健康教育对84例妊娠期糖尿病孕妇的效果分析

目的健康教育对妊娠期糖尿病孕妇的效果分析。方法对84例GDM孕妇进行糖尿病相关知识的问卷调查并实施糖尿病系统化教育和治疗,并比较教育前后孕妇对糖尿病知识掌握情况、行为改变、血糖监测值的变化情况。结果结果通过实施健康教育后的孕妇知识掌握情况比健康教育前掌握率高,P<0.01,有统计学意义;健康教育前后孕妇建立健康行为比较,教育后高于教育前P<0.01,有统计学意义;健康教育前后孕妇血糖值比较,教育后低于教育前,P<0.01,有统计学意义。结论对妊娠合并糖尿病孕妇施行健康教育,可使孕妇自身健康的维护能力提高,有效控制血糖,减少并发症,保障母婴健康。     

动态血糖监测仪在血糖控制良好的糖尿病患者中的应用

目的了解血糖控制良好的糖尿病患者的血糖波动及动态血糖检测系统应用的优势。方法血糖控制良好的糖尿病病人23例,患者均符合1999年WHO诊断标准,均口服降糖药或胰岛素注射治疗。检测空腹血糖≤7.0mmoL/L,早餐后2h血糖≤10.0mmoL/L,HbA1C≤7.5%。选用CGMS对病人行连续72h血糖监测。结果有5例患者发生低血糖(血糖≤2.8mmoL/L),共13次,低血糖均发生于23:00至次日07:00,仅3例次有自觉症状,经进食后缓解。有7例患者有高血糖发生(血糖≥11.1mmol/L),均发生于餐后1～3h。结论血糖控制良好的糖尿病患者仍可能存在较大的血糖波动,动态血糖检测系统可发现高血糖事件及无症状低血糖,为严格控制血糖,正确调整用药提供客观准确的依据,更有效地减少急慢性并发症的发生。     

妊娠期糖尿病的健康教育

妊娠期糖尿病(GDM)是妊娠后才发生和首次发现的糖尿病,其发病率占妊娠的1%～5%,近年有明显增高趋势,GDM属于高危妊娠,对母儿均有较大危害,如不及时治疗,会导致一系列母婴合并症,如酮症酸中毒,妊娠高血压疾病,感染,羊水过多,巨大儿,窒息和早产等。因此,做好GDM孕妇的护理直接关系到患者的疾病控制,可减少母婴并发症的发生,而健康教育是GDM护理的重要组成部分,本文旨在通过对GDM的健康教育,可以提高其健康知识水平和自我管理,从而可以有效降低母婴并发症,保证母婴安全。     

妊娠期糖尿病对妊娠结局的影响

目的通过对116例妊娠期糖尿病(GDM)产妇的临床资料进行回顾性分析,评估GDM治疗对妊娠结局的影响。方法116例GDM产妇中92例经产前糖尿病筛查发现并确诊。24例于入院后发现。将116例GDM产妇分为两组,A组为经产前糖尿病筛查发现并确诊,血糖控制达理想水平者72例。B组为产前确诊但孕妇血糖控制不理想者20例及未经治疗者24例共44例。收集并比较分析两组孕产妇及围产儿并发症情况。结果92例产前确诊并治疗患病产妇中72例(78.3%)血糖控制达到理想水平,孕期血糖控制理想的GDM孕产妇妊娠高血压疾病、早产、剖宫产、新生儿低血糖、死胎的发生率均低于血糖控制不理想者及未治疗者的发生率(P<0.05)。结论孕期血糖控制可降低GDM孕产妇和围产儿并发症的发生率。     

糖尿病患者门诊血糖规范化管理对血糖控制的影响

目的探讨门诊规范化管理对血糖控制的影响。方法将本门诊2005年3月至2011年2月间确诊的180例糖尿病患者作为研究对象,将其随机分为观察组和对照组,观察组90例患者进行规范化血糖管理,对照组90例患者可自行就医,6个月之后对比血糖控制水平。结果经过6个月的规范化管理之后,观察组空腹血糖为(6.12±1.33)mmol/L,对照组空腹血糖为(9.14±1.27)mmol/L,观察组餐后2h血糖为(8.53±1.42)mmol/L,对照组餐后2h血糖为(12.24±1.63)mmol/L,2组患者血糖对比具有明显差异,具有统计学意义(P<0.05)。结论通过对门诊血糖的有效管理能够积极控制患者的血糖水平,对糖尿病患者的血糖控制影响很大,具有重要意义。     

