糖代謝正常組)的臨床資料,探討GDM孕婦參加一日門診(研究組605例)和未參加一日門診(對照組236例)的母兒結跼差異.採用成組t檢驗或x2檢驗對數據進行統計學分析. 結果 (1) GDM組孕婦平均年齡(31.5±4.2)歲,稍高于糖代謝正常組的(30.0±3.7)歲(t=9.13,P＜0.01).研究組的平均年齡為(31.7±4.2)歲,與對照組平均年齡[(31.7±4.9)歲]相比,差異無統計學意義(t=2.32,P＞0.05).研究組口服葡萄糖耐量試驗(oral glucose tolerance test,OGTT)空腹血糖水平為(5.2±0.5) mmol/L,稍低于對照組的(5.3±0.8) mmol/L,差異有統計學意義(t=2.48,P＜0.05).2組OGTT服糖後l和2h血糖水平差異無統計學意義(P值均＞0.05).(2) GDM組和糖代謝正常組孕婦巨大兒的髮生率分彆為6.5％(55/841)和5.9％(182/3 043),差異無統計學意義(x2=0.36,P＞0.05).GDM組孕婦早產率明顯高于糖代謝正常組[10.1％(83/841)與7.4％(225/3 043),x2=5.56;P＜0.05],妊娠期高血壓和輕度子癇前期的髮生率亦明顯高于糖代謝正常組[妊娠期高血壓:4.2％ (35/841)與2.6％(82/3 043),x2=4.85;輕度子癇前期:1.7％(14/841)與0.9％(26/3 043),x2=4.24;P值均＜0.05],而2組重度子癇前期的髮生率[分彆為2.4％(20/841)與1.6％(49/3 043)]差異無統計學意義(x2=2.22,P＞0.05).(3)GDM組孕婦妊娠期胰島素使用率為9.3％(78/841).其中研究組胰島素使用率為7.9％(48/605),對照組為11.9％(28/236),差異無統計學意義(x2=3.54,P＞0.05).2組巨大兒和妊娠期高血壓疾病的髮生率相似[巨大兒:6.9％(42/605)與5.3％(13/236),x2=0.57;妊娠期高血壓疾病:7.4％(45/605)與9.9％(24/236),x2=1.68;尸值均＞0.05].研究組早產率明顯低于對照組[7.2％ (44/605)與16.0％(38/236),x2=15.04,P＜0.05].研究組足月分娩561例中,分娩巨大兒42例.分娩巨大兒與非巨大兒孕婦的平均年齡、妊娠前體重指數、妊娠期體重增長和參加一日門診的孕週差異無統計學意義[平均年齡:(31.4±3.9)歲與(31.7±4.2)歲,t=4.27;妊娠前體重指數:(23.5±3.9)與(22.6±3.2),t=1.58;妊娠期體重增長:(16.1±5.6) kg與(15.7±11.4)kg,t=0.22;參加一日門診的孕週:(27.5±4.3)週與(28.1±2.8)週,t=0.86;P值均＞0.05].分娩巨大兒者妊娠中晚期糖化血紅蛋白水平高于分娩非巨大兒者[(5.6±0.4)％與(5.4±0.4)％,t=2.13,P＜0.05]. 結論 通過一日門診綜閤管理可以降低GDM孕婦的早產率和巨大兒髮生率.一日門診是目前應對醫療資源不足的一種群體式管理模式,尚需改進和完善.
목적 평개응용임신기당뇨병(gestational diabetes mellitus,GDM)신진단표준후환자적모인결국급일일문진적효과. 방법 회고성분석재북경대학제일의원부산과2011년7월1일지2012년6월30일분면적GDM잉부(GDM조)841례화당대사정상잉부3 043례(당대사정상조)적림상자료,탐토GDM잉부삼가일일문진(연구조605례)화미삼가일일문진(대조조236례)적모인결국차이.채용성조t검험혹x2검험대수거진행통계학분석. 결과 (1) GDM조잉부평균년령(31.5±4.2)세,초고우당대사정상조적(30.0±3.7)세(t=9.13,P＜0.01).연구조적평균년령위(31.7±4.2)세,여대조조평균년령[(31.7±4.9)세]상비,차이무통계학의의(t=2.32,P＞0.05).연구조구복포도당내량시험(oral glucose tolerance test,OGTT)공복혈당수평위(5.2±0.5) mmol/L,초저우대조조적(5.3±0.8) mmol/L,차이유통계학의의(t=2.48,P＜0.05).2조OGTT복당후l화2h혈당수평차이무통계학의의(P치균＞0.05).(2) GDM조화당대사정상조잉부거대인적발생솔분별위6.5％(55/841)화5.9％(182/3 043),차이무통계학의의(x2=0.36,P＞0.05).GDM조잉부조산솔명현고우당대사정상조[10.1％(83/841)여7.4％(225/3 043),x2=5.56;P＜0.05],임신기고혈압화경도자간전기적발생솔역명현고우당대사정상조[임신기고혈압:4.2％ (35/841)여2.6％(82/3 043),x2=4.85;경도자간전기:1.7％(14/841)여0.9％(26/3 043),x2=4.24;P치균＜0.05],이2조중도자간전기적발생솔[분별위2.4％(20/841)여1.6％(49/3 043)]차이무통계학의의(x2=2.22,P＞0.05).(3)GDM조잉부임신기이도소사용솔위9.3％(78/841).기중연구조이도소사용솔위7.9％(48/605),대조조위11.9％(28/236),차이무통계학의의(x2=3.54,P＞0.05).2조거대인화임신기고혈압질병적발생솔상사[거대인:6.9％(42/605)여5.3％(13/236),x2=0.57;임신기고혈압질병:7.4％(45/605)여9.9％(24/236),x2=1.68;시치균＞0.05].연구조조산솔명현저우대조조[7.2％ (44/605)여16.0％(38/236),x2=15.04,P＜0.05].연구조족월분면561례중,분면거대인42례.분면거대인여비거대인잉부적평균년령、임신전체중지수、임신기체중증장화삼가일일문진적잉주차이무통계학의의[평균년령:(31.4±3.9)세여(31.7±4.2)세,t=4.27;임신전체중지수:(23.5±3.9)여(22.6±3.2),t=1.58;임신기체중증장:(16.1±5.6) kg여(15.7±11.4)kg,t=0.22;삼가일일문진적잉주:(27.5±4.3)주여(28.1±2.8)주,t=0.86;P치균＞0.05].분면거대인자임신중만기당화혈홍단백수평고우분면비거대인자[(5.6±0.4)％여(5.4±0.4)％,t=2.13,P＜0.05]. 결론 통과일일문진종합관리가이강저GDM잉부적조산솔화거대인발생솔.일일문진시목전응대의료자원불족적일충군체식관리모식,상수개진화완선.
