个体化医学营养疗法对妊娠期糖尿病初产妇剖宫产术后糖脂代谢的影响

Effect of Individualized Medical Nutrition Therapy on Glucose and Lipid Metabolism after Caesarean Section in Pregnant Women with Diabetes Mellitus

目的:探讨个体化医学营养疗法(IMNT)对妊娠期糖尿病(GDM)初产妇剖宫产术后糖脂代谢的影响。方法:将246例接受剖宫产并成功随访的GDM初产妇分为观察组(n=101)及对照组(n=145),观察组接受IMNT干预治疗,对照组采用GDM相关教育等指导常规治疗;比较2组患者生产后12周及1年的体质量、体质量指数(BMI)、腰臀比(WHR)及产妇产后滞留体质量,比较2组患者产前、产后12周及1年时的空腹血糖(FPG)、餐后2 h血糖(2hPG)、稳态模型胰岛β细胞功能(HOMA-β)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C);比较2组患者生产后12周及1年的糖脂代谢异常率。结果:观察组患者产后12周及1年的BMI、WHR、产后滞留体质量及体脂率均显著低于对照组,同组产后1年BMI、WHR、产后滞留体质量及体脂率均显著低于产后12周(P<0.05);2组患者产后12周及1年的HDL-C显著高于同组产前水平,FPG、2hPG、HOMA-β、TC、TG及LDL-C显著低于产前水平,观察组同时点变化更显著(P<0.05);产后12周及1年时,观察组患者糖代谢异常率、高TG血症、高TC血症及低HDL-C血症异常率均低于对照组(P<0.05);产后1年,2组患者的糖代谢异常率、高TG血症和低HDL-C血症异常率显著高于同组产后12周时,观察组显著低于对照组(P<0.05),观察组患者高LDL-C血症异常率显著低于同组产后12周,对照组患者高LDL-C血症异常率显著高于于同组产后12周(P<0.05)。结论:IMNT可改善GDM初产妇剖宫产术后近远期糖脂代谢转归,降低糖脂代谢异常发生率。

Objective:To discass the effect of individualized medical nutrition therapy on glucose and lipid metabolism after caesarean section in pregnant women with diabetes mellitus.Methods:The GDM primiparas of 246 cases were divided into observation group(n=101)and control group(n=145).The observation group received IMNT intervention treatment,and the control group used GDM related education to guide routine treatment.The body mass,body mass index(BMI),waist-hip ratio(WHR)and postpartum hysteretic mass were compared after 12 weeks and 1 year.Fasting glucose(FPG),postprandial 2h blood glucose(2hPG),islet beta-cell function(HOMA-β),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)were compared in two groups after prenatal and postnatal 12 weeks and 1 year.The abnormal rates of glycolipid metabolism were compared between 12 weeks and 1 year after production in 2 groups.Results:The BMI,WHR,body mass and body fat rate were significantly lower in the observation group than in the control group after 12 weeks and 1 year postpartum,and in the same group,one year postpartum BMI,WHR,body mass and body fat rate were significantly lower than 12 weeks postpartum(P<0.05).HDL-C was significantly higher in the 2 groups than in the same group after 12 weeks and 1 year postpartum.FPG,2hPG,HOMA-β,TC,TG and LDL-C were significantly lower than prenatal levels,and the simultaneous change of observation group was more significant(P<0.05).The abnormal rates of glucose metabolism,high TG mass formed by blood stasis,high TC mass formed by blood stasis and low HDL-C mass formed by blood stasis in the observation group were lower than those in the control group at 12 weeks and 1 year postpartum(P<0.05).The abnormal rate of high LDL-C in the observation group was significantly lower than that in the same group at 12 weeks postpartum,and the abnormal rate of high LDL-C in the control group was significantly higher than that in the same group at 12 weeks postpartum(P<0.05).Conclusion:IMNT can improve the long-term glycolipid metabolic outcome and reduce the incidence of abnormal glycolipid metabolism in GDM primipara after cesarean section.