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目的探讨纯母乳喂养对妊娠期糖尿病(GDM)患者产后糖、脂代谢和体成分的影响。方法选取80例GDM患者,根据产后母乳喂养情况分为纯母乳喂养组和混合喂养组,测定产前和产后第42天口服葡萄糖耐量试验(OGTT)、血脂谱、胰岛素及产后24 h内和第42天体成分。结果 58例患者完成观察,其中纯母乳喂养组30例,产后42 d较产前OGTT血糖、胰岛素值和胆固醇(TC)、低密度脂蛋白胆固醇(LDL)水平均明显降低(P<0.05),胰岛素敏感指数(ISI)明显升高(P<0.01);较产后24 h内的基础代谢明显增加(P<0.01)、内脏脂肪等级降低(P<0.05)。混合喂养组28例,产后42 d较产前空腹血糖(FBG)、OGTT 2h血糖(2hPG)降低(P<0.05),而其余指标均无明显变化(P>0.05)。产后42 d时纯母乳喂养组较混合喂养组血糖、胰岛素及血脂、内脏脂肪等级均明显低(P<0.05),ISI和基础代谢明显高(P<0.01)。结论 GDM患者产后进行纯母乳喂养可以有效改善其糖、脂代谢,提高胰岛素敏感性,降低胰岛素抵抗,改善脂代谢;并有利于提高基础代谢率和减少内脏脂肪。
Objective To investigate the effects of exclusive breastfeeding on postpartum glucose, lipid metabolism and body composition in patients with gestational diabetes mellitus (GDM). Methods Eighty patients with GDM were divided into exclusive breastfeeding group and mixed feeding group according to postpartum breastfeeding status. The oral glucose tolerance test (OGTT), serum lipid profile, insulin, 42 celestial composition. Results Fifty-eight patients completed the observation. Among them, 30 were exclusively breastfeeding group, and the blood glucose, insulin, TC and LDL levels were significantly lower than those of prenatal OGTT at 42 d postpartum (P <0.05) Insulin sensitivity index (ISI) was significantly increased (P <0.01). The basal metabolism was significantly increased within 24 hours after birth (P <0.01), while the visceral fat level was lower (P <0.05). There were 28 cases in mixed feeding group, which were lower than FBG and 2hPG (P <0.05) on 42nd postnatal day, while no significant changes were found on other indexes (P> 0.05). The levels of blood glucose, insulin, lipids and visceral fat were significantly lower in the exclusive breastfeeding group than in the mixed feeding group on the 42nd day after delivery (P <0.05), and the ISI and basal metabolism were significantly higher (P <0.01). CONCLUSIONS: Postpartum exclusively breastfeeding GDM patients can effectively improve their glucose and lipid metabolism, improve insulin sensitivity, reduce insulin resistance, improve lipid metabolism, improve basal metabolic rate and reduce visceral fat.