连续动态血糖监测评估妊娠期糖尿病营养运动治疗后效果

Effect of continuous glucose monitoring in assessment of curative effects of nutritional therapy and excise therapy in patients with gestational diabetes mellitus

目的：采用连续动态血糖监测（CGMS）评估妊娠期糖尿病（GDM）营养运动治疗后效果。方法：对150例GDM孕妇经3～5天饮食和运动指导治疗后，采用CGMS进行72h血糖监测。结果：餐前血糖平均值、餐后血糖平均值与葡萄糖耐量试验（OGTY）时的空腹和餐后血糖相比，均有明显下降，餐后血糖的平均值的下降有统计学意义（P〈0．05）。按照体重指数（BMI）将孕妇分成正常组和超重组，超重组24h内平均血糖值均高于正常组血糖值，孕妇血糖水平呈波动性变化。三餐后0～120min血糖的平均值与晨起指尖毛细血管血糖值比较，差异有统计学意义（P〈0．05）。71．0％孕妇空腹或餐前血糖值小于3．9mmol/L，其中32．3％小于3．3mmol/L。结论：连续动态监测妊娠期糖尿病孕妇血糖，使临床医生更加便捷地评估和调整治疗方案，可以诊断妊娠期妇女餐后所遗漏的高血糖和夜间无症状低血糖事件，是现在常用的自我血糖监测方法，建议在临床上对孕妇间断应用CGMS作为控制调节血糖。

Objective： To evaluate the curative effects of nutritional therapy and excise therapy in patients with gestational diabetes melfitus （GDM） by means of continuous glucose monitoring （CGMS） . Methods： CGMS was used to monitor blood glucose levels for 72 hours after nutritional therapy and excise therapy for 3 - 5 days in GDM pregnant women. Results ： Compared with fasting blood glucose lev- el and postprandial blood glucose level during oral glucose tolerance test （OGTF）, the mean preprandial blood glucose level and mean post- prandial blood glucose level decreased significantly, there was statistically significant difference in the decreasing amplitude of mean post- prandial blood glucose level （ P 〈 0. 05 ） . The pregnant women were divided into normal weight group and overweight group according to body mass index （BMI） , the mean blood glucose level within 24 hours in overweight group was higher than that in normal weight group, the blood glucose levels of pregnant women changed fluctuantly. There was statistically significant difference between the mean levels of blood glucose at 0 - 120 minutes after three meals and fingertip capillary vessel blood glucose level in the morning （P 〈 0. 05 ） . The fasting blood glucose level or preprandial blood glucose level in 71.0% of pregnant women were less than 3.9 mmol/L, and the levels in 32. 3% of them were less than 3.3 mmol/L. Conclusion： Monitoring blood glucose level of GDM pregnant women by means of CGMS can make clinicians e- valuate, adjust the therapeutic schedule more conveniently, and diagnose the omissively postprandial hyperglycemia and night asymptomatic hypoglycemic events, which is a common self - monitoring method of blood glucose, it is recommended to apply CGMS intermittently among pregnant women in clinic to adjust blood glucose.