妊娠期糖尿病妇女产后糖代谢转归调查及糖代谢异常的危险因素分析

摘要 目的：研究妊娠期糖尿病(GDM)妇女产后糖代谢转归情况及糖代谢异常的危险因素。方法：选取2018年6月~2020年6月期间本院收治的GDM患者119例为研究对象,对患者产后进行随访观察,调查患者的糖代谢转归情况。根据患者的糖代谢转归情况将患者分为糖代谢正常组(64例)和糖代谢异常组(55例),采用单因素分析的方法对两组患者的人口学资料、临床检测数据等进行统计比较,并采用多因素Logistic回归分析影响GDM患者产后糖代谢异常的危险因素。结果：119例GDM患者中产后12周内糖代谢异常患者55例,糖代谢异常发生率为46.22%。经单因素分析显示：糖代谢异常组年龄、孕前体质指数(BMI)、糖尿病家族史患者占比均高于糖代谢正常组,产后每天运动时间少于糖代谢正常组(P<0.05)。经多因素Logistic回归分析显示：年龄≥35岁、孕前BMI≥25 kg/m²、糖尿病家族史、产后每天运动时间<1 h是GDM患者产后糖代谢异常的危险因素。结论：GDM患者产后有较高的糖代谢异常发生率,患者产后糖代谢异常受多种因素影响,临床工作中应尽早根据相关因素制定干预方案。     

Emergence and selection of the dominant follicle and gonadotropin dynamics in postpartum lactating versus non-postpartum cycling mares

Among female livestock, the mare has the shortest interval from parturition to first ovulation. Due to the scarcity of research on postpartum mares, little progress has been made on the characterization of the resumption of ovarian cyclicity after parturition. This study compared follicular and gonadotropin dynamics during follicle emergence and deviation in postpartum lactating (PP Lactating) versus non-postpartum cycling (N-PP Cycling) mares. On the day of parturition, every PP Lactating mare was paired with a N-PP Cycling mare. Comparisons were made by considering the partum-ovulation interval and the postpartum interovulatory interval for the PP Lactating mares, and two interovulatory intervals for the N-PP Cycling mares. The results presented herein demonstrate that during the postpartum period, lactating mares have some similarities in follicular and hormonal profiles around emergence and deviation when compared with non-postpartum cycling mares. However, some peculiar and important characteristics were noticed during the postpartum period in lactating mares: (1) The emergence of the DF occurs around the day of parturition; (2) follicle deviation in the ovulatory wave occurs earlier during the foal heat than in other intervals; (3) lower FSH and LH systemic concentrations were not detrimental enough to prevent the rapid resumption of ovarian activity just after parturition; and (4) the association between parturition and season can have an additional and confounding effect during postpartum ovarian activity in mares. The novel findings of this study provide better knowledge of the resumption of ovarian activity after parturition and may help provide insight into the reproductive management of this species.     

Replacing sweetened caloric beverages with drinking water is associated with lower energy intake

Objective: Reduced intake of sweetened caloric beverages (SCBs) is recommended to lower total energy intake. Replacing SCBs with non‐caloric diet beverages does not automatically lower energy intake, however. Compensatory increases in other food or beverages reportedly negate benefits of diet beverages. The purpose of this study was to evaluate drinking water as an alternative to SCBs. Research Methods and Procedures: Secondary analysis of data from the Stanford A TO Z intervention evaluated change in beverage pattern and total energy intake in 118 overweight women (25 to 50 years) who regularly consumed SCBs (>12 ounces/d) at baseline. At baseline and 2, 6, and 12 months, mean daily beverage intake (SCBs, drinking water, non‐caloric diet beverages, and nutritious caloric beverages), food composition (macronutrient, water, and fiber content), and total energy intake were estimated using three 24‐hour diet recalls. Beverage intake was expressed in relative terms (percentage of beverages). Results: In fixed effects models that controlled for total beverage intake, non‐caloric and nutritious caloric beverage intake (percentage of beverages), food composition, and energy expenditure [metabolic equivalent (MET)], replacing SCBs with drinking water was associated with significant decreases in total energy intake that were sustained over time. The caloric deficit attributable to replacing SCBs with water was not negated by compensatory increases in other food or beverages. Replacing all SCBs with drinking water was associated with a predicted mean decrease in total energy of 200 kcal/d over 12 months. Discussion: The results suggest that replacing SCBs with drinking water can help lower total energy intake in overweight consumers of SCBs motivated to diet.     

