糖尿病,妊娠%产后期%随访研究
糖尿病,妊娠%產後期%隨訪研究
당뇨병,임신%산후기%수방연구
Diabetes,gestational%Postpartum period%Follow-up studies
目的 探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)新的诊断标准实施后新增GDM患者产后6～12周时的糖代谢转归及其影响因素. 方法 北京大学第一医院自2011年5月1日开始实施新的GDM诊断标准(妊娠24～28周行75 g口服葡萄糖耐量试验,空腹、服糖后1和2h血糖值任一点达到或超过5.1、10.0和8.5 mmol/L),并同时开设GDM一日门诊.选择2011年5月1日至2012年12月31日住院分娩的GDM孕妇共1 439例作为研究对象.根据妊娠期诊断GDM时的血糖水平,将孕妇分为Ⅰ组(新增GDM组),血糖水平仅达到GDM新的诊断标准,未达到美国国家糖尿病数据组(National Diabetes Data Group,NDDG)诊断标准;Ⅱ组,血糖水平达到NDDG诊断标准的一项及以上者.根据妊娠期是否参加GDM一日门诊,将Ⅰ组患者分为GDM一日门诊组和GDM非一日门诊组.分析2组产后6～12周随访率、糖代谢异常检出率.根据产后是否发生糖代谢异常,将Ⅰ组患者分为产后糖代谢异常组与糖代谢正常组,分析糖代谢异常的影响因素.采用t检验、x2检验及多因素Logistic回归分析进行统计学分析. 结果 (1)1 439例GDM患者中Ⅰ组849例,占59.0％;Ⅱ组590例,占41.0％.Ⅰ组产后随访率低于Ⅱ组[25.9％(220/849)与32.0％ (189/590),x2=6.110,P=0.013].Ⅰ组产后6～12周时糖代谢异常检出率为17.7％(39/220),包括空腹血糖受损5例和葡萄糖耐量受损34例,低于Ⅱ组[38.6％(73/189),包括空腹血糖受损4例,葡萄糖耐量受损56例,空腹血糖受损+葡萄糖耐量受损8例,糖尿病5例],差异有统计学意义(x2=33.810,P=0.000).(2)口服葡萄糖耐量试验服糖后2h血糖值高(OR=1.547,95％CI:1.038～2.306,P=0.032)和有糖尿病家族史(OR=1.879,95％CI:1.066～3.313,P=0.020)是Ⅰ组患者产后发生糖代谢异常的危险因素,母乳喂养为保护因素(OR=0.290,95％CI:0.092～0.914,P=0.035).(3)Ⅰ组患者参加GDM一日门诊者的产后随访率高于未参加GDM一日门诊者[30.7％(185/603)与14.2％(35/246),x2=23.780,P=0.000],但2组产后6～12周糖代谢异常检出率差异无统计学意义[17.8％(33/185)与17.1％(6/35),x2=0.020,P=0.887]. 结论 新增GDM患者在产后随访时仍有一部分存在糖代谢异常,尤其是妊娠期口服葡萄糖耐量试验服糖后2h血糖值高及有糖尿病家族史者产后发生糖代谢异常的风险较高.GDM一日门诊综合管理有助于提高GDM患者的产后随访率.
