目的 深入分析实时动态血糖监测系统（CGMS）在2型糖尿病患者接受胰岛素泵强化治疗过程中的实际应用意义。方法 本研究采用前瞻性随机对照试验设计，收集2025年1月至2026年3月间收治的80名2型糖尿病患者，运用随机数字表法将其随机分配为两组，每组40名患者。对照组患者接受常规指尖血糖检测与胰岛素泵治疗，研究组采用深圳硅基传感公司生产的GS1型动态血糖监测系统辅助胰岛素泵治疗，两组患者的治疗周期均延长至14天。主要观测指标：目标血糖范围内时间占比（TIR，3.9~10.0 mmol/L）；次要观测指标：糖化血红蛋白（HbAlc）、空腹血糖（FBG）、餐后2 h血糖（2hPBG）等代谢指标，低血糖发生频率、日内血糖波动幅度（MAGE）、日间血糖平均绝对差（MODD）、血糖高于目标范围时间占比（TAR，＞10.0 mmol/L）、血糖低于目标范围时间占比（TBR，＜3.9 mmol/L）。结果 治疗14天后，两组患者的血糖指标均较治疗前改善，研究组主要指标TIR（78.65%±8.23%）高于对照组（62.34%±9.56%）（P＜0.001）；次要指标中，研究组HbAlc、FBG和2hPBG的改善幅度及MAGE、MODD的降低幅度均优于对照组（P＜0.05）；研究组低血糖发生率（2.5%）、TBR（1.82%±0.95%）低于对照组（20%、5.68%±1.32%），TAR（19.53%±7.81%）低于对照组（31.98%±8.64%）（P＜0.05）。研究组动态血糖图谱（AGP）显示血糖波动更平稳，峰值与谷值差异缩小，TIR分布更集中。结论 实时动态血糖监测技术通过提供连续、完整的血糖数据，精准捕捉血糖波动规律，为胰岛素泵参数调整提供科学依据，显著提升目标血糖达标时间占比，优化整体血糖控制效果，同时有效降低低血糖事件及血糖偏离目标范围的风险，是2型糖尿病患者胰岛素泵强化治疗的重要辅助手段。

      Objective To analyze the practical significance of real-time continuous glucose monitoring system（CGMS） in patients with type 2 diabetes mellitus（T2DM） receiving intensive insulin pump therapy．Methods A prospective randomized controlled trial design was used to collect 80 patients with T2DM from January 2025 to March 2026．The patients were randomly divided into two groups by random number table method，with 40 patients in each group．The patients in the control group received routine fingertip blood glucose detection and insulin pump therapy，while the patients in the study group received insulin pump therapy assisted by GS1 type CGMS produced by Shenzhen Sili-based Sensor company．The treatment period of the two groups was extended to 14 days．Primary outcome measures：time in range（TIR，3.9-10.0 mmol/L）；secondary outcomes：hemoglobin A1c（HbAlc），fasting blood glucose（FBG），2-hour postprandial blood glucose（2hPBG），frequency of hypoglycemia，mean amplitude of glycemic excursion（MAGE），mean of daily differences（MODD），time above range（TAR，＞10.0 mmol/L） and time below the target range（TBR，＜3.9 mmol/L），and other metabolic indicators．Results After 14 days of treatment，the blood glucose indexes of the two groups were significantly improved compared with those before treatment．The main index TIR in the study group（78.65%±8.23%） was significantly higher than that in the control group（62.34%±9.56%）（P＜0.001）．Among the secondary indexes，the improvement of HbAlc，FBG and 2hPBG and the reduction of MAGE and MODD in the study group were significantly better than those in the control group（P＜0.05）．The incidence of hypoglycemia（2.5%），TBR（1.82%±0.95%） and TAR（19.53%±7.81%） in the study group were significantly lower than those in the control group（20%，5.68%±1.32%，31.98%±8.64%）（P＜0.05）．The ambulatory glucose profile（AGP） of the study group showed that blood glucose fluctuation was more stable，the difference between peak and trough was reduced，and TIR distribution was more concentrated．Conclusions Real-time CGMS can accurately capture blood glucose fluctuation by providing continuous and complete blood glucose data，provide scientific basis for insulin pump parameter adjustment，significantly improve the proportion of time to reach the target blood glucose，optimize the overall blood glucose control effect，and effectively reduce the risk of hypoglycemia events and blood glucose deviation from the target range．It is an important auxiliary method for intensive insulin pump therapy in patients with type 2 diabetes．

