妊娠糖尿病的概述及中医证候学调查分析
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摘要
妊娠期糖尿病(Gestational diabetes mellitus, GDM)是指妊娠期发生或首次识别出的不同程度的葡萄糖耐量异常,如果在妊娠早期发现,不排除在妊娠前已经存在葡萄糖耐量异常的可能性。如不及时治疗,GDM患者发生先兆子痫、难产、手术产和产褥感染等多种产科以及围产期并发症如巨大儿、胎儿宫内生长受限、不明原因的胎死宫内、新生儿呼吸窘迫综合征、新生儿低血糖和新生儿高胆红素血症等概率明显升高。而由于其病是近代随着妇产科的发展而发现的,故其中医方面的研究尚有欠缺。
本课题是在中医理论及证素思想的指导下,对妊娠糖尿病进行证候学研究,希望通过该研究,进一步探讨本病证候的特点,分析其病因病机,深化对症与证之间关系的认识,为提高临床疗效提供参考。
本论文包括文献综述和临床研究两个部分。回顾了近年来现代医学对本病的研究进展,西医方面主要从其流行病学、病因病机、临床表现、临床检查、治疗等方面进行了阐述。中医方面着重介绍了中医对妊娠病及糖尿病的认识,包括病名探讨、病因、病机、辨证论治等方面。
临床研究部分观察了90例糖尿病肾病的患者,应用SPSS(StatisticaPackage for Social Science) 13.0软件进行统计分析,其中根据中华中医药学会中医诊断学分会修正的中医常见证诊断标准,对临床所见症状进行评分、诊断。
90例妊娠糖尿病患者研究的结果显示：1.妊娠糖尿病的常见症状是：夜尿多-81.11%,尿频-80.00%,多食善饥-75.56%,口渴-63.33%,腰酸-63.33%,倦怠乏力-62.22%,手足心烧-57.78%,健忘-51.11%,多梦-50.00%,自汗-47.78%。2.妊娠糖尿病患者的主要证侯为：气阴两虚证>肾气虚证=心神阴虚证>脾肾阳虚证>心气阴虚证>心肾不交证；以本虚证为主,其本虚证又以气阴两虚证为主。
Gestational diabetes mellitus (GDM) is the first identified during pregnancy occurred or the different degrees of abnormal glucose tolerance, if early detection of pregnancy, do not rule out pregnancy before the existence of the possibility of abnormal glucose tolerance.If not treated in time, GDM patients with pre-eclampsia, dystocia, operative delivery, and puerperal infection and other obstetric and perinatal complications such as large child, intrauterine growth restriction, unexplained stillbirth, newbornchildren with respiratory distress syndrome, neonatal hypoglycemia and other neonatal hyperbilirubinemia was significantly higher probability. And because the disease is the development of modern obstetrics and gynecology as found, so its still a lack of research in Chinese medicine.
Under the instruction of the Chinese medicine theory, this paper researches on Gestational diabetes mellitus, further discusses the character of this disease, analyzes the cause and the pathogenesis, and makes clear the relations between syndrome and pattern of syndrome, in order to supply the proof for the dialectical therapy and to prove clinical curative effect.
This paper consists of two parts which include one summaries of document and a clinical study.
The summarizes modern medicine studies on Gestational diabetes mellitus in the resent years, including its epidemic,pathogenic,clinical manifestation, laboratory,examination and treatment. The Chinese medicine on DM and Pregnancy Disease, including the name of the disease, pathogenic factors, pathogenesis, differentiation and treatment of common syndromes.
Clinical research observes 90 Gestational diabetes mellitus patients, applies SPSS(Statistical Package for Social Science) 13.0 to analyze.
The results:①Polyuria at night-81.11%, frequent micturition-80.00%,-75.56% more food good hunger, thirst-63.33%,-63.33%sore waist, malaise and fatigue-62.22%,-57.78%burn feeling in palm and sole, forgetful-51.11%, dreaminess-50.00%,-47.78% spontaneous sweating.
②The main single syndrome of Gestational diabetes mellitus are insufficiency of both Qi and Yin> Kidney Qi deficiency= Heart Vitality Yin deficiency> Yang deficiency of both spleen and kidney> Heart Qi and Yin deficiency>disharmony between Heart and Kidney.To the deficiency in the "root" of the main, its present insufficiency of both Qi and Yin.
