妊娠合并糖尿病的临床研究现状.docx

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妊娠合并糖尿病的临床研究现状

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刘桂萍张林张国领

[摘要]妊娠合并糖尿病包括糖尿病合并妊娠（PGDM）和妊娠期糖尿病（GDM），是一类能导致多种不良妊娠结局的重要疾病，近年来患病率持续上升，越来越受到临床重视。研究表明，微生物与妊娠期代谢性疾病密切相关。妊娠期高血糖对母体的影响表现为糖代谢异常、心血管疾病、代谢综合征、产后抑郁症的风险增加，对子代的影响表现为胎儿死亡、畸形等不良妊娠结局以及远期发生糖代谢异常、肥胖的风险增加。GDM的早期诊断具有重要的临床意义，血糖管理应贯穿孕前、孕期及产后全程，良好血糖控制可改善母婴的近远期预后，生活方式干预是基本策略，药物治疗首选胰岛素，选择符合生理性分泌特征的基础胰岛素是优化治疗策略。本文就国内外的相关研究现状进行综述，以期为临床诊疗提供有益参考。

[关键词]妊娠合并糖尿病；糖尿病合并妊娠；妊娠期糖尿病；不良妊娠结局；血糖管理；胰岛素

[]R587.1[]A[]1674-4721（2018）9（b）-0046-04

[Abstract]Diabetesinpregnancyincludingpre-gestationaldiabetesmellitus（PGDM）andgestationaldiabetesmellitus（GDM）isanimportantdiseasewhichcanleadtomanyadversepregnancyoutcomes.Inrecentyears，theprevalenceratecontinuestorise，whichisattractingmoreandmoreattention.Studieshaveshownthatmicrobesarecloselyrelatedtothemetabolicdiseasesofpregnancy.Theinfluenceofgestationhyperglycemiaonmaternalbodyisabnormalglucosemetabolism，cardiovasculardisease，metabolicsyndrome，andpostpartumdepression.Theinfluenceoftheoffspringismanifestedbyfetaldeath，malformationandotheradversepregnancyoutcomesaswellasthelong-termoccurrenceofabnormalglucosemetabolismandobesity.EarlydiagnosisofGDMhasimportantclinicalsignificance.Bloodglucosemanagementshouldrunthroughthewholecourseofpre-pregnancy，pregnancyandpostpartum.Goodbloodglucosecontrolcanimprovethenearandlongtermprognosisofmotherandinfant.Lifestyleinterventionisthebasicstrategyofbloodglucosemanagement.Insulinisthefirstchoicefordrugtreatment.Theselectionofbasicinsulin，whichaccordswiththephysiologicalsecretioncharacteristics，isoptimizedtreatmentstrategy.Inthispaper，therelevantresearchstatusathomeandabroadisreviewed，inordertoprovideusefulreferenceforclinicaldiagnosisandtreatment.

[Keywords]Diabetesinpregnancy；Pre-gestationaldiabetesmellitus；Gestationaldiabetesmellitus；Adversepregnancyoutcome；Bloodglucosem