      目的 探讨不同体质指数（BMI）分组成年1型糖尿病（T1DM）患者的临床特征以及超重/肥胖与心血管代谢危险因素之间的关系。方法 纳入2015年6月至2022年6月在广州市第一人民医院内分泌代谢科住院的268例成人T1DM患者。分为超重肥胖组（BMI≥24.0 kg/m²，41例）、体质量正常组（18.5≤BMI＜24.0 kg/m²，155例）和体质量过低组（BMI＜18.5 kg/m²，72例）。比较三组人口学、人体测量及代谢指标的差异，采用多元线性回归分析BMI与估算肾小球滤过率（eGFR）的关联。结果 超重肥胖组患者的特征表现为年龄更大、病程更长、体脂肪量更高、腹部皮下脂肪面积更大、腰围、臀围更大、合并高血压比例更高、收缩压更高、高密度脂蛋白胆固醇更低、eGFR更低、糖化血红蛋白（HbA1c）更低。多元线性回归分析显示，校正年龄、性别、病程后，BMI与eGFR呈负相关（β=-2.050，P=0.012）；进一步校正HbA1c、血压、血脂后，该关联不再显著。结论 超重/肥胖成人T1DM患者存在多重代谢异常聚集，BMI与eGFR的负向关联可能主要与血糖、血压、血脂等代谢因素有关。

Objective To investigate the clinical characteristics of adult patients with type 1 diabetes mellitus（T1DM）in different body mass index（BMI）categories and the associations of overweight and obesity with cardiometabolic risk factors．Methods A total of 268 adult T1DM inpatients from Guangzhou First People’s Hospital were enrolled．Patients were divided into three groups：overweight/obese（BMI≥24.0 kg/m²，n=41），normal-weight（18.5≤BMI＜24.0 kg/m²，n=155），and underweight（BMI＜18.5 kg/m²，n=72）．Demographic characteristics，anthropometric measurements，and metabolic parameters were compared among the three groups．Multivariable linear regression analyses were performed to evaluate the association between BMI and estimated glomerular filtration rate（eGFR）．Results Patients in the overweight/obesity group were characterized by older age，longer diabetes duration，higher body fat mass，larger abdominal subcutaneous fat area，greater waist and hip circumferences，a higher prevalence of hypertension，higher systolic blood pressure，lower high-density lipoprotein cholesterol levels，lower eGFR，and lower glycated hemoglobin（HbA1c）levels．Multivariable linear regression analysis demonstrated that BMI was inversely associated with eGFR after adjustment for age，sex，and diabetes duration（β=-2.050，P=0.012）．However，this association was no longer significant after further adjustment for HbA1c，blood pressure，and lipid parameters．Conclusions Overweight/obese adult T1DM patients exhibit clustering of metabolic abnormalities．The negative association between BMI and eGFR may be primarily mediated by metabolic factors such as hyperglycemia，hypertension，and dyslipidemia．

      目的   残余胆固醇（RC）是反映动脉粥样硬化性血脂异常的重要指标，其在糖尿病合并冠心病患者中的临床意义尚不明确。本研究旨在探讨RC水平对糖尿病合并冠心病患者心力衰竭风险的预测价值，并分析其相关性。方法   本研究为回顾性横断面研究，纳入2021年1月—2024年1月期间在鹤壁市人民医院接受诊治的292例糖尿病合并冠心病患者。根据是否存在心力衰竭分为心力衰竭组（128例）和无心力衰竭组（164例）。对基线特征进行比较，采用单因素和多因素Logistic回归分析RC与心力衰竭的相关性。同时，通过限制性立方样条（RCS）分析探讨RC与心力衰竭风险的线性关系，并通过受试者操作特征（ROC）曲线和曲线下面积（AUC）评估RC的预测价值。结果   心力衰竭组患者的男性比例、高血压患病率、RC水平等高于无心力衰竭组，而估算肾小球滤过率水平显著降低（P＜0.05）。单因素分析显示，RC＞0.7 mmol/L显著增加心力衰竭风险（OR=1.854，95%CI：1.161~2.960，P=0.010）。多因素Logistic回归分析中，全调整模型结果显示，RC作为分类变量时，RC＞0.7 mmol/L的患者心力衰竭风险显著增加1.891倍（OR=1.891，95%CI：1.047~3.415，P=0.035）；作为连续变量时，RC每增加1单位，心力衰竭风险增加2.464倍（OR=2.464，95%CI：1.495~4.064，P＜0.001）；Log₁₀RC的风险比为6.411（95%CI：2.246~18.302，P=0.001）；标化RC的风险比为1.687（95%CI：1.262~2.255，P＜0.001）。限制性立方样条分析表明RC与心力衰竭风险呈线性正相关，ROC分析显示RC预测心力衰竭的AUC为0.621（95%CI：0.555~0.687，P＜0.001）。结论  RC水平与糖尿病合并冠心病患者心力衰竭风险显著相关，且呈线性正相关。RC具有一定的预测价值，可作为该人群心力衰竭风险评估的潜在指标。