社区健康教育对糖尿病患者血糖控制的影响

目的客观评价社区健康教育对糖尿病患者血糖控制的影响,总结社区健康教育中的要点与经验,利用有效的健康教育方案,使患者达到良好的血糖控制。方法将本社区中118例登记的糖尿病患者随机均分为对照组与观察组,对照组中糖尿病患者采取常规医院教育方法,观察组患者进行系统规范的糖尿病健康教育。为糖尿病患者建立健康档案,定期进行日常护理、心理干预、饮食指导、运动指导以及血糖等指标的监测。6个月后对比2组中糖尿病患者的各项指标以及2组糖尿病与并发症的发病率。结果对照组糖尿病患者的空腹血糖、餐后2h血糖以及糖化血红蛋白三项指标均明显高于观察组。结论社区是糖尿病防治工作的最基层,在社区开展健康教育可有效提高患者的遵医行为,使患者对糖尿病有了系统正确地认识,学会了自我管理,血糖得到良好控制。从而提高患者的生活质量,降低并发症的发生率。     

2型糖尿病空腹血糖对血液流变学指标的影响

目的了解不同空腹血糖状态下的2型糖尿病患者血液流变学指标的特点。方法入选172例2型糖尿病患者,空腹测定血糖和血液流变学指标,按血糖控制是否达标分成两组,比较其血液流变学指标是否有差异。结果空腹血糖较高的一组血液流变学各项指标均高于空腹血糖较好的一组。结论2型糖尿病空腹血糖对血液流变学指标有影响,控制好血糖对改善血液流变学指标、预防血栓性疾病有好处。     

护理干预对糖尿病患者控制血糖中的作用

目的探讨护理干预对糖尿病患者控制血糖中的作用。方法 2009年6月至2010年6月门诊就诊的糖尿病患者156例进行护理干预。结果本组病例均顺利的按照护理干预内容完成3个月的调整,中途无一例退出,3个月内无一例患者出现糖尿病加重,出现糖尿病酮症酸中毒、低血糖、糖尿病合并感染等急性并发症。护理干预前与护理干预后观察空腹血糖、餐后2h血糖、胰岛素用量、糖化血红蛋白比较P<0.01有显著差异性。结论通过对糖尿病患者进行系统的护理干预可以使患者增强战胜疾病的决心,积极配合治疗;饮食控制、运动疗法是干预的主要内容,可以从生活中对疾病进行治疗,减少药物的应用,防范并发症的发生。     

动态血糖监测系统在2型糖尿病患者中的应用

目的探讨不同治疗方式后血糖波动的特点。方法根据糖化血红蛋白(HbA1c)及病程,将抽样对象分为格列美脲(A)组、胰岛素皮下注射(B)组及胰岛素泵(C)组,3组患者血糖控制至目标值即开始进行72h动态血糖监测,根据监测结果调整治疗及饮食。结果 A组的病程、HbA1c及空腹C肽水平明显高于其他2组,其余各项基线资料3组均具有较好的可比性。各组平均血糖值几乎相等;A组低血糖的发生率最低,接近零;B组低血糖的发生率明显高于C组,回归分析显示,B组血糖的波动与晚餐后2h血糖成线性回归关系。结论根据动态血糖监测及双C治疗方案调整降糖药物及饮食规律,可更高效率、更安全地强化血糖控制。     

胰岛素泵治疗妊娠期糖尿病临床观察及对妊娠结局的影响

目的探讨胰岛素泵治疗妊娠期糖尿病的临床疗效,及GDM对妊娠结局的影响。方法对我科收治的GDM孕妇进行治疗并对妊娠结局的影响进行分析。结果在GDM的治疗中,198例血糖、OGTT均控制在正常水平,有效率为92,9%,无低血糖及其他并发症发生。GDM孕妇妊高征、羊水过多、产后出血、早产的发生率明显高于正常组(P<0.05),新生儿窒息、新生儿低血糖的发生率明显高于正常组(P<0.05)。结论胰岛素泵是GDM患者安全有效的治疗手段。加强孕期保健,重视GDM的早期筛查,对减少母体和患儿并发症发生,提高孕妇优生优育有重要意义。     

Synbiotic Food Consumption Reduces Levels of Triacylglycerols and VLDL,but not Cholesterol,LDL, or HDL in Plasma from Pregnant Women

