基于三位一体妊娠期糖尿病随访系统的开发设计

介绍了一种基于妊娠期糖尿病三位一体随访管理系统的开发设计。从设计思路、系统流程、系统功能模块及系统管理四个方面,介绍了工作站、随访患者、营养方案、运动、血糖监测、设备管理、批量导入、云平台安全等的管理,完成对妊娠期糖尿病患者三位一体随访,解决孕产妇家庭血糖监测及运动管理监管难等问题。通过动态数据的智能化采集,改变了原有手工数据采集或靠患者回忆记录数据的模式,将数据精准匹配到治疗方案中,从而辅助医生进行科学的治疗管理。通过三位一体随访系统的构建,建立妊娠期糖尿病疾病智能诊治系统。

初产妇产后早期盆腔器官脱垂的高危因素分析

目的:探讨初产妇足月阴道分娩后产后早期盆腔器官脱垂(POP)发生的高危因素。方法:选取2017年1—4月在上海交通大学医学院附属国际和平妇幼保健院产后6~8周复诊的经阴道足月分娩的初产妇1 216例。同时行盆腔器官脱垂定量分度法(POP-Q)评分,按评分结果分为POP组(644例)和对照组(572例),采用单因素和多因素Logistic回归分析各种产科因素与产后早期发生POP的相关性。结果:在1 216例阴道分娩的初产妇中,POP的发生率为52.96%(644/1 216);POP组的年龄、分娩孕周、新生儿出生体质量以及产钳助产率显著高于对照组,差异有统计学意义(均P<0.05);而2组产妇孕前体质量指数(BMI)、孕期体质量增加量、产时BMI、第二产程时间、是否会阴裂伤和是否会阴侧切比较,差异均无统计学意义(均P>0.05)。多因素Logistic回归分析显示,与年龄<28岁的产妇相比,年龄≥36岁的产妇产后早期POP的发生风险显著升高(OR=2.352,P=0.010,95%CI:1.222~4.526);与新生儿出生体质量<3 000 g的产妇相比,新生儿出生体质量为3 500~3 999 g和≥4 000g的产妇产后POP的发生风险均显著增加(OR=2.039,P=0.000,95%CI:1.385~3.003;OR=2.676,P=0.007,95%CI:1.303~5.495);与自然分娩的产妇相比,行产钳助产的产妇产后POP发生风险显著升高(OR=1.760,P=0.019,95%CI:1.097~2.823)。结论:初产妇阴道分娩产后POP的发生与年龄、新生儿出生体质量以及产钳助产有关。阴道分娩产后POP发生率高,应加强产妇盆底疾病的预防及重视产后康复训练,尤其是有高危因素的产妇。

孕中期甲状腺激素和血脂水平的相关性及其对新生儿出生体质量的影响

【目的】探讨孕中期(妊娠12?16周)孕妇游离甲状腺素(FT4)、游离三碘原氨酸(FT3)、促甲状腺激素(TSH)与三酰甘油(TG)、总胆固醇(TC)的相关性及其对新生儿出生体质量的影响。【方法】选取2018年1?12月在上海交通大学医学院附属国际和平妇幼保健院和上海松江区妇幼保健院按期产检的孕妇10574例,分析孕12?16周甲状腺激素(FT4、FT3、TSH)和血脂水平(TG、TC)的相关性,以其对新生儿出生体质量的影响。【结果】孕妇FT4水平与TG、TC均呈负相关,孕妇较高的FT3水平与较高的TG、较低TC水平相关(均P<0.05);孕妇TSH与TG呈负相关(P<0.05),TSH与TC无相关性(P=0.79)。FT4水平降低,TG水平升高增加大于胎龄儿(LGA)风险;FT4水平升高,TG水平降低增加女婴小于胎龄儿(SGA)风险;孕妇FT4水平降低联合TG水平升高对新生儿出生体质量呈交互作用,出生男婴的LGA风险增加[OR=1.79,95%CI(1.38,2.33)]。【结论】孕妇FT4水平降低与TG水平升高发生男婴LGA风险增加,监测甲状腺激素和血脂水平,并采取相应的措施,可降低新生儿发生SGA、LGA的风险。

Reference intervals for common thyroid function tests, during different stages of pregnancy in Chinese women

Background The importance of diagnosis of thyroid dysfunction during pregnancy has been widely recognized. Our study was designed to compare two different detection reagents between Abbott and Roche and to establish the gestational- related reference intervals for thyroid function tests （TFT） in Chinese women and to assay the reference ranges with the American Thyroid Association recommended standard. Methods Serum samples were collected from 693 normal pregnant Chinese women and divided into five groups according to their gestational age： 9-13, 16-20, 24-28, 32-34 and 37-40 weeks. Thyroid stimulating hormone （TSH） and free thyroxine （FT4） levels were determined by two different detection reagents： Abbott Architect 1 2000 and Roche Cobas Elecsys 600. The reference ranges of the TFT indexes were calculated according to the National Academy of Clinical Biochemistry （NACB）. The 2.5th and 97.5th percentiles of each stage were calculated, and the results were analyzed by one-way analysis of variances, t-test, and Spearman correlation analysis. Results Thyroid hormone levels varied greatly among different gestational stages. TSH levels, as assessed via two different TSH ELISA kits showed consistent changing pattern during pregnancy and displayed linear correlation （P 〈0.001）. In 9-13 gestational weeks, TSH levels were significantly lower than that of other groups; and in 37-40 gestational weeks, it was higher than that of other groups （all P 〈0.001）. TSH reference ranges determined by Roche detection reagent in each group were higher than those by Abbott detection reagent （P 〈0.01 respectively）. FT4 levels were higher in 9-13 gestational weeks than that of other groups （P 〈0.001）. FT4 levels determined by Roche reagent were higher than Abbott reagent in 9-13 weeks, （P 〈0.001）, and lower in 24-28 and 37-40 weeks （P 〈0.001 and P=0.016, respectively）. The TSH level was correlated with FT4 levels in 9-13 gestational weeks by detection reagents （for Abbott reagent, r=-0.319 for FT4 P 〈0.001; for Roche reagent, t=-0.352 for FT4, P 〈0.001）. Conclusion Accurate evaluation of TFT in pregnant women should be based on the gestational-related reference intervals in Chinese population, and different detection reagents should also establish their own reference intervals.