       Objective  Residual cholesterol（RC）is  an important marker  reflecting  dyslipidemia  associated with atherosclerosis．Its clinical significance in patients with diabetes and coronary heart disease（CHD）remains unclear．To explore the predictive value of RC level for the risk of heart failure（HF）in patients with diabetes and CHD and analyze their association．Methods  This retrospective cross-sectional study included 292 patients with diabetes and CHD who were treated at Hebi People’s Hospital between January 2021 and January 2024．Patients were divided into the HF group（128 cases）and the non-HF group（164 cases）based on the presence of HF．Baseline characteristics were compared，and univariate and multivariate Logistic  regression analyses were performed to assess the association between RC and HF．Additionally，restricted cubic spline（RCS）analysis was used to explore the linear relationship between RC and HF risk，and the predictive value of RC was evaluated using receiveroperating characteristic（ROC）curves and the area under the curve（AUC）．Results  The HF group had significantly higher proportions of males，hypertension prevalence and RC levels，while estimated glomerular filtration rate were significantly lower compared to the non-HF group（P＜0.05）．Univariate analysis showed that RC＞0.7 mmol/L significantly increased the risk of HF（OR=1.854，95%CI：1.161–2.960，P=0.010）．In the fully adjusted multivariate Logistic regression model，RC（RC＞0.7 mmol/L）was associated with a 1.891-fold increased risk of HF as a categorical variable（OR=1.891，95%CI：1.047–3.415，P=0.035）．As a continuous variable，each increased unit in RC was associated with a 2.464-fold increased risk of HF（OR=2.464，95%CI：1.495–4.064，P＜0.001）．The odds ratios for Log₁₀RC and standardized RC were 6.411（95%CI：2.246–18.302，P=0.001）and 1.687（95%CI：1.262–2.255，P＜0.001），respectively．ROC analysis indicated a linear positive association between RC and HF risk（P=0.002）．ROC analysis showed that RC had predictive value for HF，with an AUC of 0.621（95%CI：0.555–0.687，P＜0.001）．Conclusions  RC levels are significantly associated with the risk of HF in patients with diabetes and CHD，demonstrating a linear positive correlation．RC has potential predictive value and may serve as a useful indicator for assessing HFrisk in this population．

      目的   探讨妊娠期糖尿病（GDM）患者载脂蛋白B（Apo-B）、载脂蛋白A1（Apo-A1）水平在分娩巨大儿中的预测价值。方法   选取2023年1月—2024年1月在珠海市第五人民医院建档并进行孕检、分娩的85例GDM患者，按照分娩的新生儿体质量情况分为分娩正常组55例（新生儿体质量＜4 000 g）和分娩异常组30例（新生儿体质量≥4 000 g）。比较两组孕妇一般资料及孕早期的Apo-B、Apo-A1、Apo-B/Apo-A1比值，采用受试者操作特征（ROC）曲线分析Apo-B、Apo-A1、Apo-B/Apo-A1对GDM患者分娩巨大儿的预测价值。结果   分娩异常组Apo-B水平、Apo_B/Apo_A1比值（1.05±0.15）g/L、（0.81±0.23）］高于分娩正常组（0.95±0.12）g/L、（0.65±0.18）］（t分别为3.357、3.544，P＜0.05）；Apo-A1水平［（1.29±0.26）g/L］低于分娩正常组［（1.47±0.23）g/L］（t=3.292，P＜0.05）；ROC曲线显示，Apo-B、Apo-A1水平及Apo-B/Apo-A1比值预测GDM患者分娩巨大儿的曲线下面积（AUC）分别为0.705、0.660、0.709，灵敏度分别为63.33%、63.33%、66.67%，特异度分别为72.73%、74.55%、76.36%，其中Apo-B/Apo-A1比值预测效能最高（P＜0.05）。结论  GDM患者分娩巨大儿与孕早期Apo-B升高、Apo-A1水平降低密切相关，监测患者孕早期的Apo-B、Apo-A1水平及Apo-B/Apo-A1比值有助于临床对分娩巨大儿进行预测。