目的 探討妊娠期糖尿病(gestational diabetes mellitus,GDM)新的診斷標準實施後新增GDM患者產後6～12週時的糖代謝轉歸及其影響因素. 方法 北京大學第一醫院自2011年5月1日開始實施新的GDM診斷標準(妊娠24～28週行75 g口服葡萄糖耐量試驗,空腹、服糖後1和2h血糖值任一點達到或超過5.1、10.0和8.5 mmol/L),併同時開設GDM一日門診.選擇2011年5月1日至2012年12月31日住院分娩的GDM孕婦共1 439例作為研究對象.根據妊娠期診斷GDM時的血糖水平,將孕婦分為Ⅰ組(新增GDM組),血糖水平僅達到GDM新的診斷標準,未達到美國國傢糖尿病數據組(National Diabetes Data Group,NDDG)診斷標準;Ⅱ組,血糖水平達到NDDG診斷標準的一項及以上者.根據妊娠期是否參加GDM一日門診,將Ⅰ組患者分為GDM一日門診組和GDM非一日門診組.分析2組產後6～12週隨訪率、糖代謝異常檢齣率.根據產後是否髮生糖代謝異常,將Ⅰ組患者分為產後糖代謝異常組與糖代謝正常組,分析糖代謝異常的影響因素.採用t檢驗、x2檢驗及多因素Logistic迴歸分析進行統計學分析. 結果 (1)1 439例GDM患者中Ⅰ組849例,佔59.0％;Ⅱ組590例,佔41.0％.Ⅰ組產後隨訪率低于Ⅱ組[25.9％(220/849)與32.0％ (189/590),x2=6.110,P=0.013].Ⅰ組產後6～12週時糖代謝異常檢齣率為17.7％(39/220),包括空腹血糖受損5例和葡萄糖耐量受損34例,低于Ⅱ組[38.6％(73/189),包括空腹血糖受損4例,葡萄糖耐量受損56例,空腹血糖受損+葡萄糖耐量受損8例,糖尿病5例],差異有統計學意義(x2=33.810,P=0.000).(2)口服葡萄糖耐量試驗服糖後2h血糖值高(OR=1.547,95％CI:1.038～2.306,P=0.032)和有糖尿病傢族史(OR=1.879,95％CI:1.066～3.313,P=0.020)是Ⅰ組患者產後髮生糖代謝異常的危險因素,母乳餵養為保護因素(OR=0.290,95％CI:0.092～0.914,P=0.035).(3)Ⅰ組患者參加GDM一日門診者的產後隨訪率高于未參加GDM一日門診者[30.7％(185/603)與14.2％(35/246),x2=23.780,P=0.000],但2組產後6～12週糖代謝異常檢齣率差異無統計學意義[17.8％(33/185)與17.1％(6/35),x2=0.020,P=0.887]. 結論 新增GDM患者在產後隨訪時仍有一部分存在糖代謝異常,尤其是妊娠期口服葡萄糖耐量試驗服糖後2h血糖值高及有糖尿病傢族史者產後髮生糖代謝異常的風險較高.GDM一日門診綜閤管理有助于提高GDM患者的產後隨訪率.
목적 탐토임신기당뇨병(gestational diabetes mellitus,GDM)신적진단표준실시후신증GDM환자산후6～12주시적당대사전귀급기영향인소. 방법 북경대학제일의원자2011년5월1일개시실시신적GDM진단표준(임신24～28주행75 g구복포도당내량시험,공복、복당후1화2h혈당치임일점체도혹초과5.1、10.0화8.5 mmol/L),병동시개설GDM일일문진.선택2011년5월1일지2012년12월31일주원분면적GDM잉부공1 439례작위연구대상.근거임신기진단GDM시적혈당수평,장잉부분위Ⅰ조(신증GDM조),혈당수평부체도GDM신적진단표준,미체도미국국가당뇨병수거조(National Diabetes Data Group,NDDG)진단표준;Ⅱ조,혈당수평체도NDDG진단표준적일항급이상자.근거임신기시부삼가GDM일일문진,장Ⅰ조환자분위GDM일일문진조화GDM비일일문진조.분석2조산후6～12주수방솔、당대사이상검출솔.근거산후시부발생당대사이상,장Ⅰ조환자분위산후당대사이상조여당대사정상조,분석당대사이상적영향인소.채용t검험、x2검험급다인소Logistic회귀분석진행통계학분석. 결과 (1)1 439례GDM환자중Ⅰ조849례,점59.0％;Ⅱ조590례,점41.0％.Ⅰ조산후수방솔저우Ⅱ조[25.9％(220/849)여32.0％ (189/590),x2=6.110,P=0.013].Ⅰ조산후6～12주시당대사이상검출솔위17.7％(39/220),포괄공복혈당수손5례화포도당내량수손34례,저우Ⅱ조[38.6％(73/189),포괄공복혈당수손4례,포도당내량수손56례,공복혈당수손+포도당내량수손8례,당뇨병5례],차이유통계학의의(x2=33.810,P=0.000).(2)구복포도당내량시험복당후2h혈당치고(OR=1.547,95％CI:1.038～2.306,P=0.032)화유당뇨병가족사(OR=1.879,95％CI:1.066～3.313,P=0.020)시Ⅰ조환자산후발생당대사이상적위험인소,모유위양위보호인소(OR=0.290,95％CI:0.092～0.914,P=0.035).(3)Ⅰ조환자삼가GDM일일문진자적산후수방솔고우미삼가GDM일일문진자[30.7％(185/603)여14.2％(35/246),x2=23.780,P=0.000],단2조산후6～12주당대사이상검출솔차이무통계학의의[17.8％(33/185)여17.1％(6/35),x2=0.020,P=0.887]. 결론 신증GDM환자재산후수방시잉유일부분존재당대사이상,우기시임신기구복포도당내량시험복당후2h혈당치고급유당뇨병가족사자산후발생당대사이상적풍험교고.GDM일일문진종합관리유조우제고GDM환자적산후수방솔.