Dietary fat and weight gain among women in the Nurses' Health Study

Objective: To assess the association of dietary fat and weight gain among adult women and to investigate whether offspring of overweight parents have a greater predisposition to weight gain due to intake of dietary fat. Research Methods and Procedures: This was an 8‐year follow‐up of 41,518 women in the Nurses’ Health Study (NHS), a population‐based, prospective cohort. The women were 41 to 68 years of age, free of cardiovascular disease, cancer, and diabetes in 1986 when “baseline” weight and diet were assessed. Eight years later (1994), changes in weight and dietary intake were assessed. Linear regression models were used to relate change in weight to fat intake and change in fat intake, using the percentage of energy from carbohydrate as the comparison, adjusted for age, BMI in 1986, leisure time physical activity, time spent sitting, percent of calories from protein, and change in percentage of calories from protein. Results: Overall, there was a weak positive association between total fat intake (β = 0.11) and weight gain. Increases in monosaturated and polyunsaturated fat were not associated with weight gain, but increases in animal fat, saturated fat, and trans fat had a positive association with weight change. There was not strong evidence of effect modification by parental weight status (p = 0.7 to 0.8 for percentage of calories from total fat, animal fat, and vegetable fat); however, the associations were stronger among the overweight compared with leaner women (p < 0.05 for percentage of calories from each type of fat). Among overweight women, for every one percentage increase in percentage of calories from trans fat, women gained an additional 2.3 lb (95% confidence interval, 1.80 to 2.86). Conclusion: Our results show that, overall, percent of calories from fat has only a weak positive association with weight gain; however, percentage of calories from animal, saturated, and trans fat has stronger associations. There was no clear evidence that the diet‐weight gain association was stronger among offspring of overweight parents, but dietary fat was associated with greater weight gain among overweight women.     

孕妇体内维生素D含量与新生儿湿疹的相关性

目的:研究孕妇维生素D(25(OH)D)含量与新生儿湿疹的关系,为改善孕期维生素D缺乏,预防婴儿湿疹提供临床依据。方法:选取2013年9月-2013年11月在我院生产的孕妇及所生的新生儿,调查研究对象的基本情况。采集孕妇的静脉血进行25(OH)D含量测定,并诊断新生儿湿疹的发生情况。结果:孕妇25(OH)D含量的中位数是15.17 ng/m L,新生儿湿疹的发病率是26.1%。孕妇不同含量25(OH)D水平与孕中晚期补充复合维生素、服用奶制品、摄入鱼蛋类次数、每天晒太阳时间等有关(P0.05);孕妇25(OH)D含量20 ng/m L会增加子女6个月内患湿疹的风险(OR=3.19,95%;CI:1.54,4.21)。结论:孕妇25(OH)D含量缺乏会增加新生儿湿疹的发病率。     

痛血康胶囊对早孕大鼠不完全流产模型的治疗作用

目的：探讨痛血康胶囊治疗早孕SD大鼠不完全流产模型产后出血的疗效及作用机制。方法：1）受孕7 d予米非司酮和米索前列醇,造成早孕不完全流产模型,痛血康治疗7 d观察并记录SD大鼠离体子宫平滑肌活动情况及病理组织学改变。2）用小鼠尾尖取血法,观察痛血康对小鼠出凝血时间的影响。3）用小鼠耳廓肿胀和SD大鼠棉球肉芽肿两个模型,观察痛血康的抗炎作用。4）用皮下注射肾上腺素加冰水刺激所致SD大鼠血瘀模型,观察痛血康的活血化瘀作用。结果：痛血康能增强早孕不完全流产SD大鼠子宫平滑肌收缩强度,促进残存的胚囊组织排出;能降低血瘀模型SD大鼠全血和血浆黏度,缩短小鼠出凝血时间;对二甲苯所致小鼠耳廓肿胀和SD大鼠棉球肉芽肿有明显抑制作用。结论：痛血康在早孕SD大鼠中具有治疗产后出血的作用,可能与增强流产SD大鼠的子宫收缩强度、促进残留在宫腔的绒毛或蜕膜组织排出、缩短出凝血时间、抑制炎症等有关。     

1253例孕妇和新生儿TORCH检测结果分析

目的 了解TORCH感染情况,为妇幼保健提供参考依据.方法 采用捕获ELISA方法对1 253例孕妇和新生儿的血清进行TORCH-IgM抗体检测.结果 689例孕妇CMV、TOX、RV及HSVⅡ特异性IgM抗体阳性率分别为1.89％、0.87％、0.44％和0.73％;564例新生儿CMV-IgM、TOX-IgM、RV-IgM和HSVⅡ-IgM阳性率分别为6.91％、0.18％、0和0.35％.结论 检测TORCH特异性抗体对优生优育有重要关系.     