      Objective  To explore the predictive value of apolipoprotein B（Apo-B）and apolipoprotein A1（Apo-A1）levels on delivery of macrosomia in patients with gestational diabetes mellitus（GDM）．Methods  From January 2023 to January 2024，85 patients with GDM who were filed in the hospital and received pregnancy examination and delivery were selected．According to the neonatal body mass，the patients were divided into 55 cases in normal delivery group（newborn birth weight ＜4 000 g）and 30 cases in abnormal delivery group（ newborn birth weight ≥4 000 g）．The general data and levels of Apo-B，Apo-A1 and Apo-B/Apo-A1 in early pregnancy were compared between the two groups．Receiver operating characteristic（ROC）curve was used to analyze the predictive value of Apo-B，Apo-A1 and Apo-B/Apo-A1 on delivery of macrosomia in GDM patients．Results  The Apo-B and Apo-B/Apo-A1 in abnormal delivery group were（1.05±0.15）g/L and（0.81±0.23），which were higher than（0.95±0.12）g/L and（0.65±0.18）in normal delivery group（t=3.357，3.544，P＜0.05）．While the level of Apo-A1 in abnormal delivery group，（1.29±0.26）g/L，was lower than（1.47±0.23）g/L in normal delivery group（t=3.292，P＜0.05）．ROC curve showed that the areas under the curve（AUC）of Apo-B，Apo-A1 and Apo-B/Apo-A1 in  predicting macrosomia in GDM patients were 0.705，0.660 and 0.709，and the sensitivities were 63.33%，63.33% and 66.67%，and the specificities were 72.73%，74.55% and 76.36%，respectively．Apo-B/Apo-A1 had the highest predictive efficiency（P＜0.05）．Conclusions  The delivery of macrosomia in GDM patients is closely related to the increase of Apo-B and the decrease of Apo-A1 in early pregnancy．Monitoring Apo-B，Apo-A1 and Apo-B/Apo-A1 in early pregnancy is helpful to predict the delivery of macrosomia．

     目的   探讨2型糖尿病（T2DM）患者葡萄糖目标范围内时间（TIR）与高尿酸血症（HUA）的相关性。方法   纳入2021年10月—2024年10月厦门大学附属第一医院收治的110例T2DM合并HUA的患者，将其分为T2DM并HUA组，另选取同期110例单纯T2DM患者，分为单纯T2DM组，比较两组一般资料及实验室相关指标，采用Logistics回归模型分析T2DM患者HUA发生的影响因素。随后将110例T2DM合并HUA的患者依照其病情严重程度分为轻度组（58例）、中度组（37例）及重度组（15例），比较三组临床相关指标及TIR水平，分析临床相关指标及TIR水平与T2DM患者HUA严重程度的相关性。结果  T2DM并HUA组与单纯T2DM组患者体质指数（BMI）、糖化血红蛋白、总胆固醇、甘油三酯、血肌酐（Scr）、TIR对比差异有统计学意义（P＜0.05）；将具有统计学差异的指标纳入Logistics回归模型，以是否合并HUA作为因变量（合并HUA=1，未合并HUA=0），结果显示，BMI、糖化血红蛋白、总胆固醇、甘油三酯、Scr、TIR为T2DM患者HUA发生的重要影响因素（P＜0.05）；HUA不同严重程度患者临床相关指标及TIR水平对比发现，轻度组、中度组与重度组糖化血红蛋白、总胆固醇、甘油三酯、Scr水平对比差异无统计学意义（P＞0.05），轻度组、中度组与重度组BMI、TIR对比差异显著（P＜0.05），重度组BMI高于轻度组对比差异有统计学意义（P＜0.05），重度组TIR低于轻度组和中度组对比差异有统计学意义（P＜0.05）；Spearman相关分析显示：BMI与HUA严重程度呈正相关，TIR与HUA严重程度呈负相关（P＜0.05）。结论  TIR降低为T2DM患者HUA发生的重要影响因素之一，且TIR水平与HUA严重程度密切相关。

