【作者】 张雪；

【导师】 翟凤霞；

【作者基本信息】 河南中医学院 ， 中医妇科学（专业学位）， 2014， 硕士

【摘要】 目的：探讨新诊断标准下妊娠期糖尿病(gestational diabetes mellitus,GDM)发病的危险因素及炎症因子C反应蛋白(C-reactive protein,CRP)与GDM发病的相关性，为临床通过对GDM的危险因素进行早期干预，以预防GDM及远期并发症提供一定的循证学依据，顺应中医“治未病”理念，为创建具有中医特色的围产保健模式提供参考。方法：本课题采用横断面调查的研究方法，对2013年4月～2014年2月在河南中医学院第一附属医院建卡并定期行围产保健检查的孕28周内的单胎孕妇进行抽样调查。选出符合GDM诊断标准的孕妇91例作为观察组，并采用单纯随机抽样法从179份完整问卷中选出同期围产保健的健康孕妇91例作为对照组。对调查对象采用GDM流行病学调查表(见附录1)进行调查，将调查结果录入SPSS并建立数据库。采用SPSS18.0统计软件用χ2检验对计数资料进行分析，采用t检验对计量资料进行分析，对于计量资料首先进行正态分布检验，采用单样本k-s检验法，若为正态分布，则进行两独立样本的t检验法进行分析，反之则进行两独立样本的非参数检验法进行分析。对于多因素的研究采用Logistic回归分析法。结果：①观察组和对照组在饮食偏嗜，孕前体重指数，本次妊娠年龄，初次妊娠年龄，OGTT时体重增幅，糖尿病家族史，GDM史，不良孕产史，妊娠次数，巨大儿或羊水过多分娩史，多囊卵巢综合征病史，本次妊娠胎儿大于孕周或羊水过多等方面存在有显著性统计学差异(P＜0.05)。②观察组和对照组CRP水平具有显著性统计学差异(P＜0.05)。③观察组与对照组在职业，教育文化程度，产次，分娩方式，乙肝病毒表面抗原携带，反复性假丝酵母菌感染史等方面的组间比较中差异无统计学意义(P＞0.05)。④经多因素Logistic回归分析，孕前体重指数，本次妊娠年龄，妊娠次数，不良孕产史，巨大儿或羊水过多分娩史，多囊卵巢综合征病史，CRP七个危险因素均进入回归模型，各影响回归系数分别为1.334,0.520,-0.813,1.580,1.709,1.513,0.262。结论：①多因素Logistic回归结果显示：孕前体重指数，妊娠年龄，不良孕产史，巨大儿或羊水过多分娩史，多囊卵巢综合征病史是新诊断标准下GDM的独立危险因素。②CRP水平与新诊断标准下GDM的发病呈正相关性，有一定的早期预测作用。③饮食偏嗜，初次妊娠年龄，GDM史，糖尿病家族史，本次妊娠胎儿大于孕周或羊水过多等因素未能进入回归模型，可能是GDM的混杂因素。更多还原

【Abstract】 Objective: The purpose of this survey is to investigate the relativity between risk factorsand inflammatory cytokins of C-reactive protein (C-reactive protein, CRP) under thenew diagnostic standard.It provide evidence-based evidence for early prevent of riskfactors of GDM, prevention of GDM and longterm compications.From the cure not illthe guiding ideology of TCM,to provide reference for structuring perinatal care modelcreated with TCM feature.Methods: Cross session study method is used for this research.this research carry on asampling survey among the singletons of pregnant women who pregnant within28weeksthat underwent regular perinatal care in first affiliated hospital of Henan University ofTraditional Chinese Medicine from April2013to February2014.Detecting GRP before firsttime Perinatal Health Care. Selecting91cases of pregnant women with GDM diagnosisstandard as observation group, and using simple random sampling method is chosen fromamong179completed questionnaires during the same period among the health care of91cases of healthy pregnant women as control group. To investigate the selected pregnantwomen with GDM epidemiological questionnaire (see Appendix1), record the results,andtype into the SPSS and to establish the database. The χ2test is used for the count data usingSPSS18.0statistics software,the t test is used for measurement data, Single sample k-s testis first used for measurement data to test its distribution is normal distribution.if it is normaldistribution,two independent sample t test is used for statistical analysis,if it dose not belongto the normal distribution,two independent sample nonparametric test is used for statisticalanalysis.Results:①O bservation group and control group, these2groups have obvious statisticsdifference (P＜0.05) in below aspects: diet partial addicted,weight before pregnant, currentpregnant age, first time pregnant age, weight increasing when OGTT, diabetes history offamily, the history of GDM, the histories of abnormal pregnant, times of gestation, huge newborn, the histories of amniotic fluid delivery, the histories of polycystic oophoron symptom,The pregnancy with fetal huger than gestational age or amniotic fluid pregnancy. ②O bservation group and control group, these2groups have obvious statistics difference (P＜0.05) in CRP level.③After compare between observation group and control group,difference don’t have statistics significance (P>0.05) with below aspects: occupation,education degree, delivery times, delivery methods, hepatitis b virus surface antigen,the histories of repetitive candida infection.④After multi-factor Logistic regressionanalysis,these7dangerous factors are categorized as regression model, which areweight before pregnant, pregnant age, times of gestation, the histories of abnormal pregnant,huge new born, the histories of amniotic fluid delivery, the histories of polycystic oophoronsymptom,CRP. Regression coefficient individually are1.334,0.520,-0.813,1.580,1.709,1.513,0.262.Conclusions:①Logistic regression result reveals that below6are independent dangerousfactors of GDM under new diagnostic standard, which are weight before pregnant, pregnantage, the histories of abnormal pregnant, huge new born, the histories of amniotic fluiddelivery,the histories of polycystic oophoron symptom.②CRP level and the risk ofdeveloping new diagnostic criteria for GDM was a positive correlation,there are certainearly prediction effect.③The factors such as diet partial addicted,the age of first pregnant,the histories of GDM, diabetes history of family,current pregnancy with fetal huger thangestational age or amniotic fluid pregnancy, was not included regression model, might be themixed factors which causing GDM.更多还原