To our knowledge, no reports are available indicating the effects of synbiotic food consumption on blood lipid profiles and biomarkers of oxidative stress among pregnant women. This study was conducted to evaluate the effects of daily consumption of a synbiotic food on blood lipid profiles and biomarkers of oxidative stress in pregnant women. This randomized, double-blind, controlled clinical trial was performed among 52 primigravida pregnant women, aged 18 to 35-year-old at their third trimester. After a 2-week run-in period, subjects were randomly assigned to consume either a synbiotic (n = 26) or control food (n = 26) for 9 weeks. The synbiotic food consisted of a probiotic viable and heat-resistant Lactobacillus sporogenes (1 × 10⁷ CFU) and 0.04 g inulin (HPX)/g as the prebiotic. Patients were asked to consume the synbiotic and control foods two times a day. Biochemical measurements including blood lipid profiles, plasma total antioxidant capacity (TAC) and total glutathione (GSH) were conducted before and after 9 weeks of intervention. Consumption of a synbiotic food for 9 weeks resulted in a significant reduction in serum TAG (P = 0.04), VLDL (P = 0.04) and a significant rise in plasma GSH levels (P = 0.004) compared to the control food. No significant effects of the synbiotic food consumption on serum TC, LDL, HDL and plasma TAC levels (P > 0.05) were observed. Trial registry code: http://www.irct.ir. IRCT201212105623N3.     

富GIF啤酒酵母制品对糖尿病大鼠空腹血糖和糖耐受量的影响

目的研究富GTF啤酒酵母制品对糖尿病大鼠空腹血糖和糖耐受量的影响。方法采用腹腔注射四氧嘧啶建立糖尿病大鼠模型,将模型大鼠随机分为3组,分别每天服用普通面包酵母0.1g、富GTF啤酒酵母干粉0.1g和富GTF啤酒酵母胶囊1粒,每天测空腹血糖。30d后进行糖耐受量试验,测0、0.5和2h各时间点血糖。结果富GTF啤酒酵母胶囊和富GTF啤酒酵母干粉不降低正常大鼠血糖。服药30d后,富GTF啤酒酵母胶囊组糖尿病大鼠空腹血糖下降52.45%,富GTF啤酒酵母干粉组血糖下降32.34%,而面包酵母干粉无降糖作用。各样品组糖耐受量2h后均下降,富GTF啤酒酵母胶囊组血糖下降迅速。结论富GTF啤酒酵母胶囊降血糖效果显著,优于富GTF啤酒酵母干粉,并能显著改善糖尿病大鼠糖耐受量。     

不同干预措施对母乳喂养中孕产妇认知水平的影响研究

目的观察个体性化干预对母乳喂养中孕产妇认知程度的分析。方法选择2008年1月至2010年1月间我站分娩的110名健康初产妇作为研究对象。随机分为试验组60名,对照组50名。对照组进行常规入院健康知识宣传;试验组实施个体性化干预护理,观察2组母乳喂养的认知水平的变化情况。结果 2组经过实施不同的干预措施后孕产妇对母乳喂养的认知水平比较,实施个体性化干预护理的母乳喂养的认知水平明显优于对照组,差异有统计学意义(P<0.05)。结论实施个体性化干预护理措施,孕产妇对母乳喂养的认知水平明显提高,提升了母乳喂养率。     

Vitamin D and Evening Primrose Oil Administration Improve Glycemia and Lipid Profiles in Women with Gestational Diabetes