Objective To evaluate the results of one-day care for gestational diabetes mellitus (GDM) and pregnancy outcome after application of new diagnostic criteria.Methods We retrospectively analyzed the clinical features of a GDM group (n=841) and a normal glucose metabolism group (n=3 043) who delivered in Department of Obstetrics and Gynecology,Peking University First Hospital between July 1,2011 and June 30,2012,to discuss the difference in maternal and newborn outcomes between these two groups,and to compare the maternal and newborn outcomes between the GDM one-day care group (study group,n=605) and non-GDM one-day care group (control group,n=236).Statistical analysis was performed by t test and x2 test.Results The average age of pregnant women with GDM was (31.5±4.2) years,which was higher than the normal glucose metabolism group (30.0±3.7) years (t=9.13,P＜0.01).The average age of the study group was (31.7±4.2) years,and the average age of the control group was (31.7±4.9) years,which was not a significant difference (t=2.32,P＞0.05).In the oral glucose tolerance test,fasting blood glucose level was (5.2±0.5) mmol/L,which was significantly lower than that in the control group (5.3±0.8) mmol/L (t=2.48,P＜0.05).The difference between 1 and 2 h glucose sugar levels did not differ significantly (P＞0.05) between the two groups.In the GDM and normal glucose metabolism groups of pregnant women,the incidence of macrosomia was 6.5％ (55/841) and 5.9％ (182/3 043),respectively,although the difference was not significant (x2=0.36,P＞0.05).In the GDM group,the rate of premature delivery was significantly higher than in the normal glucose metabolism group [preterm birth:10.1％ (83/841) and 7.4％ (225/3 043),x2=5.56; P＜0.05)].In the GDM group,gestational hypertension and mild pre-eclampsia were significantly more frequent than in the normal glucose metabolism group [gestational hypertension:4.2％ (35/841) vs 2.6％ (82/3 043),x2=4.85; mild pre-eclampsia:1.7％ (14/841) vs 0.9％ (26/3 043),x2=4.24; P＜0.05].The incidence of severe pre-eclampsia was 2.4％ (20/841) and 1.6％ (49/3 043),respectively,which was not significantly different (x2=2.22,P＞0.05) between the two groups.The rate of insulin use was 9.3％ (78/841) in the GDM group.In the study group,the rate of insulin use was 7.9％ (48/605),compared with 11.9％ (28/236) in the control group; this difference was not significant (x2=3.54,P＞0.05).In the study group,the incidence of macrosomia and hypertensive disorder complicating pregnancy (HDP) was similar to that in the control group [macrosomia:6.9％ (42/605) vs 5.3％ (13/236),respectively; x2=0.57; HDP:7.4％ (45/605) vs 9.9％ (24/236),x2=1.68; P＜0.05].The rate of premature delivery in the study group was significantly lower than in the control group [7.2％ (44/605) vs 16.0％ (38/236),x2=15.04,P＜0.05].In the study group,among the 561 cases of term birth,there were 42 cases of macrosomia.The average age of macrosomic and non-macrosomic pregnant women [(31.4±3.9) vs (31.7±4.2) years,t=4.27],pre-pregnancy body mass index [(23.5±3.9) vs (22.6±3.2),t=1.58],gestational weight gain [(16.1±5.6) vs (15.7± 11.4) kg,t=0.22] and pregnant weeks at visit to a one-day care clinic [(27.5 ± 4.3) vs (28.1 ± 2.8) weeks,t=0.86; P＞0.05] showed no significant differences.In women who delivered an infant with macrosomia,glycosylated hemoglobin levels in mid and late pregnancy were higher than in woman who did not deliver an infant with macrosomia [(5.6±0.4) ％ vs (5.4±0.4) ％,t=2.13,P＜0.05].Conclusions Through one-day care for GDM,the rate of preterm labor is reduced.This is a good model for group management of GDM women,and more efforts is required to improve its effect.
