妊娠期糖尿病患者血液流变学测定的临床意义

Clinical Significance of Hemorrheology in Gestational Diabetes Mellitus

目的通过监测妊娠期糖尿病(GDM)患者的血液流变学特点,探讨其对GDM诊疗的意义。方法选取2013年1月1日至2014年5月31日在中山市小榄人民医院建产检手册并定期产检的121例孕妇,根据是否患有妊娠期糖尿病分为正常妊娠组(63例)和GDM组(58例),GDM组孕妇又根据血糖控制情况分为血糖控制良好组(41例)和血糖控制不佳组(17例)。观察并比较三组孕妇的血液流变学指标、妊娠结局及围生儿结局的差异。结果血糖控制不佳组孕妇的全血黏度(高切、中切、低切)、血浆黏度、还原黏度、红细胞沉降率、红细胞刚性指数、红细胞电泳时间及纤维蛋白原数据均高于正常妊娠组和血糖控制良好组,血细胞比容、红细胞沉降率方程K值、红细胞聚集指数高于正常妊娠组,红细胞变形指数低于正常妊娠组(P<0.05);血糖控制不佳组孕产妇妊娠期高血压、羊水过多、产褥感染等的发生率(82.35%)显著高于正常妊娠组(11.11%)和血糖控制良好组(14.63%)(χ2=35.098,24.393,P<0.05),正常妊娠组与血糖控制良好组比较,差异无统计学意义(P>0.05);围生儿早产、巨大儿等的发生率显著(64.71%)高于正常妊娠组(4.76%)和血糖控制良好组(7.32%)(χ2=33.320,21.614,P<0.05)。结论 GDM患者存在明显的血液流变学异常,提示血液流变学测定技术可作为临床诊疗工作的重要监测及评估手段,并推广应用。

Objective To explore the clinical significance of hemorrheology determination for the diag- nosis and treatment of gastational diabetes mellitus（GDM）. Methods Total of 121 GDM patients for regular antenatal examination in Xiaolan People＇s Hospital of Zhongshan city from Jan. Ist,2013 to May 31st,2014 were selected. They were divided into normal pregnancy group（ n=63 ） and GDM group（ n = 58 ）, according to the degree of blood sugar,GDM group were further divided into glucose well controlled group（ n =41 ） and glucose poorly controlled group （n = 17 ）. Hemorrheology indexes, the outcomes of pregnancy and perinatal were compared among the three groups. Results In glucose poorly controlled group,the value of whole blood viscosity （ high, middle and low）, plasma viscosity, reduced viscosity, hematocrit, erythrocyte sedimentation rate （ESR） , erythrocyte rigidity index, erythrocyte electrophoresis time and fibrinogen were higher than the normal pregnancy group and glucose well controlled group,ESR equation K, erythrocyte aggregation index,were higher than normal pregnancy group and erythrocyte deformation index was lower than the normal pregnancy group （all P 〈 0. 05） ;there were no statistically significant difference between the glucose well controlled group and normal pregnancy group （P 〉 0. 05）. The incidence of gestational hypertension, polyhydramnios, puerperal infection（82. 35% ） of the glucose poorly controlled group was significantly higher than normal pregnancy group（ 11.11% ） and the glucose well controlled group （ 14.63% ）, with statistical significant differences （X2 =35. 098,24. 393 ,P 〈 0. 05 ） ; there was no statistical significant difference between the glucose well controlled group and the normal pregnancy group （P 〉 0. 05 ）. The incidence of perinatal premature and mac- rosomia of the glucose poorly controlled group（64. 71% ） was obviously higher than the normal pregnancy group（4. 76% ） and the glucose well controlled group（7. 32% ） （ X2 = 33. 320,21. 614 ,P 〈 0. 05 ）. Conclu- sion GDM patients have an obvious abnormal hemorrheology,which suggests that the hemorrheology meas- urement can be used as an important monitoring and evaluation method in clinial, and is worth of populariza- tion and application.