Limited data are available assessing the effects of vitamin D and evening primrose oil (EPO) administration on markers of insulin resistance and lipid concentrations in gestational diabetes mellitus (GDM). This study was designed to evaluate the effects of vitamin D and EPO administration on insulin resistance and lipid concentrations among women with GDM. In this prospective randomized, double‐blind, placebo‐controlled clinical trial, 60 participants with GDM were divided into 2 groups of either 1000 IU vitamin D3 and 1000 mg EPO or placebo for 6 weeks. At the beginning and end of the study, fasting blood samples were obtained from the participants to measure related variables. After 6 weeks of intervention, changes in fasting plasma glucose (?3.6 ± 7.5 vs. +1.5 ± 11.4 mg/dL, P = 0.04), serum insulin concentrations (?2.0 ± 5.3 vs. +4.6 ± 10.7 µIU/mL, P = 0.004), homeostasis model of assessment (HOMA) insulin resistance (?0.5 ± 1.1 vs. +1.1 ± 2.5, P = 0.003), HOMA‐B cell function (?7.7 ± 23.3 vs. +17.4 ± 42.9, P = 0.007) and the quantitative insulin sensitivity check index (+0.01 ± 0.02 vs. ?0.01 ± 0.02, P = 0.007) in the vitamin D plus EPO group were significantly different from the placebo group. In addition, compared with the placebo, vitamin D and EPO supplementation resulted in significant reductions in serum TAG (?20.0 ± 54.3 vs. +34.3 ± 38.2 mg/dL, P < 0.001), VLDL (?4.0 ± 10.9 vs. +6.9 ± 7.6 mg/dL, P < 0.001), TC (?22.1 ± 32.6 vs. +5.3 ± 20.1 mg/dL, P < 0.001), LDL concentrations (?18.0 ± 25.5 vs. +1.8 ± 15.7 mg/dL, P = 0.001) and TC/HDL (?0.3 ± 0.4 vs. +0.3 ± 0.5 mg/dL, P < 0.001). We did not observe any significant effect of vitamin D and EPO supplementation on serum HDL concentrations. Clinical trial registration number: http://www.irct.ir : IRCT201509115623N52.     

Asymmetric Dimethylarginine Plasma Levels and Endothelial Function in Newly Diagnosed Type 2 Diabetic Patients

It is now well established that major risk factors for cardiovascular diseases (CVD) impact upon endothelial function by decreasing nitric oxide (NO) bioavailability. Asymmetric dimethylarginine (ADMA), an endogenous analog of l-arginine, is able to inhibit the activity of endothelial-NO synthase, promoting endothelial dysfunction. Type 2 diabetes (T2D) is characterized by a reduced endothelium-dependent vasodilation and increased ADMA levels and ADMA is strongly associated with micro- and macrovascular diabetic complications. However, there are not a lot of data about the role of ADMA on endothelial function in newly diagnosed T2D patients without cardiovascular (CV) complications. For this aim, we have enrolled forty-five newly diagnosed T2D patients, evaluated by a oral glucose tolerance test, and thirty normal subjects. Endothelium-dependent and -independent vasodilatation was investigated by intra-arterial infusion of increasing doses of acetylcholine (ACh) and sodium nitroprusside. ADMA was measured by high-performance liquid chromatography and insulin resistance (IR) by HOMA. Newly diagnosed T2D patients showed higher ADMA and l-arginine mean values in comparison with normal subjects and a significantly reduced ACh-stimulated forearm blood flow (FBF). In T2D patients FBF was significantly and inversely correlated with ADMA (r = −0.524, p < 0.0001) and in a multivariate regression analysis, ADMA resulted the stronger predictor of FBF, explaining the 27.5% of variability (p < 0.0001). In conclusion, ADMA was strongly related to endothelial dysfunction also in patients with newly diagnosed T2D, without clinically manifest vascular complications. This field is of great interest for understanding the mechanisms underlying the pathogenesis of diabetic disease and its CV complications.     

未结合胆红素直接测定法研究孕妇各项肝功能与新生儿高胆红素血症关系

目的探讨孕妇各项肝功能特别是未结合胆红素直接测定法结果与新生儿高胆红素血症的关系。方法对本院295例孕妇肝功能指标与新生儿高胆红素血症关系进行前瞻性研究。结果新生儿高胆红素血症患儿与孕妇血清转氨酶(ALT)、间接胆红素(直接测定法)(IBIL)、血清胆汁酸(TBA)存在相关性。结论我们可以监测围生期孕妇的肝功能,并能尽早的对新生儿高胆红素血症或核黄疸进行干预。     

Validation of a Rapid Measure of Blood PUFA Levels in Humans

An assay involving a finger stick and filter paper blood spotting was developed to determine polyunsaturated fatty acid (PUFA) levels in blood. Capillary whole blood from a finger stick was blotted on antioxidant impregnated filter paper, air dried, saponified and methylated using sodium hydroxide and boron trifluoride in methanol. The method differed from those described previously because separation of plasma and red blood cells (RBCs) was not needed, thin-layer chromatography (TLC) was not required to separate phospholipids, initial extraction of lipids before transesterification was not necessary, and the fatty acid methyl ester (FAME) method was able to methylate steryl esters, free fatty acids, and sphingomyelins. Twenty-six subjects provided blood samples by finger stick and venipuncture. Levels of long-chain polyunsaturated fatty acids (LC-PUFA) from capillary whole blood were correlated with those from RBCs and PLs in venous blood (P < 0.001, R ² ranged from 0.64 to 0.86). Although highly significant (P < 0.002), the R ² values for the correlation between arachidonic acid (ARA) levels in capillary whole blood with ARA levels in RBCs and plasma phospholipids (PLs) were relatively lower (R ² = 0.31–0.41, respectively). Results indicate that the described finger stick assay represents a fast, reliable method to measure specific LC-PUFA levels.     

