| ObjectiveThis study aims to investigate patients with main TCM constitution types of gestational diabetes mellitus(GDM) and summarize the pattern of their distribution, further analyse them with blood glucose and lipids metabolism index, and then observe the differentiation of pregnancy outcomes among them. So as to provide theoretical reasons for the TCM researches of gestational diabetes mellitus and foundation for the clinical treatment and prevention of the disease.Methods220 outpatients who were diagnosed GDM in the obstetric high-risk clinic of the first affiliated hospital of guangzhou university of TCM during March 2013 to December 2015 were selected as research subjects. All subjects above were collected the personal data related to, including ages, heights, progestational weights and correlative past histories. Questionnaires were designed according to diagnosis standards in TCM constitution types in order to acquire each TCM constitution type of the 220 subjects. The completed valid questionnaires from all subjects are given conversion points in the light of criterions by which we categorize them to 9 different TCM constitution types. Blood glucose and lipids metabolism index of the outpatients including fasting and postprandial blood glucose, glycosylated hemoglobin, total cholesterol (TC), triglyceride(TG), low density lipoprotein(LDL), high density lipoprotein(HDL). were detected and filled into the database of each corresponding type above. Choosing 5 main TCM constitution groups of gestational diabetes mellitus to compare differences of the blood glucose and lipids metabolism index among them and analyze correlation of BMI and metabolism index as well as pregnancy outcomes of the 5 main TCM constitution groups. All materials are adopted into SPSS22.0 statistical software for statistical analysis.Results1 The distribution of TCM constitution in GDM:phlegm-dampness consti tution(62 cases, accounting for 28.2%), heat-dampness constitution(45 case s, accounting for 20.4%), qi-insufficiency constitution (35 cases, accounti ng for 15.9%), mild constitution(29cases, accounting for 13.2%), yang-insu fficiency constitution(21 cases, accounting for 9.5%), qi-stagnation consti tution(16 cases, accounting for 7.3%), yin-insufficiency constitution(6 ca ses, accounting for 2.7%), blood stasis constitution(5 cases, accounting fo r 2.1%), special innateness constitution(1 cases, accounting for 0.5%).2 The average age of gestational diabetes mellitus outpatients in this study equaled 30.15±4.49 years old and the the advanced age part was 18.2% accounting for the total. There was no difference in average ages among all groups. The average gestational weeks of GDM outpatients on diagnosis were the 24.8±3.23 weeks, concentrating in 25 weeks by 25.5% accounting for the total. There was also no difference in gestational weeks on diagnosis among all groups. The average progestational body mass index (BMI) of GDM outpatients was 22.58±3.76kg/m2, of which 37% were either overweight or obesity. The result indicated that there was statistically significant difference in the average progestational BMI between qi-insufficiency constitution group and three other groups. (P<0.05). In all 19 outpatients were diagnosed as polycystic ovarian syndrome(PCOS) progestationally of the study and there was no difference in the complication of PCOS among all groups.3 The comparison of blood glucose and lipids metabolism index of the 5 main TCM constitution groups of GDM revealed as followings: ①There was statistically significant difference in the average TC of all groups, in more detail, the phlegm-dampness constitution group tended to have high level TC than qi-insufficiency constitution group, mild constitution group and yang-insufficiency constitution group (P<0.05). ②There was no difference in average TG among all groups (P>0.05). ③There was statistically significant difference in the average LDL of all groups, in more detail, the phlegm-dampness constitution group tended to have hight level LDL than qi-insufficiency constitution group, mild constitution group and yang-insufficiency constitution group(P<0.05).④There was no difference in average HDL among all groups(P>0.05).4 The research on the correlation between BMI and blood glucose, lipids metabolism index of the 5 main TCM constitution groups of GDM revealed as followings:①BMI of the phlegm-dampness constitution group is positively correlated with 1 hour postprandial blood glucose and TC level (r=0.329 and 0.266, P< 0.05 both).②BMI of the heat-dampness constitution group is positively correlated with TC,TG and LDL level (r=0.470,0.447 and 0.517,P<0.05 all).③BMI of the qi-insufficiency constitution group is positively correlated with 2 hour postprandial blood glucose, TC, TG and LDL level(r=0.467,0.489, 0.517 and 0.309, P<0.05 all).④BMI of the mild constitution group is positively correlated with fasting blood glucose and TC level (r=0.420 and 0.580, P<0.05 both).⑤BMI of the yang-insufficiency constitution group is positively correlated with 2 hour postprandial blood glucose, TC and TG level(r=0.460, 0.660 and 0.590, P<0.05 all).5 The analysis on pregnancy outcomes of the 5 main TCM constitution groups of GDM were as followings:①There was no difference in the distribution of delivery mode among all groups (P> 0.05).②There was statistically significant difference in the distribution of average gestational weeks on delivery between phlegm-dampness constitution group and heat-dampness constitution group (P<0.05).③There was no difference in the distribution of neonatal complications among all groups (P>0.05).Conclusion1 The 5 main TCM constitutions of GDM are phlegm-dampness constitutio n, heat-dampness constitution, qi-insufficiency constitution, mild constitut ion and yang-insufficiency constitution, which indicates that biased const itutions of GDM appear more often as dampness and deficiency constitution s.2 Proximately half of the main biased constitutions of GDM patients are with conversion points between 40 and 60, which indicates that these patients have mild clinical symptoms. As a result, the TCM determination of treatment based on symptoms of GDM seems to be relatively restricted.3 There is no difference in the fasting and postprandial blood glucose along with glycosylated hemoglobin of the 5 main TCM constitutions of GDM, however, lipids metabolism index shows the opposite. The phlegm-dampness constitution group tends to have hight level TC and LDL than qi-insufficiency constitution group, mild constitution group and yang-insufficiency constitution group. There is no difference in average TG and HDL among all groups. It might be the reason of the deficient transportation function of the spleen in the phlegm-dampness constitution group compared with others.Therefore, propaganda of healthy diet and treatments of invigorating spleen and resolving dampness are likely to improve high level of lipids metabolism index.4 There are certain correlations between BMI and blood glucose and lipids metabolism index of 5 main TCM constitution groups of GDM, which indicates that individual medical nutrition therapy based on BMI might more effectively improve the index above.5. The TCM constitution is neither the determinant factor of delivery mode nor the influencing factor of neonatal complications of GDM patients, however, there is statistically significant difference in gestational weeks on delivery between certain TCM constitutions. |
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