本课题是在中医理论及证素思想的指导下,对妊娠糖尿病进行证候学研究,希望通过该研究,进一步探讨本病证候的特点,分析其病因病机,深化对症与证之间关系的认识,为提高临床疗效提供参考。
本论文包括文献综述和临床研究两个部分。回顾了近年来现代医学对本病的研究进展,西医方面主要从其流行病学、病因病机、临床表现、临床检查、治疗等方面进行了阐述。中医方面着重介绍了中医对妊娠病及糖尿病的认识,包括病名探讨、病因、病机、辨证论治等方面。
临床研究部分观察了90例糖尿病肾病的患者,应用SPSS(StatisticaPackage for Social Science) 13.0软件进行统计分析,其中根据中华中医药学会中医诊断学分会修正的中医常见证诊断标准,对临床所见症状进行评分、诊断。
90例妊娠糖尿病患者研究的结果显示：1.妊娠糖尿病的常见症状是：夜尿多-81.11%,尿频-80.00%,多食善饥-75.56%,口渴-63.33%,腰酸-63.33%,倦怠乏力-62.22%,手足心烧-57.78%,健忘-51.11%,多梦-50.00%,自汗-47.78%。2.妊娠糖尿病患者的主要证侯为：气阴两虚证>肾气虚证=心神阴虚证>脾肾阳虚证>心气阴虚证>心肾不交证；以本虚证为主,其本虚证又以气阴两虚证为主。
Gestational diabetes mellitus (GDM) is the first identified during pregnancy occurred or the different degrees of abnormal glucose tolerance, if early detection of pregnancy, do not rule out pregnancy before the existence of the possibility of abnormal glucose tolerance.If not treated in time, GDM patients with pre-eclampsia, dystocia, operative delivery, and puerperal infection and other obstetric and perinatal complications such as large child, intrauterine growth restriction, unexplained stillbirth, newbornchildren with respiratory distress syndrome, neonatal hypoglycemia and other neonatal hyperbilirubinemia was significantly higher probability. And because the disease is the development of modern obstetrics and gynecology as found, so its still a lack of research in Chinese medicine.
Under the instruction of the Chinese medicine theory, this paper researches on Gestational diabetes mellitus, further discusses the character of this disease, analyzes the cause and the pathogenesis, and makes clear the relations between syndrome and pattern of syndrome, in order to supply the proof for the dialectical therapy and to prove clinical curative effect.
This paper consists of two parts which include one summaries of document and a clinical study.
The summarizes modern medicine studies on Gestational diabetes mellitus in the resent years, including its epidemic,pathogenic,clinical manifestation, laboratory,examination and treatment. The Chinese medicine on DM and Pregnancy Disease, including the name of the disease, pathogenic factors, pathogenesis, differentiation and treatment of common syndromes.
Clinical research observes 90 Gestational diabetes mellitus patients, applies SPSS(Statistical Package for Social Science) 13.0 to analyze.
The results:①Polyuria at night-81.11%, frequent micturition-80.00%,-75.56% more food good hunger, thirst-63.33%,-63.33%sore waist, malaise and fatigue-62.22%,-57.78%burn feeling in palm and sole, forgetful-51.11%, dreaminess-50.00%,-47.78% spontaneous sweating.
②The main single syndrome of Gestational diabetes mellitus are insufficiency of both Qi and Yin> Kidney Qi deficiency= Heart Vitality Yin deficiency> Yang deficiency of both spleen and kidney> Heart Qi and Yin deficiency>disharmony between Heart and Kidney.To the deficiency in the "root" of the main, its present insufficiency of both Qi and Yin.
引文
[1]American Diabetes Association Gestational DiabetesMellitus[J].Diabetes Care,2006,27[Sup 1 I]:88-90.
[2]乐 杰.妇产科学[M].6版.北京人民卫生出版社,2005： 159-162.
[3]HodM, Rbaniesron, Kap lna B, et al. Perinatal comp liactions following gestational diabetesmellitus how'sweet'is ill?Acta Obstet Gy2 neocl Snacd,1989,257:110821116.
[4]Tan, Y, Yeo G. n IlPaired glucose tolerance in p rengnacy:is ofconse puenee? AustN Z Obstet Gynaecol,1996,36:2482255.
[5]庄依亮.奸娠合并糖尿病的孕期处理[J].中国实用妇科与产科杂志,2000,16(11)： 6512.
[6]Espinosa de los Monteros A, Parra A, Hidalgo R, et al.The after breakfast 50g,1-hour glucose challenge test in urban Mexican pregnant women:its sensitivity and specificity evaluated by three diagnostic criteria for gestational diabetes mellitus. Acta Obstet Gynecol Scand,1999,78(4):294.
