妊娠期糖尿病患者发生酮症的临床特点

Clinical characteristics of ketosis in patients with gestational diabetes mellitus

目的 探讨妊娠期糖尿病患者发生酮症的临床特点.方法 选取于2015年1月至2016年4月来北京安贞医院临床营养科就诊的77例妊娠期糖尿病患者作为本次回顾性分析的研究对象.根据门诊尿酮体和血β羟丁酸检测结果分为2组,将妊娠期糖尿病中酮症患者作为观察组（37例）,无酮症者作为对照组（40例）.收集记录患者家族史、既往病史及治疗情况、血压值,检测糖化血红蛋白、总蛋白（TP）、血清白蛋白（ALB）、尿素、肌酐、血红蛋白等指标,根据动态血糖监测记录血糖变化情况及各项检测指标数据,运用X2检验和t检验分析比较两组临床特点.结果 观察组患者全天平均血糖、空腹血糖、晚餐后2h血糖、高血糖事件数、高血糖时间比和最低血糖显著低于对照组患者（t=-4.156～-0.745,均P＜0.05）.观察组TP水平显著低于对照组[（58.4±3.7）比（67.0±2.9） g/L,t=-0.796,P=0.034].观察组低蛋白血症发生率和ALB减少率显著高于对照组[100％（37/37）比25.0％（10/40）、100％（37/37）比80.0％（32/40）,x2=45.463,8.258,均P＜0.05].观察组总热量、碳水化合物摄入量和供能比显著低于对照组[（1 846±229）比（2 119±186）g、（230±45）比（300±36）g、50.2％±4.1％比57.5％±3.6％,t=-5.780、-7.568、-8.363,均P＜0.05].结论 GDM患者的酮症主要为饥饿性酮症.与未发生酮症者相比,发生酮症者总热量尤其碳水化合物摄入不足更明显.在强调GDM患者饮食控制的前提下,要保证总热量摄入,适量提高优质蛋白质摄入.

Objective To explore the clinical characteristics of ketosis in patients with gestational diabetes mellitus （GDM）.Methods It was an observational retrospective study.Based on the testing result of urine ketone body and blood β-hydroxybutyric acid,77 cases with gestational diabetes mellitus from January 2015 to April 2016 treated in the Clinical Nutrition Department of Beijing Anzhen Hospital were allocated into two groups：GDM with diabetic ketosis as the observation group （n=37） and GDM without diabetic ketosis as the control group （n=40）.Family history,past medical history and treatment record,blood pressure,glycosylated hemoglobin,total protein （TP）,serum albumin （ALB）,urea,creatinine,hemoglobin and other indexes were collected.Blood glucose was recorded by the continuous glucose monitoring system.The data of two groups was statistically compared by using X2 test and t test.Results The daily average blood glucose,fasting blood glucose,2-hour after dinner blood glucose,hyperglycemia events,hyperglycemic duration and minimal blood glucose in the observation group were all significantly lower than those in the control group （t=-4.156--0.745,all P〈0.05）.The level of TP in the observation group was lower than that of the control group [（58.4±3.7） vs （67.0±2.9） g/L,t=-0.796,P=0.034].The incidence rate of hypoproteinemia and percentage of patients who had decreased ALB in the observation group were both significantly higher than those of the control group [100%（37/37） vs 25.0%（10/40）,100%（37/37） vs 80.0% （32/40）,X2=45.463,8.258,both P〈0.05].Total calorie intake,carbohydrate intake and energy contribution in the observation group were all significantly lower than those in the control group [（1 846±229） vs （2 119± 186） g,（230±45） vs （300± 36）g,50.2%±4.1% vs 57.5%± 3.6%,t=-5.780,-7.568,-8.363,all P〈0.05].Conclusions Ketosis in GDM patients is mainly starvation ketosis.Compared with patients withoutketosis,total calorie intake,especially carbohydrate intake in GDM with ketosis are more insufficient.On the premise of diet control in GDM patient,it is suggested to ensure total calorie intake,and high quality protein intake should be appropriately increased,so as to attain the qualified blood glucose meanwhile reducing the risk of ketosis.