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浙江大学学报（医学版）
浙江大学学报（医学版）  2021, Vol. 50 Issue (3): 305-312    DOI: 10.3724/zdxbyxb-2021-0115
专题报道     
高纤复合膳食纤维摄入对妊娠糖尿病患者血糖控制及妊娠结局的影响
张壮威1(),李君琴2,胡甜甜1,徐春景2,谢妮3,陈丹青2,*()
1.浙江大学医学院附属妇产科医院营养室，浙江 杭州 310006
2.浙江大学医学院附属妇产科医院产科，浙江 杭州 310006
3.丽水市妇幼保健院产科，浙江 丽水 323000
Interventional effect of dietary fiber on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus
ZHANG Zhuangwei1(),LI Junqin2,HU Tiantian1,XU Chunjing2,XIE Ni3,CHEN Danqing2,*()
1. Department of Nutrition, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China;
2. Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China;
3. Department of Obstetrics, Lishui Maternity and Child Health Care Hospital, Lishui 323000, Zhejiang Province, China
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摘要：

目的：探讨高纤复合膳食纤维对妊娠糖尿病（GDM）患者血糖控制及妊娠结局的影响。方法：选取 112 例浙江大学医学院附属妇产科医院收治的孕中期 GDM 患者为研究对象，随机分为膳食纤维组（n=56）和对照组（n=56），两组患者均接受基础营养治疗方案，膳食纤维组在此基础上添加膳食纤维方案（9.5?g膳食纤维/d，餐前服用），共干预 8 周。每周检测空腹血糖、餐后2?h末梢血糖（2 h BG），产后42?d进行口服葡萄糖耐量试验（OGTT），并记录围产结局。结果：干预 8 周内膳食纤维组患者 2 h BG 低于对照组（P<0.05）；第 3~8 周血糖控制合格率高于对照组（P<0.05或P<0.01）；产后 OGTT 服糖后2?h血糖值及糖耐量减低率低于对照组，且 OGTT 合格率高于对照组（均P<0.01）；胎膜早破、新生儿高胆红素血症发生率低于对照组（P<0.05或P<0.01）。结论：高纤复合膳食纤维干预可有效控制 GDM 患者孕期血糖水平，改善围产期不良妊娠结局，减少产后糖耐量减低发生率。
关键词： 膳食纤维;  妊娠期糖尿病;  临床营养;  糖耐量减低;  妊娠结局;  随机对照试验    
Abstract:

Objective: To investigate the effect of dietary fiber on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus (GDM). Methods: One hundred and twelve patients with GDM in the second trimester of pregnancy were recruited from Women’s Hospital, Zhejiang University School of Medicine. Patients were randomized into two groups with 56 in each group: the control group received basic nutrition support; while the dietary fiber group were given additional dietary fiber (9.5?g total dietary fiber per day) before meals in addition to basic nutrition support. Intervention for all cases lasted for 8 weeks. Fasting blood glucose and 2?h postprandial blood glucose (2 h BG) were measured every week, and oral glucose tolerance test (OGTT) was performed at 42 d postpartum to evaluate the glycemic outcomes. Perinatal outcomes were recorded. Results: The dietary fiber intervention markedly improved 2 h BG in patients with GDM and significantly elevated the glucose compliance rate from the 3rd to 8th week compared to the control group ( P<0.05 orP<0.01). OGTT 2 h glucose and the incidence of impaired glucose tolerance in the dietary fiber group were significantly lower than those in the control group, while the glucose compliance rate was significantly higher than that in the control group (allP<0.01). Moreover, the rates of adverse perinatal outcomes, such as premature rupture of membranes and neonatal hyperbilirubinemia were declined in the dietary fiber group (P<0.05 orP<0.01).Conclusion:Dietary fiber intervention can ameliorate hyperglycemia in GDM patients, improve perinatal outcomes and reduce the incidence of postpartum impaired glucose tolerance.
Key words: Dietary fiber    Gestational diabetes mellitus    Clinical nutrition    Impaired glucose tolerance    Pregnancy outcome    Randomized controlled trial
收稿日期: 2021-01-21 出版日期: 2021-08-16
CLC:  R153.1  
基金资助: 浙江省重点研发计划（2018C03010）
通讯作者: 陈丹青     E-mail: zhangzhuangwei@zju.edu.cn;chendq@zju.edu.cn
作者简介: 张壮威，注册营养师，主要从事慢性病的营养治疗；E-mail：zhangzhuangwei@zju.edu.cn；https：//orcid.org/0000-0003-0185-8546
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引用本文:

张壮威,李君琴,胡甜甜,徐春景,谢妮,陈丹青. 高纤复合膳食纤维摄入对妊娠糖尿病患者血糖控制及妊娠结局的影响[J]. 浙江大学学报（医学版）, 2021, 50(3): 305-312.