[7]廖彦、谢勇、卢晓珠.糖化血红蛋白在妊娠糖尿病诊断中的作用[J].现代生物医学进展.2009,11：2160-2161.
[8]Rasouli N, Kern P A. A dipocytokines and the metabolic comp lications of obesity [J]. J C lin EndocrinolM etab,2008,93 (11 Supp 11):S642S73.
[9]Hutley L, Prins JB. Fat as endocrine organ:relationship to the metabolic syndrome[J]. Am J Med Sci,2005,6:280-289.
[10]卢静、梁西岚、冯燕,孕期体重异常增加对妊娠结局的影响[J].《中国现代医生·临床研究》2009.47(11)：57-58.
[11]杨慧霞.妊娠期糖尿病流行病学现况[J].中华全科医师杂志,2005,4(8)：4532455.
[12]Jang HC, Cho NH, Jung KB, et al.Screening for gestational diabetes.mellitus in Korea.Int J Gynecol Obstet,1995,51(2):115.
[13]Martin AO, Simpson JL, Ober C, et al.Frequency of diabetes mellitus in mothers of probands with gestational diabetes:possible maternal influence on the predisposition to gestational diabetes.Am J Obstet Gynecol,1985,151(4):471.
[14]Ben HA, Yogev Y, Hod M. Ep idem iology of gestational diabetes mellinis and insassociation with type-diabetes [J]. D iaber M ed,2004,21 (2):1032113.
[15]Sanchez-Vera I, Bonet B, VianaM, et al. Changes in p lasma lip ids and increased low- density lipop rotein suscep tibility to oxidation in p regnancies comp licated by gestational diabetes:onsequences of obesity [J]. Metabolism,2007,56:1527-1533.
[16]Enquobahrie DA, WilliamsMA, Qiu C, et al. Early p regnancy lip id concentrations and the risk of gestational diabetesmellitus [J]. Diabetes Res Clin Pract,2005,70:134-142.
[17]张丽丽,黄亚绢,葛 声,陆秀芳,高脂饮食诱导妊娠期胰岛素抵抗大鼠糖脂代谢特征,现代妇产科进展2009,18(16)：446-447.
[18]李平.心理社会应激与妊娠期糖尿病关系的研究.中国实用护理杂志,2006,22(4) ： 15.
[19]张红,杨西林,张翠萍,等.妊娠糖尿病筛查与筛查阳性的危险因素分析.中国全科医学,2004,7(2)：86
[20]Hadaegh F, TohidiM, Harati H, et al. Prevalence of gestational diabetesmellitus in southern Iran (BandarAbbasCity) [J]. Endocr Pract,2005,11:3132318.
[21]Buchanan TA, Xiang A, Kjos SL, et al. Gestational diabetes:antepartum characteristics that predict postpartum glucose intolerance and type 2 diabetes in Latino women[J].Diabetes, 1998,47:1302-1310.
[22]di Cianni G, Seghieri G, Lencioni C, et al. Normal glucosetolerance and gestational diabetes mellitus [J]. Diabetes Care,2007,30 (7):178321788.
[23]程飞,康慨,李莹等.妊娠期不同糖代谢状态胰岛素抵抗和胰岛β细胞分泌功能的临床分析.《临床荟萃》2009.20(5)：881-883.
[24]FAGEN C, KING J D, ER ICK M. Nutrition management in women with gestational diabetes mellitus a review by ADAps dia-betes cat and education dietetic pactice groups [J].Am Diet As2soc,1995,95 (4):460-467.
[25]王永丽,任卫东.妊娠糖尿病的围产期护理[J]. 张家口医学院学报,2003,20(5)：49-50.
[26]夏燕琼,汤捷.55例妊娠期糖尿病营养治疗的效果分析[J]. 《现代医院·专业技术篇》2009.9(2)：52-53.
[27]杜曲晓、乔玉环.妊娠期糖尿病诊疗体会[J].《医药论坛杂志》2009.30(1)：93-94.
[28]Coustan DR. Making the diagnosis of gestational diabetes[J].Clin Obstet Gynecol,2000, 43(21):99-105.
[29]徐琳,叶元华,王艳,等.控制血糖对妊娠期糖尿病孕妇胰岛β细胞功能及胰岛素抵抗的影响[J].山东医药,2004,44(15)：22-23.
