摘要
目的探讨妊娠期糖尿病（GDM）孕妇不同血糖指标异常与妊娠结局的关系。方法选择2011年1月至2012年7月在北京大学第一医院行产前检查并分娩的4090例产妇，孕24～28周均直接行75g葡萄糖耐量试验（75g OGTT），其空腹血糖、服糖后1、2h血糖均正常为血糖正常组，任意时间点血糖值异常即诊断为GDM（GDM组），其中仅空腹血糖异常为GDMA、空腹血糖异常合并其他任一时间点血糖异常为GDMB、空腹血糖正常而其他任一时间点血糖异常为GDMc。为分析不同血糖异常项数对妊娠结局的影响，对75gOGTT检测结果中仅其中1项血糖异常为GDMI、两项血糖异常为GDMⅡ、3项血糖异常为GDM III。对各组孕妇及其中空腹血糖〈4．4mmol／L的GDM孕妇的妊娠结局进行分析。结果（1）4090例中，858例被诊断为GDM（GDM组），发生率为21．98％，其中82例（9．6％，82／858）应用胰岛素治疗；3232例血糖正常（血糖正常组）。GDM组中剖宫产率（51．9％，445／858）、早产率（8．4％，72／858）及大于胎龄儿（LGA）发生率（5．9％，51／858）均明显高于血糖正常组[分别为（43．5％，1406／3232）、（5．8％，189／3232）及（4．2％，137／3232）]，分别比较，差异均有统计学意义（P〈0．05）。而巨大儿发生率在GDM组（6．8％，58／858）及血糖正常组（6．2％，199／3232）中比较，差异无统计学意义（P〉0．05）。（2）GDM组中GDMA317例（36．9％，317／858）、GDMB239例（27．8％，239／858）、GDMC302例（35．2％，302／858）。GDMB中巨大儿及LGA发生率明显高于GDMC及血糖正常组，分别比较，差异有统计学意义（P〈0．05）；但GDMA分别与GDMC、血糖正常组比较，差异无统计学意义（P〉0．05）。（3）GDM组中GDMI521例（60．7％）、GDMⅡ203例（15．6％）、GDMⅢ134例（23．7％），分别与血糖正常组比较，GDMⅢ中巨大儿及LGA发生率、剖宫产率均显著升高，差异有统计学意义（P〈0．01），而GDMⅡ中仅剖宫产率高于血糖正常组，差异有统计学意义（P〈0．01）。（4）在4090例孕妇中，空腹血糖〈4．4mmol／L共1118例（27．3％），其中发生GDM55例（4．92％，55／1118）。55例GDM孕妇中发生早产4例（7．3％，4／55），分娩巨大儿1例（2％）。结论GDM孕妇空腹血糖异常合并1项或两项不同时间点血糖异常，其不良妊娠结局发生率明显增加，提示对此种情况临床应高度关注并积极干预；空腹血糖〈4．4mmol／L的孕妇GDM发生率及不良妊娠结局发生率均很低，对此类孕妇不建议行75gOGTT检测。
Objective To investigate the relationship of different types of gestational diabetes mellitus （GDM） and pregnancy outcomes. Methods A total of 4090 cases, who received prenatal examination and delivered in Peking University First Hospital and performed a 75 g oral glucose tolerance test （75 g OGTT） at 24-28 gestational weeks, from January. 1st, 2011 to Jul 31~t, 2012 ,were divided into 2 groups. Normal blood glucose group ： the result of OGTr （ fasting plasma glucose, 1 hour glucose and 2 hour glucose ） was normal; Gestational diabetes mellitus group （GDM group） ：the result of OGTT was abnormal at any time point. GDM group were separated into A, B and C. GDM A means fasting plasma glucose annormal but others were normal, GDM B ：fasting plasma glucose, 1 hour and/or 2 hour glucose abnormal, GDM C ： fasting plasma glucose normal. To analyse the effect of different number of abnormal result of OGTY on pregnancy outcomes, GDM group were divided into I , II and III. GDM I means one abnormal blood glucose of OGTT result, GDM II ：two abnormal blood glucose and GDM III ：three abnormal blood glucose. We analyzed the pregnant outcomes of each group. Results （ 1 ） Among the 4090 cases, 858 cases （21.98%） were diagnosed as GDM （GDM group）, and 82 cases （9. 6%, 82/858） were treated with insulin, other 3232 cases with normal blood glucose（ normal blood glucose group）. In GDM group, the rate of cesarean section （51.9%, 445/858）, premature delivery （8.4% ,72/858） and LGA （5.9%, 51/858） were respectively significantly higher than those of normal blood glucose group [ （43.5% , 1406/3232）, （5.8%, 189/3232 ） and （ 4. 2%, 137/3232） ] （ P 〈 0. 05 ）. But, there was no statistically significant differences for the rate of macrosomia （ P 〉 0. 05 ） between the GDM group （ 6. 8% , 58/858 ） and normal blood glucose group （6. 2% ,199/3232） . （2）In the GDM group, GDM A was 317 cases （36.9%）, GDM B 239 cases （27.8%）, GDM C 302 cases （35.2%）. The incidence of Macrosomia and LGA in GDM B was significantly higher than that in GDM C and normal blood glucose group （ P 〈 0. 05 ）. Comparing with GDM A , there was no statistically significance in GDM B and GDM C （P 〉 0. 05 ）. （3）In GDM group, GDM [ was 521 cases （60. 7% ）, GDM 11203 cases （15.6%）, GDM UI 134 cases （23.7%）. Compared with the normal blood glucose group, GDM III had a significantly higher incidence of macrosomia and LGA and cesarean section（P 〈 0. 01 ） ;and GDM II had only a significantly higher incidence of cesarean section （ P 〈 0. 01 ）. （ 4 ） Among the 4090 cases, there were 1118 patients （ 27.3 % ） whose fasting blood glucose was below 4.4mmol/L, of which 55 cases were diagnosed as GDM. There were 4 premature infants and 1 macrosomia. Conclusions The GDM group with more than FBG ≥5.1 mmol/L had a higher incidence of adverse pregnancy outcomes, it suggested that we should pay more attention and take actively intervented; the pregnant woman is not recommended for 75g OGTI＇ detection when fasting blood glucose was below 4. 4 mmol/L because of the low rate of GDM and adverse pregnancy outcomes among them.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2013年第12期899-902,共4页
Chinese Journal of Obstetrics and Gynecology
关键词
糖尿病
妊娠
血糖
妊娠结局
Diabetes, gestational
Blood glucose
Pregnancy outcome
