运动加饮食干预对妊娠期糖尿病患者血糖水平、胰岛素抵抗及妊娠结局的影响

Effects of exercise plus diet intervention on blood glucose level, insulin resistance and pregnancy outcome in patients with gestational diabetes mellitus

目的探讨运动加饮食干预对妊娠期糖尿病患者相关指标以及胰岛素抵抗的影响。方法选取2017年8月至2019年5月广州中医药大学祈福医院妊娠糖尿病患者78例,按抓阄法分为对照组与试验组,每组39例。对照组给予常规孕期指导,试验组给予运动加饮食干预。比较两组干预后空腹血糖、餐后2 h血糖、糖化血红蛋白水平,比较两组干预后胰岛素抵抗指数、内脂素和脂联素改善程度。结果干预后,两组的血糖状况均有突出改善,并且干预后试验组空腹血糖(8.04±1.52)mmol/L、餐后2 h血糖(10.13±1.54)mmol/L、糖化血红蛋白[(7.05±1.87)%]均较对照组[(8.94±2.08) mmol/L,(12.27±2.06)mmol/L,(8.14±2.08)%]改善程度明显,差异有统计学意义(P<0.05)。干预后,两组胰岛素抵抗指数、内脂素和脂联素均有突出改善,并且干预后试验组胰岛素抵抗指数(2.44±0.64)、内脂素[(7.75±2.14)μg/L]和脂联素[(10.21±2.54)mg/L]均较对照组[(3.24±0.85),(9.57±2.61)μg/L,(7.98±2.04) mg/L]改善程度明显,差异有统计学意义(P<0.05)。试验组剖宫产、感染、早产以及新生儿低血糖的不良妊娠结局的总发生率(20.51%,8/39)较对照组(41.03%,16/39)低,差异有统计学意义(P<0.05)。试验组新生儿出生后1 min以及出生后5 min的Apgar评分均明显高于对照组,差异有统计学意义(P<0.05)。结论运动加饮食干预可以促进改善妊娠糖尿病患者的胰岛素抵抗,控制好血糖水平,减少不良妊娠结局。

Objective To investigate the effect of exercise plus diet intervention on related indexes and insulin resistance of gestational diabetes.Methods From August 2017 to may 2019, 78 cases of gestational diabetes mellitus were selected from the blessing Hospital of Guangzhou University of traditional Chinese medicine. They were divided into control group and experimental group by lot drawing, with 39 cases in each group.The control group was given regular pregnancy guidance, and the experimental group was given exercise plus diet intervention. The fasting blood glucose, 2 hours postprandial blood glucose and glycosylated hemoglobin levels were compared between the two groups, and the improvement of insulin resistance index, endolipid and adiponectin were compared.Results After intervention, the level of fasting blood glucose [(8.04 ± 1.52) mmol/L], postprandial blood glucose [(10.13±1.54) mmol/L], glycosylated hemoglobin [(7.05 ± 1.87)%] in the experimental group were significantly improved compared with that in the control group [(8.94±2.08) mmol/L,(12.27±2.06) mmol/L,(8.14±2.08)%], and the differences were significant(P<0.05). After intervention, the insulin resistance index, the level of adiponectin and the level of insulin resistance index(2.44±0.64), the level of adiponectin [(7.75±2.14) μg/L] and the level of adiponectin [(10.21±2.54) mg/L] in the intervention group were significantly higher than those in the control group [(3.24±0.85),(9.57±2.61) μg/L,(7.98± 2.04) mg/L], with significant differences(P<0.05). The total incidence of adverse pregnancy outcomes(20.51%, 8/39) in the experimental group was lower than that in the control group(41.03%, 16/39), the difference was significant(P<0.05). The Apgar scores of the experimental group at 1 min and 5 min after birth were significantly higher than those of the control group(P<0.05).Conclusions Exercise and diet intervention can improve insulin resistance, control blood glucose level and reduce adverse pregnancy outcome.