[30]Zierath JR, Krook A, Wallberg HH. Insulin action and insulin resistance in human skeletal muscle[J]. Diabetologia,2000,43(10):821-335.
[31]顾美皎.临床妇产科学[M].北京人民卫生出版社,2001： 282-296.
[32]谭自然,金良玉.护理新概念与临床[M].合肥：中国科学技术大学出版社,1998.
[33]孟凤仙、倪青、闫秀峰、等.消渴病的中医认识思路与方法.中国中医药信息杂志.2005,12(9).92-94.
[34]张恩虎.糖尿病论治四法.山东中医杂志.1996,15(7)：291-292
[35]林兰.糖尿病的中西医结合论治.北京：北京科学技术出版社.1992,143-151.
[36]钟洪,赵洁.糖尿病辨治心法.四川中医.2002,20(7)：12-13.
[37]张孝,宋桂英.任继学教授治疗消渴病经验拾萃.长春中医学院学报.1994,12(43)：10.
[38]顾再强,蓝海珍.糖尿病病机及辨治浅探.安徽中医学院学报.1997,16(3)：14-15.
[39]黄佳娜.糖尿病从气阴两虚论治的理论探讨.中国中医基础医学杂志.2000,6(9)：1-2.
[40]吕仁和,赵进喜,王世东.吕仁和糖尿病及其并发症的临床研究.新中医.2001,33(3)：3-5.
[41]石焕玉,龚琳玲,仝小林.浅述2型糖尿病分阶段辨证诊治.工企医刊.2001,14(5)：58-59.
[42]吕仁和.糖尿病及其并发症中西医诊治学.人民卫生出版社.第一版.1997,67-68.
[1]张红,杨西林,张翠萍,等.妊娠糖尿病筛查与筛查阳性的危险因素分析.中国全科医学,2004,7(2)：86
[2]张荣君,许茜,刘爱民.青岛市城区妊娠期糖代谢异常相关因素的调查分析.现代妇产科进展,2006,15(5)：368
[3]杨慧霞.妊娠合并糖尿病的诊断[J].中国实用妇产与产科志,2000,16(11)：648-650.
[2]乐 杰.妇产科学[M].6版.北京人民卫生出版社,2005： 159-162.
[3]HodM, Rbaniesron, Kap lna B, et al. Perinatal comp liactions following gestational diabetesmellitus how'sweet'is ill?Acta Obstet Gy2 neocl Snacd,1989,257:110821116.
[4]Tan, Y, Yeo G. n IlPaired glucose tolerance in p rengnacy:is ofconse puenee? AustN Z Obstet Gynaecol,1996,36:2482255.
[5]庄依亮.奸娠合并糖尿病的孕期处理[J].中国实用妇科与产科杂志,2000,16(11)： 6512.
[6]Espinosa de los Monteros A, Parra A, Hidalgo R, et al.The after breakfast 50g,1-hour glucose challenge test in urban Mexican pregnant women:its sensitivity and specificity evaluated by three diagnostic criteria for gestational diabetes mellitus. Acta Obstet Gynecol Scand,1999,78(4):294.
[7]廖彦、谢勇、卢晓珠.糖化血红蛋白在妊娠糖尿病诊断中的作用[J].现代生物医学进展.2009,11：2160-2161.
[8]Rasouli N, Kern P A. A dipocytokines and the metabolic comp lications of obesity [J]. J C lin EndocrinolM etab,2008,93 (11 Supp 11):S642S73.
[9]Hutley L, Prins JB. Fat as endocrine organ:relationship to the metabolic syndrome[J]. Am J Med Sci,2005,6:280-289.
[10]卢静、梁西岚、冯燕,孕期体重异常增加对妊娠结局的影响[J].《中国现代医生·临床研究》2009.47(11)：57-58.
[11]杨慧霞.妊娠期糖尿病流行病学现况[J].中华全科医师杂志,2005,4(8)：4532455.
[12]Jang HC, Cho NH, Jung KB, et al.Screening for gestational diabetes.mellitus in Korea.Int J Gynecol Obstet,1995,51(2):115.
[13]Martin AO, Simpson JL, Ober C, et al.Frequency of diabetes mellitus in mothers of probands with gestational diabetes:possible maternal influence on the predisposition to gestational diabetes.Am J Obstet Gynecol,1985,151(4):471.
[14]Ben HA, Yogev Y, Hod M. Ep idem iology of gestational diabetes mellinis and insassociation with type-diabetes [J]. D iaber M ed,2004,21 (2):1032113.