ZHANG Zhuangwei,LI Junqin,HU Tiantian,XU Chunjing,XIE Ni,CHEN Danqing. Interventional effect of dietary fiber on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus. J Zhejiang Univ (Med Sci), 2021, 50(3): 305-312.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0115    或    http://www.zjujournals.com/med/CN/Y2021/V50/I3/305

组别

n

年龄（岁）

入组孕周（周）

孕前 BMI（kg/m2）

产次

孕期增重（kg）

初产妇

经产妇

膳食纤维组

56

33.4±4.4

26.6±2.0

22.8±3.1

27（48.2）

29（51.8）

11.46±4.92

对照组

56

33.9±4.1

26.0±1.8

21.9±3.1

26（51.8）

30（53.6）

10.94±3.17

t/χ2值

—

–0.577

1.751

1.540

0.036

0.660

P值

—

>0.05

>0.05

>0.05

>0.05

>0.05
表 1  膳食纤维组与对照组基线资料比较

营养素

含量（每 18 g 纤维粉）

营养素参考值（%）*

能量

46.5 kcal

2.0

蛋白质

1.7?g

3.0

脂肪

0.3?g

1.0

碳水化合物

3.7?g

1.0

膳食纤维

9.5?g

38.0

钠

8.6?mg

0.0
表 2  高纤复合膳食纤维粉营养成分表
图 1  膳食纤维组和对照组患者干预 8 周血糖水平变化趋势与对照组比较，<0.05

组别

n

第 0 周

第 1 周

第 2 周

第 3 周

第 4 周

第 5 周

第 6 周

第 7 周

第 8 周

膳食纤维组

56

9（16.1）

24（42.9）

26（46.4）

29（51.8）

30（53.6）

38（67.9）

37（66.1）

37（66.1）

40（71.4）

对照组

56

8（14.3）

15（26.8）

19（33.9）

13（23.2）

17（30.4）

25（44.6）

23（41.1）

18（32.1）

18（32.1）

χ2值

—

0.069

3.187

1.820

9.752

6.196

6.132

7.036

12.897

17.308

P值

—

>0.05

>0.05

>0.05

<0.01

<0.05

<0.05

<0.01

<0.01

<0.01
表 3  膳食纤维组与对照组干预 8 周血糖控制合格率比较

组别

n

FPG（mmol/L）

OGTT 2 h 血糖（mmol/L）

FPG€合格率

OGTT 2 h 血糖合格率

OGTT€合格率

FPG€受损率

糖耐量减低率

膳食纤维组

56

5.18±0.56

7.30±1.30

96.4

78.6

76.8

3.6

17.9

对照组

56

5.00±0.48

8.07±1.60

98.2

39.3

39.3

1.8

55.4

t/χ2值

—

1.761

–2.784

0.000

17.855

16.168

0.000

16.967

P值

—

>0.05

<0.01

>0.05

<0.01

<0.01

>0.05

<0.01
表 4  膳食纤维组与对照组产后 42 d OGTT 血糖控制率比较

组　别

n

产 　妇

新生儿

早　产

剖宫产

产道裂伤

胎儿窘迫

胎膜早破

巨大儿

低出生体重儿

高胆红素血症

新生儿窒息

膳食纤维组

56

6（10.7）

31（55.4）

13（23.2）

7（12.5）

7（12.5）

5（8.9）

6（10.7）

5（8.9）

0（0.0）

对照组

56

9（16.1）

24（42.9）

15（26.8）

10（17.9）

16（28.6）

8（14.3）

4（7.1）

21（37.5）

6（10.7）

χ2值

—

0.693

1.751

0.190

0.624

4.432

0.783

0.439

12.823

—

P值

—

>0.05

>0.05

>0.05

>0.05

<0.05

>0.05

>0.05

<0.01

<0.05*
表 5  膳食纤维组与对照组妊娠结局比较
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