孕妇IgG类红细胞血型不规则抗体对早期诊断Non-ABO-HDN的意义

目的探讨孕妇IgG类红细胞血型不规则抗体对早期诊断Non-ABO-HDN的意义。方法筛查4200份孕妇血清中红细胞血型不规则抗体,阳性者检测抗体特异性、免疫球蛋白类型及效价;对检测出IgG类不规则抗体者,分娩时取脐血(或新生儿血)检测血清(浆)游离抗体,并进行红细胞直接抗球蛋白试验和红细胞放散试验,以诊断其是否发生HDN。结果4200份孕妇血清中检出红细胞血型不规则抗体44份(阳性率为1.05%),其中20份孕妇血清的抗体为IgG类或IgG及IgM混合抗体,脐血(或新生儿血)检测结果,10名婴儿发生了Non-ABO-HDN,1名发生了宫内死胎。致病的抗体特异性分布为:抗-D2例、抗-c1例、抗-E2例、抗-cE1例、抗-M4例(其中1例并有抗-A)。结论孕妇体内IgG类的Rh血型系统的抗体及抗-M易引起non-ABO-HDN,检测孕妇IgG类红细胞血型不规则抗体对早期诊断Non-ABO-HDN、鉴别引发HDN的抗体型别、评估HDN的严重程度及制定治疗方案均具有重要意义。     

洋甘菊对1型糖尿病模型小鼠血糖的影响及其抗血栓作用研究

采用四氧嘧啶诱导建立1型糖尿病模型小鼠,通过测定血糖值、降糖率、血糖曲线下面积(AUC),探讨了洋甘菊提取物对1型糖尿病模型小鼠血糖和糖耐量的影响;通过测定凝血时间、止血时间、血栓抑制率,研究了洋甘菊提取物对正常小鼠和大鼠的抗血栓作用。结果表明,洋甘菊提取物对1型糖尿病模型小鼠具有一定的降血糖作用;洋甘菊醇提物和水提物(高剂量)可明显改善1型糖尿病模型小鼠的糖耐量;洋甘菊醇提物(高、中剂量)可以明显延长正常小鼠的凝血时间和止血时间;洋甘菊醇提物和水提物对大鼠的血栓抑制率最高分别可达42.62%和31.00%,阳性对照(阿司匹林)组的血栓抑制率为48.69%。表明,洋甘菊提取物具有较好的降血糖作用和抗血栓作用。     

Plasma Levels of Dimethylarginines in Preterm Very Low Birth Weight Neonates: Its Relation with Perinatal Factors and Short-Term Outcome

Endogenously produced inhibitors of nitric oxide (NO) synthase, in particular asymmetric dimethylarginine (ADMA), are currently considered of importance in various disease states characterized by reduced NO availability. We investigated the association between plasma levels of ADMA, symmetric dimethylarginine (SDMA), l-arginine, and citrulline and perinatal factors and outcome in 130 preterm (gestational age ≤30 weeks) very low birth weight (VLBW, <1500 g) infants. Plasma samples were collected 6–12 h after birth. We did not find significant correlations between ADMA, SDMA, l-arginine, and citrulline levels and gestational age or birth weight. However, the arginine:ADMA ratio (AAR, a better indicator of NO availability than either arginine or ADMA separately) was positively correlated with gestational age. ADMA and arginine levels were not significantly different between males and females but males showed a negative correlation between ADMA levels and gestational age. Perinatal factors such as preeclampsia, chrorioamnionitis, prolonged rupture of membranes, or form of delivery did not significantly alter dimethylarginine levels or AAR. In contrast, the AAR was significantly reduced in the infants with respiratory distress, mechanical ventilation, and systemic hypotension Therefore, our data suggest that altered NO availability may play a role in the respiratory and cardiovascular adaptation in preterm VLBW infants.