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目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)不同血糖水平孕妇的临床特点与妊娠结局。方法选择2013年1月至2015年3月在山东省单县东大医院行产前检查并住院分娩的GDM孕妇150例,依据75g葡萄糖耐量试验(75g oral glucose tolerance test,75 g OGTT)各时点血糖结果,以其中1项血糖水平异常为GDM A组,2项血糖水平异常为GDM B组,3项血糖水平均异常为GDM C组。对3组孕妇的临床特点和妊娠结局进行分析。结果 GDM C组孕前体质量指数(body mass index,BMI)和肥胖率(26.2±4.8、36.0%)均明显高于GDM B组(24.3±3.8、17.6%)和GDM A组(24.3±3.8、2.7%)(P<0.05)。GDM C组胰岛素使用率(24.0%)明显高于GDM B组(3.9%)和GDM A组(1.3%)(P<0.05)。GDM C组空腹胰岛素、胰岛素抵抗指数(21.2±4.9、6.1±2.0)明显高于GDM B组(18.6±5.1、4.2±1.1)和GDM A组(13.2±3.3、2.8±0.8)(P<0.05)。GDM C组巨大儿发生率(44.0%)明显高于GDM B组(15.6%)和GDM A组(13.5%)(P<0.05)。结论 OGTT血糖多点异常的GDM患者与多项危险因素呈显著相关性,临床上应根据OGTT异常情况进行分层管理,积极干预。
Objective To investigate the clinical features and pregnancy outcome of pregnant women with gestational diabetes mellitus (GDM) with different blood glucose levels. METHODS: From January 2013 to March 2015, 150 GDM pregnant women who were examined at prenatal and hospitalized in Dong County Hospital of Shan County, Shandong Province were selected according to 75g oral glucose tolerance test (75 g OGTT) Point blood glucose results, in which an abnormal glucose level for the GDM A group, two abnormal glucose levels for the GDM B group, three abnormal glucose levels for the GDM C group. The clinical features and pregnancy outcomes of 3 groups of pregnant women were analyzed. Results The body mass index (BMI) and obesity rate (26.2 ± 4.8, 36.0%) in GDM group were significantly higher than those in GDM group (24.3 ± 3.8,17.6%) and GDM group (24.3 ± 3.8, 2.7%) (P <0.05). The insulin use rate (24.0%) in GDM group C was significantly higher than that in GDM group B (3.9%) and GDM group A (1.3%) (P <0.05). The fasting insulin and insulin resistance index in GDM C group were significantly higher than those in GDM group B (18.6 ± 5.1, 4.2 ± 1.1) and GDM group A (13.2 ± 3.3, 2.8 ± 0.8) (P <0.05) ). The incidence of macrosomia in GDM group (44.0%) was significantly higher than that in GDM group (15.6%) and GDM group (13.5%) (P <0.05). Conclusions There is a significant correlation between the multiple risk factors and GDM patients with OGTT hyperglycemia. Clinically, they should be stratified according to the abnormality of OGTT and actively intervened.