大鼠产后压力性尿失禁模型的建立与探讨

目的 应用在大鼠阴道内放置水囊模拟产伤破坏大鼠盆底组织的方法建立产后压力性尿失禁( postpartum urinary incontinence,PPUI)的动物模型,并对此模型进行初步研究.方法 对40只SD雌性大鼠进行持续8h水囊扩张阴道,随机选取PPUI模型建立成功的大鼠25只并与对照同龄大鼠5只分别于模型建立后1d、1周、2周、4周、8周进行喷嚏实验以及尿动力学测定,张力换能器测定盆底肌肉肌力强度,采用JSCC标准化对应法测定血清生化指标(LDH,CK),应用逆转录-聚合酶链反应检测caspase-3基因表达,胆碱酯酶染色法计数盆底肌肉乙酰胆碱受体数量.结果 建模后喷嚏实验阳性率明显升高,阳性率为72.5％(29/40),尿动力学检测最大膀胱容量及漏尿点压力均降低,盆底肌肉收缩力下降,血清LDH、CK水平上升,盆底耻尾肌乙酰胆碱受体数量减少,与对照组比较均差异有显著性(P＜0.05).耻尾肌组织中caspase-3基因表达在建立模型当日达到最高,与对照组差异有显著性(P＜0.05),之后逐渐下降.结论 大鼠阴道内放置8h水囊的方法可以成功模拟产后压力性尿失禁,引起尿动力以及盆底肌肉的相关损伤指标发生改变.     

30例妊娠妇女阴道微生态改变

目的 探讨妊娠妇女的阴道微生态变化.方法 采用检测妊娠妇女雌、孕激素水平、阴道理化指标及部分阴道常见菌群来分析阴道微生态的改变.结果 (1)孕妇组阴道白细胞数较高,与育龄健康组妇女相比,差异有统计学意义(P＜0.01);唾液酸酶在两组间相比,差异无统计学意义(P＞0.05);育龄妇女组阴道内的乳酸杆菌含量最高,与孕妇组相比,差异有统计学意义(P＜0.01);大肠埃希菌含量在育龄妇女组最少,与孕妇组相比,差异有统计学意义(P＜0.05);两组加德纳菌相比,差异无统计学意义(P＞0.05).结论 育龄妇女与妊娠妇女的阴道微生态环境不同,与其体内的雌、孕激素水平有关.     

母亲唾液中2种牙周致病菌对胎儿的影响

目的检测早产低体重儿（pretermlowbirthweight,PLBW）与正常体重儿（normalbirthweight,NBW）母亲的牙周临床状况及唾液中牙龈卟啉单胞菌（porphyromonasgingivalis,Pg）和直形弯曲菌（campylobacterrectus,Cr）检出率,探讨2种牙周病致病菌与PLBW发生的关系。方法选取北京四所医院产后1～1．5年的母亲99人,PLBW（试验组）母亲64人,NBW（对照组）母亲35人,收集母亲唾液样本,行全口牙周检查记录探诊深度（probingdepth,PD）、菌斑指数（plaqueindex,PLI）、出血指数（bleedingindex,BI）及临床附着丧失（clinicalattachmentloss,CAL）。用PCR检测唾液中的P岔和Cr;根据赡、Cr检出与否分为％、Cr阳性组、阴性组。结果（1）PLBW和NBW牙周临床指标及与Pg、cr水平：PLBW和NBW组CAL分别（0．06,0．62）mm（25％,75％）、（0．00,0．18）mm（25％,75％）,差异有统计学意义;PLBW组心检出58人的PD2．49±2.0．37;未检出5人的PD2．03±0．54,差异有统计学意义,％检出率为92．06％;NBW组唯检出28人的PD（2．47±0．35）mm,未检出7人的PD（1．91±0．35）mm,差异有统计学意义,赡检出率为80％。PLBW与NBW的瞻检出率差异无统计学意义。PLBW组cr检出55人检出率为87．30％,检出与未检出之间4项临床指标差异均无统计学意义。NBW组D检出率为91．4％,PLBW与NBW间D检出率差异无统计学意义。（2）P譬、Cr阳性组与阴性组间临床指标及与PLBW关系：Pg阳性组86人,阴性组12人,两组4项临床指标分别为PD（2．48±0．36）mm,（1．96±0．40）mm;PLI1．71±0．46,1．37±0．38;BI（1．82,3．02）（25％,75％）,（1．12,2．29）（25％,75％）;CAL（0．03,0．56）ITIm（25％,75％）,（0．00,0．11）mm（25％,75％）唯阳性组新生儿体重为（2482,78±833．85）g,阴性组为（3172．50±1190．1）g,差异均有统计学意义。cr阳性88人,D阳性11人,两组CAL值分别是（0．36±0．53）mm和（0．11±0．20）mm,差异有统计学意义,PD、PI、BI及新生儿体重差异均无统计学意义。结论珞、D在两组母亲唾液检出水平均高;Pg可能与PLBW发生有关;提示有必要进行孕前预防性牙周干预治疗。