Effect of medical nutrition therapy on insulin resistance, leptin level and pregnancy outcomes in patients with gestational diabetes mellitus
WANG Jing1, DONG Xing2, WANG Jing1, SHANG Lixin1
1. Department of Gynecology and Obstetrics, the Seventh Medical Center of Chinese PLA General Hospital, Beijing 100700,China; 2. Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing 100700,China
摘要目的 研究医学营养治疗对妊娠期糖尿病患者胰岛素抵抗、瘦素水平及妊娠结局的影响。方法 选取2018年1月至2019年7月在解放军总医院第七医学中心建档的100例妊娠期糖尿病患者作为研究对象,以自愿接受医学营养治疗的60例患者作为研究组,以接受普通营养干预的40例患者作为对照组,比较两组患者的胰岛素抵抗、血清瘦素水平及妊娠结局。结果 (1)干预12周后,研究组与对照组比较,空腹血糖[(4.81±0.47)mmol/Lvs.(5.43±0.42) mmol/L]、餐后2 h血糖(6.49±0.54)mmol/L vs (6.84±0.38)mmol/L,空腹胰岛素水平(18.06±0.55)mU/L vs (18.41±0.39) mU/L,糖化血红蛋白(5.42±0.28)% vs (5.83±0.26)%,胰岛素抵抗指数(3.91±0.16) vs (4.24±0.27),瘦素水平[(17.99±0.61)ng/ml vs (18.33±0.64)ng/ml]均明显降低,差异有统计学意义(P＜0.01);(2)研究组妊娠高血压疾病(6.67%)、羊水过多(1.67%)、巨大胎儿(8.33%)、胎儿生长受限(6.67%)的发生率显著低于对照组(20.00%、12.50%、25.00%、22.50%),差异有统计学意义(P＜0.05);(3)研究组剖宫产率(18.33%)、产后出血(3.33%)、胎儿窘迫(6.67%)、新生儿窒息(1.67%)、新生儿呼吸窘迫综合征(3.00%),新生儿低血糖(6.00%)的发生率明显低于对照组。结论 医学营养治疗可降低妊娠期糖尿病患者的血糖、瘦素水平,改善胰岛素抵抗,降低母婴并发症发生率,减少不良妊娠结局的发生。
Abstract：Objective To study the effect of medical nutrition therapy on insulin resistance, leptin levels and pregnancy outcomes of patients with gestational diabetes mellitus.Methods One hundred patients with gestational diabetes mellitus who were put on file in our hospital between January 2018 and July 2019 were selected as the subjects. Sixty of these patients voluntarily received medical nutrition therapy and served as the study group, while the rest were subjected to general nutrition intervention and assigned to the control group. Insulin resistance, serum leptin levels and pregnancy outcomes were compared between the two groups.Results After twelve weeks of intervention, the fasting plasma glucose (4.81±0.47)mmol/L/(5.43±0.42)mmol/L, plasma glucose two hours after meal (6.49±0.54) mmol/L/(6.84±0.38)mmol/L, fasting insulin level (18.0±0.55) mIU/L/(18.41±0.39)mIU/L, glycohemoglobin (5.42±0.28)%/(5.83±0.26)%, insulin resistance index (3.91±0.16)/(4.24±0.27) and leptin level (17.99±0.61) ng/ml/(18.33±0.64)ng/ml in the study group were significantly lower than those of the control group (P＜0.01). The incidence of hypertensive disorder of pregnancy(6.67%), polyhydramnios(1.67%), macrosomia(8.33%) and fetal growth restriction(6.67%) in the study group was significantly lower than that of the control group (20.00%) (12.50%) (25.00%) (22.50%),(P＜0.05), so was the incidence of cesarean section(18.33%), postpartum hemorrhage(3.33%), fetal distress(6.67%), neonatal asphyxia(1.67%), neonatal respiratory distress syndrome(3.00%) and neonatal hypoglycemia(6.00%).Conclusions Medical nutrition therapy can effectively lower the levels of blood sugar and leptin in patients with gestational diabetes mellitus, improve insulin resistance, reduce maternal and infant complications, and prevent adverse pregnancy outcomes.
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2020, Vol. 31 
