饮食疗法对妊娠期糖尿病孕妇血脂代谢动态变化的研究

目的:探讨脂代谢紊乱在妊娠期糖尿病(GDM)中的作用,为妊娠期糖尿病的预防及指导临床干预提供理论依据。方法:观察妊娠期糖尿病患者和糖耐量正常孕妇血脂水平及胰岛素抵抗程度差异,分析妊娠期糖尿病患者饮食治疗前后的血脂及炎症标志物的动态变化,于孕12W、24W及36W分别抽取两组孕妇空腹静脉血,测定糖、脂代谢指标及炎症标志物水平,计算血浆致动脉粥样硬化指数(atherogenic index of the plasma,AIP);应用稳态模型胰岛素抵抗指数(HOMA-IR)及胰岛分泌功能指数(HBCI),评价胰岛素抵抗指数(IR)程度及胰岛功能。结果:(1)GDM组的C肽、FINS、HOMA-IR明显高于糖耐量正常组(normal glucose tolerance,NGT)组(p0.05),GDM组HBCI指数低于NGT组(p0.05)。(2)干预组与对照组比较,12W时,TC、TG、HDL、LDL差异均无统计学意义(p0.05);24W及32W差异均有统计学意义(p0.05),均较对照组高。(3)对GDM组中TC、TG、HDL、LDL、AIP、hs-CRP、N及WBC值进行分析,TG、TC、LDL、AIP、hs-CRP、N及WBC值24W较36W及12W高(p0.05);HDL水平24W较36W及12W低(p0.05)。(4)NGT组中TG、TC、LDL、AIP、hs-CRP、N及WBC值36W较24W及12W高(p0.05);HDL水平36W较24W及12W高(p0.05)。结论:GDM孕妇存在着明显的胰岛素抵抗和胰岛β细胞分泌功能受损。GDM孕妇合并较正常妊娠更为严重的炎症反应,血脂水平明显升高,饮食治疗后对改善IR有益,提示在妊娠期糖尿病患者中,通过适当的饮食治疗进而对血糖及血脂的调整可以显著减少母儿并发症。

Dietary Treatment of Pregnant Women with Gestationaldiabetes Mellitus's Dynamic Change of Lipid Metabolism

ABSTRACT Objective: To investigate the role of lipid metabolism in gestational diabetes mellitus, and provide a theoretical basis for the prevention and clinical gestational diabetes intervention. Methods: Observation of patients with gestational diabetes mellitus and impaired glucose tolerance in normal maternal serum lipids and insulin resistance (IR) degree difference, dynamic changes of serum lipids and markers of inflammation were detected before and after pregnancy diet therapy for patients with diabetes, at 12 weeks of pregnancy, 24 weeks and 36 weeks respectively draw fasting venous blood from two group pregnant women, determination of serum saccharide, lipid metabolism andinflammatory markers, calculation of atherogenic index of plasma (atherogenic index of the plasma, AIP ); insulin resistance index of steady-state model (HOMA-IR) and insulin secretion index (HBCI), evaluation of insulin resistance index (IR) and islet function. Results: (1) C peptide, FINS, HOMA-IR in GDM group was significantly higher than that in the normal glucose tolerance group (normal glucose tolerance, NGT) group (p<0.05), group GDM HBCI index lower than that of group NGT (p< 0.05). (2) Between the intervention group and the control group, at 12 weeks, TC, TG, HDL, LDL were not statistically significant (p>0.05); 24 weeks and 32 weeks. the differences were statistically significant (p<0.05) higher than the control group. (3) In group GDM, TG, TC, HDL, LDL, AIP, hs-CRP, N and WBC value were analyzed, TG, TC, LDL, AIP, hs-CRP, N and WBC values of 24 weeks compared with 36 weeks and 12 weeks (p<0.05); high level of HDL 24 weeks compared with 36 weeks and 12 weeks low (p<0.05). (4) In NGT group TG, TC, LDL, AIP, hs-CRP, N and WBC values of 36 weeks compared with 24 weeks and 12 weeks (p<0.05) are higher; higher level of HDL 36 weeks compared with 24 weeks and 12 weeks (p<0.05). Conclusion: There is a serious insulin resistance and beta cells was significantly impaired secretory function in GDM pregnant women than normal pregnancy women. GDM of pregnant women with more severe inflammatory response, blood lipid levels than normal pregnancy women, which is positively correlated with IR. Diet therapy was benefit to ameliorate of IR, through diet therapy to adjust on blood glucose and lipid can significantly reduce the complications of mothers and infants.