        Objective  To explore the correlation between time in range（TIR）of glucose and hyperuricemia（HUA）in patients with type 2 diabetes mellitus（T2DM）．Methods  From October 2021 to October 2024，110 patients with T2DM complicated with HUA admitted to our hospital were divided into T2DM with HUA group，and 110 patients with T2DM only in the same period were divided into T2DM group．The general data and laboratory related indicators of the two groups were compared，and the influencing factors of the occurrence of HUA in T2DM patients were analyzed by logistic regression model．Subsequently，110 patients with T2DM complicated with HUA were divided into mild group（58 cases），moderate group（37 cases），and severe group（15 cases）according to their severity．The clinical related indicators and TIR levels of the three groups were compared，and the correlation between clinical related indicators and TIR levels and the severity of HUA in T2DM patients was analyzed．Results  Body mass index（BMI），glycosylated hemoglobin，total cholesterol，triglyceride，and blood creatinine（Scr）between T2DM with HUA group and T2DM group were significantly different（P＜0.05）．The indicators with statistical differences were included in the logistics regression model to determine whether to merge HUA as the dependent variable（with HUA=1，without HUA=0）．The results showed that，BMI，glycosylated hemoglobin，total cholesterol，triglycerides，Scr，and TIR were important influencing factors for the occurrence of HUA in T2DM patients（P＜0.05）．Comparison of clinical indicators and TIR levels in patients with different degrees of HUA revealed no significant differences in glycosylated hemoglobin，total cholesterol，triglycerides，and Scr levels among the mild，moderate，and severe groups（P＞0.05），while there were significant differences in BMI and TIR levels among the mild，moderate，and severe groups（P＜0.05）．The difference between the severe group and the mild group was statistically significant（P＜0.05），and the difference between the severe group and the moderate group was statistically significant（P＜0.05）．The Spearman correlation analysis  results showed that BMI was positively correlated with the severity of HUA，while TIR was negatively correlated with the severity of HUA（P＜0.05）．Conclusions  The decrease of TIR is one of the important influencing factors of HUA in T2DM patients，and the level of TIR is closely related to the severity of HUA．

目的 探讨产时超声管理妊娠期糖尿病产妇产程的应用价值。方法 选择2022年1月1日—2023年12月31日在佛山市高明区人民医院妇产科分娩的妊娠期糖尿病初产妇共100例。患者签署知情同意书后, 按照1∶1比例采用随机数字表法分为对照组和研究组各50例。对照组采用阴道指诊检查判断产程和分娩方式。研究组采用经腹联合会阴超声测量检查判断产程及分娩方式。收集两组初产妇血糖、血常规、分娩方式、产后24 h出血量以及切口情况, 新生儿Apgar评分。结果 研究组阴道分娩率高于对照组（88.0% vs 72.0%, P<0.05）, 而阴道检查次数（4.18±0.8 vs 6.82±0.8, P<0.05）少于对照组、不良事件发生率（4% vs 16%, P<0.05）低于对照组。相对于对照组,研究组血红蛋白水平较高（104.10±5.25 vs 100.30±4.78, P<0.05）、而白细胞计数（11.40±1.49 vs 12.04±1.66, P<0.05）以及中性粒细胞百分比较低（72.79±4.04 vs 75.01±5.53, P<0.05）。结论 通过产时超声监测判断妊娠期糖尿病初产妇产程,能够降低阴道操作引起的感染等风险,提高阴道分娩率,有效降低产妇感染,提高产妇分娩满意度以及舒适度,改善母婴结局。