Objective To investigate the outcomes of increased gestational diabetes mellitus (GDM) and the influencing factors after the implementation of the new GDM diagnostic criteria.Methods A total of 1 439 GDM women who delivered in the Peking University First Hospital between May 1,2011 and December 31,2012 were studied and divided into two groups.Group Ⅰ included the women who met the new GDM diagnostic criteria (fasting plasma glucose and 1 or 2 h plasma glucose levels for 75-g oral glucose tolerance test performed between 24 and 28 weeks of gestation were no less than 5.1,10.0 and 8.5 mmol/L),but did not meet the National Diabetes Data Group (NDDG) criteria;and Group Ⅱ included the women who met the NDDG criteria only.Women in Group Ⅰ were further divided into two subgroups according to whether attending the one-day GDM outpatient visit.Follow-up rate and detecting rate of abnormal glucose metabolism at 6-12 weeks after delivery were analyzed.Chi-square test,t test and multivariate Logistic analysis were used for statistical analysis.Results There were 849 GDM women in Group Ⅰ (59.0％,849/1 439) and 590 (41.0％,590/1 439) in Group Ⅱ.The follow-up rate in group Ⅰ was lower than in group Ⅱ [25.9％(220/849) vs 32.0％(189/590),x2=6.112,P=0.013].There were five cases of impaired fasting glucose and 34 impaired glucose tolerance in Group Ⅰ;and four cases of impaired fasting glucose,56 impaired glucose tolerance,eight impaired fasting glucose tolerance with impaired glucose tolerance and five diabetes mellitus in Group Ⅱ;there were significant differences [17.7％(39/220) vs 38.6％(73/189),x2=33.810,P=0.000].(2) In Group Ⅰ,the increased glucose level at 2 h in oral glucose tolerance test during pregnancy (OR=1.547,95％CI:1.038-2.306,P=0.032) and family history of diabetes mellitus (OR=1.879,95％CI:1.066-3.313,P=0.020) were risk factors for postpartum abnormal glucose metabolism,while breast-feeding was a protective factor (OR=0.290,95％CI:0.092-0.914,P=0.035).(3) In group Ⅰ,the follow-up rate in those who attended the one-day GDM outpatient visit was higher than those who did not [30.7％(185/603) vs 14.2％(35/246),x2=23.780,P=0.000],but the detecting rate of postpartum abnormal glucose metabolism were similar in women attending the one-day GDM outpatient visit and those not attending [17.8％(33/185) vs 17.1％(6/35),x2=0.020,P=0.887].Conclusions Increased GDM women still have glucose metabolism abnormality after delivery,especially those who have higher glucose level at 2 h after glucose intake in 75 g oral glucose tolerance test during pregnancy and who have a family history of diabetes mellitus.The one day GDM outpatient visit may improve the follow-up rate for these women.
