不同能量系数取值对妊娠期糖尿病患者血糖及新生儿体重的影响

Effect of different energy coefficients on blood sugar in patients with gestational diabetes mellitus and neonatal weight

目的探讨妊娠期糖尿病患者采用不同能量系数计算的每日能量供给对血糖管理及新生儿体重的影响。方法选择2016年10月～2017年6月参加首都医科大学附属北京潞河医院(以下简称"我院")糖尿病一日门诊的妊娠期糖尿病患者85例作为研究组,其中以能量系数下限值计算给予能量供应的患者作为研究组A (n=43),以能量系数上限值计算能量供应的患者作为研究组B(n=42);取同期在我院行定期孕检且未参加糖尿病一日门诊妊娠期糖尿病患者为对照组(n=50)。监测并随访研究组与对照组的糖化血红蛋白、尿酮体阳性率、新生儿出生体重。监测研究组A与研究组B患者在一日门诊的餐前及餐后2 h血糖,尿酮体及新生儿出生体重情况。结果研究组的糖化血红蛋白明显低于对照组,差异有统计学意义(P <0.05);研究组新生儿生体重明显低于对照组,差异有统计学意义(P <0.05)。研究组A的血糖达标率高于研究组B,且差异有统计学意义(P <0.05);研究组A的餐后血糖低于研究组B,差异无统计学意义(P> 0.05);研究组A的新生儿体重明显低于研究组B,差异有统计学意义(P <0.05)。结论糖尿病一日门诊有利于妊娠期糖尿病患者更好地控制血糖,降低巨大儿的发生率。取能量系数下限值计算总热量,能够保证孕妇的能量需要,且未增加低血糖发生率和尿酮体阳性率,有利于血糖达标。

Objective To investigate of the effects of daily energy supply on blood sugar management of patients with gestational diabetes mellitus and neonatal weight using different energy coefficients. Methods From October 2016 to June 2017, 85 patients with gestational diabetes mellitus enrolled in the One-day Outpatient for Diabetes of Beijing Luohe Hospital affiliated to Capital Medical University ("our hospital" for short) were selected as the study group, and the patients who calculated the energy supply with the lower limit of the energy coefficient as the study group A (n = 43), the patient who calculated the energy supply with the upper limit of the energy coefficient as the study group B (n = 42);the patients with gestational diabetes mellitus who took the pregnancy test at the same time and did not participate in the One-day Outpatient for Diabetes in our hospital as the control group (n = 50). The glycosylated hemoglobin, the positive rate of urinary ketone body and neonatal weight in the study group and the control group were monitored and followed up. The blood sugar before and 2 hours after meals in One-day Outpatient for Diabetes, urinary ketone body and neonatal weight in group A and group B were monitored. Results The glycated hemoglobin of the study group was significantly lower than that of the control group (P < 0.05). The neonatal weight in the study group was significantly lower than that of the control group (P < 0.05). The blood sugar compliance rate of study group A was higher than that of study group B, and the difference was statistically significant (P < 0.05). The postprandial blood sugar of study group A was lower than that of study group B, the difference was not statistically significant (P > 0.05). The neonatal weight of study group A was significantly lower than that of the study group B, and the difference was statistically significant (P < 0.05). Conclusion One-day Outpatient for Diabetes is beneficial to patients with gestational diabetes to better control blood sugar and reduce the incidence of macrosomia. Taking the lower limit of the energy coefficient to calculate the total calories can ensure the energy needs of pregnant women, and does not increase the incidence of hypoglycemia and the positive rate of ketone body, which is conducive to blood sugar compliance.