[15]Sanchez-Vera I, Bonet B, VianaM, et al. Changes in p lasma lip ids and increased low- density lipop rotein suscep tibility to oxidation in p regnancies comp licated by gestational diabetes:onsequences of obesity [J]. Metabolism,2007,56:1527-1533.
[16]Enquobahrie DA, WilliamsMA, Qiu C, et al. Early p regnancy lip id concentrations and the risk of gestational diabetesmellitus [J]. Diabetes Res Clin Pract,2005,70:134-142.
[17]张丽丽,黄亚绢,葛 声,陆秀芳,高脂饮食诱导妊娠期胰岛素抵抗大鼠糖脂代谢特征,现代妇产科进展2009,18(16)：446-447.
[18]李平.心理社会应激与妊娠期糖尿病关系的研究.中国实用护理杂志,2006,22(4) ： 15.
[19]张红,杨西林,张翠萍,等.妊娠糖尿病筛查与筛查阳性的危险因素分析.中国全科医学,2004,7(2)：86
[20]Hadaegh F, TohidiM, Harati H, et al. Prevalence of gestational diabetesmellitus in southern Iran (BandarAbbasCity) [J]. Endocr Pract,2005,11:3132318.
[21]Buchanan TA, Xiang A, Kjos SL, et al. Gestational diabetes:antepartum characteristics that predict postpartum glucose intolerance and type 2 diabetes in Latino women[J].Diabetes, 1998,47:1302-1310.
[22]di Cianni G, Seghieri G, Lencioni C, et al. Normal glucosetolerance and gestational diabetes mellitus [J]. Diabetes Care,2007,30 (7):178321788.
[23]程飞,康慨,李莹等.妊娠期不同糖代谢状态胰岛素抵抗和胰岛β细胞分泌功能的临床分析.《临床荟萃》2009.20(5)：881-883.
[24]FAGEN C, KING J D, ER ICK M. Nutrition management in women with gestational diabetes mellitus a review by ADAps dia-betes cat and education dietetic pactice groups [J].Am Diet As2soc,1995,95 (4):460-467.
[25]王永丽,任卫东.妊娠糖尿病的围产期护理[J]. 张家口医学院学报,2003,20(5)：49-50.
[26]夏燕琼,汤捷.55例妊娠期糖尿病营养治疗的效果分析[J]. 《现代医院·专业技术篇》2009.9(2)：52-53.
[27]杜曲晓、乔玉环.妊娠期糖尿病诊疗体会[J].《医药论坛杂志》2009.30(1)：93-94.
[28]Coustan DR. Making the diagnosis of gestational diabetes[J].Clin Obstet Gynecol,2000, 43(21):99-105.
[29]徐琳,叶元华,王艳,等.控制血糖对妊娠期糖尿病孕妇胰岛β细胞功能及胰岛素抵抗的影响[J].山东医药,2004,44(15)：22-23.
[30]Zierath JR, Krook A, Wallberg HH. Insulin action and insulin resistance in human skeletal muscle[J]. Diabetologia,2000,43(10):821-335.
[31]顾美皎.临床妇产科学[M].北京人民卫生出版社,2001： 282-296.
[32]谭自然,金良玉.护理新概念与临床[M].合肥：中国科学技术大学出版社,1998.
[33]孟凤仙、倪青、闫秀峰、等.消渴病的中医认识思路与方法.中国中医药信息杂志.2005,12(9).92-94.
[34]张恩虎.糖尿病论治四法.山东中医杂志.1996,15(7)：291-292
[35]林兰.糖尿病的中西医结合论治.北京：北京科学技术出版社.1992,143-151.
[36]钟洪,赵洁.糖尿病辨治心法.四川中医.2002,20(7)：12-13.
[37]张孝,宋桂英.任继学教授治疗消渴病经验拾萃.长春中医学院学报.1994,12(43)：10.
[38]顾再强,蓝海珍.糖尿病病机及辨治浅探.安徽中医学院学报.1997,16(3)：14-15.
[39]黄佳娜.糖尿病从气阴两虚论治的理论探讨.中国中医基础医学杂志.2000,6(9)：1-2.
[40]吕仁和,赵进喜,王世东.吕仁和糖尿病及其并发症的临床研究.新中医.2001,33(3)：3-5.
[41]石焕玉,龚琳玲,仝小林.浅述2型糖尿病分阶段辨证诊治.工企医刊.2001,14(5)：58-59.
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