CAJ | 학술논문

目的：探讨妊娠期糖尿病（gestational diabetes mellitus，GDM）患者的血糖代谢表现及预后。方法：从2009年1月1日—2012年3月31日在上海市第七人民医院行产前检查的孕妇中选择参加口服葡萄糖耐量试验（oral glucose tolerance， OGTT）的1683例孕妇作为研究对象，其中 GDM 患者208例（漏诊组116例和确诊组92例），其余1475例孕妇（对照组）糖代谢正常（normal glucose tolerance，NGT）。比较各组的空腹血糖（fasting plasma glucose，FPG）、1 h 血糖（1 h plasma glucose，1 h PG）、2 h 血糖（2 h PG）、糖化血红蛋白（HbA1c）阳性率、血糖曲线下面积（area under curve of glucose，AUCG）之间的差异及口服葡萄糖耐量试验（oval glucose tolerance test，OGTT）血糖图趋势。比较各组孕妇妊娠期高血压发病率、胎膜早破发病率、剖宫产率和新生儿结局。结果：1 h PG、2 h PG、HbA1c 阳性率和 AUCG 均为确诊组＞漏诊组＞NGT 组，组间比较差异有统计学意义（P ＜0．01）。各组 FPG 比较：确诊组明显大于漏诊组和 NGT 组（P ＜0．01），漏诊组和 NGT 组比较差异无统计学意义（P ＞0．05）。3组血糖变化趋势不一，漏诊组变化介于确诊组（最高）和 NGT 组（最低）之间。妊娠期高血压疾病发生率和剖宫产率在 NGT 组、漏诊组、确诊组依次升高，NGT 组与另2组比较差异有统计学意义（P ＜0．01），但漏诊组、确诊组GDM 组间差异无统计学意义（P ＞0．05）。胎膜早破、早产、新生儿黄疸、新生儿窒息发生率及新生儿体质量在3组间差异无统计学意义（P ＞0．05）。巨大儿和新生儿低血糖发生率在3组间差异有统计学意义（P ＜0．01）。结论：GDM 患者血糖代谢具有异质性，需要根据病情区别管理。
목적：탐토임신기당뇨병（gestational diabetes mellitus，GDM）환자적혈당대사표현급예후。방법：종2009년1월1일—2012년3월31일재상해시제칠인민의원행산전검사적잉부중선택삼가구복포도당내량시험（oral glucose tolerance， OGTT）적1683례잉부작위연구대상，기중 GDM 환자208례（루진조116례화학진조92례），기여1475례잉부（대조조）당대사정상（normal glucose tolerance，NGT）。비교각조적공복혈당（fasting plasma glucose，FPG）、1 h 혈당（1 h plasma glucose，1 h PG）、2 h 혈당（2 h PG）、당화혈홍단백（HbA1c）양성솔、혈당곡선하면적（area under curve of glucose，AUCG）지간적차이급구복포도당내량시험（oval glucose tolerance test，OGTT）혈당도추세。비교각조잉부임신기고혈압발병솔、태막조파발병솔、부궁산솔화신생인결국。결과：1 h PG、2 h PG、HbA1c 양성솔화 AUCG 균위학진조＞루진조＞NGT 조，조간비교차이유통계학의의（P ＜0．01）。각조 FPG 비교：학진조명현대우루진조화 NGT 조（P ＜0．01），루진조화 NGT 조비교차이무통계학의의（P ＞0．05）。3조혈당변화추세불일，루진조변화개우학진조（최고）화 NGT 조（최저）지간。임신기고혈압질병발생솔화부궁산솔재 NGT 조、루진조、학진조의차승고，NGT 조여령2조비교차이유통계학의의（P ＜0．01），단루진조、학진조GDM 조간차이무통계학의의（P ＞0．05）。태막조파、조산、신생인황달、신생인질식발생솔급신생인체질량재3조간차이무통계학의의（P ＞0．05）。거대인화신생인저혈당발생솔재3조간차이유통계학의의（P ＜0．01）。결론：GDM 환자혈당대사구유이질성，수요근거병정구별관리。
Objective:To explore the degree of glycometabolic disorder and prognosis of patients with gestational diabetes mel-litus (GDM).Methods:The data of pregnant women who underwent prenatal examination in Shanghai Seventh’s People’s Hospital from Jan.1st 2009 to Mar.31st 2012 were respectively analyzed.A total of 1683 pregnant women,who took oral glucose tolerance test (OGTT)were chosen as subjects.Among them,there were 208 patients with GDM (116 cases in misdiagnosis group and 92 cases in diagnosis group)and the other 1475 pregnant women with normal glucose tolerance (NGT) were set as control group.Fasting plasma glucose (FPG),1 h plasma glucose (1 h PG),2 h PG,glycosylated hemoglobin (HbA1c )positive rate,area under the curve of glucose (AUCG)and OGTT plasma glucose chart were compared among the groups.Rates of hypertension disorder complicating pregnancy,premature rupture of membrane and cesarean section and new born outcomes were compared among the three groups.Results:1 h PG,2 h PG,HbA1c positive rate and AUCG in misdiag-nosis group were lower than those in diagnosis group,but higher than those in NGT group,and the differences among groups were statistically significant(P <0.01).FPG in diagnosis group was significantly higher than that in misdiagnosis group and NGT group (P <0.01),but there was not significant difference between misdiagnosis group and NGT group (P >0.05).The trends of plasma glucose chart were different among the three groups,the data line of misdiagnosis group was between the lines of he other two groups.There was no significant difference in the incidences of hypertensive disorder complicating pregnancy and cesarean section between misdiagnosis group and diagnosis group(P >0.05),and the incidences in NGT group were signifi-cantly lower than those in the other two groups(P <0.01).There was no significant difference in the incidences of premature rupture of membrane,premature birth,neonatal jaundice,neonatal asphyxia,as well as birth weight among the three groups (P >0.05).There were significant differences in the incidences of macrosomia and neonatal hypoglycemia among the three groups (P <0.01).Conclusions:There was glycometabolic heterogeneity in patients with GDM.It is necessary to take individ-ualized management.