不同阶段的运动疗法对妊娠期糖尿病患者的长期预后作用

The prognosis for gestational diabetes mellitus patients according to different stages of physical activity

目的：探讨不同阶段的运动疗法对妊娠期糖尿病（gestational diabetes mellitus,GDM）患者预后的作用。方法：选取2010年7月~2014年7月我们妇产科接诊的560例妊娠期糖尿病患者作为研究对象,根据运动疗法的不同阶段将患者分成三组：单纯的妊娠期运动疗法组200例（A组）、单纯的产后运动疗法组180例（B组）以及妊娠期和产后均运动的联合运动组180例（C组）,进行队列研究,分析三组患者进展为2型糖尿病的风险差异。结果：三组患者的随访时间分别为2.7±1.1、2.9±0.8及2.8±1.7年,三组患者在平均随访时间上无显著差异（P〉0.05）。在随访期间,共发现2型糖尿病病例68例,其中A组38例,B组20例,C组10例。C组进展为2型糖尿病的风险明显低于A组和B组（P〈0.05）,B组疗法发展成2型糖尿病的风险低于A组疗法,但通过调整协变量体重指数后,这种差异仍显著（P〈0.05）。结论：强化运动治疗,特别是强化产后运动,能明显降低妊娠期糖尿病患者发展为2型糖尿病的风险,值得临床推广应用。

Objective： To explore the role of different stages of physical activity in the prognosis for gestational diabetes mellitus patients. Methods： In this cohort study, a total of 560 subjects with gestational diabetes mellitus from our hospital between 2010 July and 2014July were included, q-hey were divided in three groups according to different stages of physical activity （physical activity during pregnancy for group A; physical activity after pregnancy for group B and physical activity both during pregnancy and after pregnancy for group C）. We were intended to find the risk of the progression from GDM to T2DM among three groups through the cohort stud）n Results： The time for follow-up time was 2.7＋1.1, 2.9＋0.8, and 2.8＋1.7 years respectively. And there was no significant difference about the mean follow-up time among the three groups. We found 68 incident T2DM cases during the follow- up period, including 38 cases in group A, 20 cases in group B and 10 cases in group C. There was a lower risk of T2DM in group C compared to group A and group B （P〈0.05）. This association remained significant after additional adjustment for body mass index （BMI）. And there was a lower risk of T2DM in group B compared to group A, and this association remained after additional adjustment for BMI （P〉0.05）. Conclusion： Strengthening physical activity, especially strengthening postpartum exercise may lower the risk of progression from GDM to T2DM, and is worth clinical application.