Objective To explore the application value of intrapartum ultrasound for labor management of pregnant women with gestational diabetes mellitus．Methods A total of 100 primiparous women with gestational diabetes mellitus who gave birth in the Obstetrics and Gynecology Department of Foshan Gaoming District People’s Hospital from January 1, 2022 to December 31, 2023 were selected．After signing the informed consent form, the patients were randomly divided into a control group and a study group with 50 cases in each group according to a ratio of 1∶1, using a random number table method．The control group underwent vaginal digital examination to assess the labor process and delivery method．For the study group, the labor process and delivery mode were determined using transabdominal ultrasound measurement．Blood glucose level,routine blood test results, delivery methods, 24-hour postpartum bleeding volume and incision conditions of two groups of primiparas, as well as the Apgar score of newborns were collected．Results The study group demonstrated a significantly higher vaginal delivery rate than the control group（88.0% vs 72.0%, P<0.05）, with fewer vaginal examinations（4.18±0.80 vs 6.82±0.80, P<0.05）and a lower incidence of adverse events（4% vs 16%, P<0.05）．Compared to the control group, the study group exhibited higher hemoglobin levels（[104.10±5.25]g/L vs [100.30±4.78] g/L, P<0.05）, but lower white blood cell counts（[11.40±1.49]×109/L vs [12.04±1.66]×109/L, P<0.05）and reduced neutrophil percentages（[72.79±4.04]% vs [75.01±5.53]%, P<0.05）．Conclusions Intrapartum ultrasound monitoring for assessing labor progression in primiparas with gestational diabetes mellitus reduces infection risks associated with vaginal procedures, increases vaginal delivery rates, effectively decreases maternal infections, enhances maternal satisfaction and comfort during delivery,and improves maternal-neonatal outcomes．

目的 探讨妊娠期糖尿病（GDM）患者孕24~28周的75 g 口服葡萄糖耐量试验（OGTT）血糖异常项数及妊娠晚期分娩前血糖值与妊娠结局的关系。方法 选择2019年11月—2020年5月在广州医科大学附属妇女儿童医疗中心进行产检并在孕24~28周确诊的167例GDM患者为研究对象,将孕24~28周75 g OGTT结果中仅其中1项时间点血糖异常的孕妇为GDMⅠ组（92例）,2项异常为GDMⅡ组（48例）,3项异常为GDMⅢ组（27例）,比较三组血糖异常项数GDM患者的人口学特点;并分析GDM患者一般人口学特征与妊娠晚期分娩前血糖监测均值的关系,及血糖值对不良妊娠结局的影响。结果 75 g OGTT血糖异常项数与孕前不同的体质指数（BMI）及妊娠晚期的糖化血红蛋白（HbA_1c）间比较差异均有统计学意义（P<0.05）。孕前BMI指数水平对妊娠晚期的空腹血糖、餐后1 h血糖、餐后2 h血糖比较差异均有统计学意义（P<0.05）;75 g OGTT血糖异常项数对空腹血糖及餐后2 h血糖比较差异有统计学意义（P<0.05）;③空腹血糖不同水平组在新生儿低血糖、胎膜早破、早产不良结局中比较,差异有统计学意义（P<0.05）。餐后2 h不同血糖水平间组在新生儿低血糖及胎膜早破中比较,差异有统计学意义（P<0.05）。结论 孕前BMI指数与妊娠中期75 g OGTT的血糖筛查结果有关,75 g OGTT试验中血糖异常项数越多不良妊娠结局的发生概率越大,妊娠期进行规范化的运动饮食干预和必要时的药物干预后可改善妊娠晚期的HbA_1c水平。

Objective To investigate the relationship between abnormal blood glucose items in the 75 g oral glucose tolerance test（OGTT）at 24-28 weeks of pregnancy and the blood glucose levels before delivery in the third trimester of pregnancy and pregnancy outcomes in gestational disbetes mellitus（GDM）patients. Methods All 167 GDM patients diagnosed at 24-28 weeks of gestation in Women and Children's Medical Center Affiliated to Guangzhou Medical University from November 2019 to May 2020 were enrolled as subjects．The pregnant women with only 1 abnormal blood glucose item among the 75 g OGTT results were classified as GDMⅠ group（92 cases）,with 2 abnormal items were GDMⅡ group（48 cases）,and with 3 abnormal items were GDM Ⅲ group（27 cases）．The demographic characteristics of the three groups of GDM patients were compared．The relationship between the general demographic characteristics of GDM patients and the mean value of blood glucose monitoring before delivery in the third trimester was analyzed,and the influence of blood glucose monitoring on adverse pregnancy outcomes was also analyzed．Results ①With different BMI and HbA_1c,there were significant differences in 75 g OGTT blood glucose items（P<0.05）．BMI level had statistically significant effects on fasting blood glucose,1-hour postprandial blood glucose and 2-hour postprandial blood glucose in the third gestational trimester（P<0.05）．②With different number of abnormal blood glucose items,there were significant in fasting blood glucose and 2 hours postprandial blood glucose（P<0.05）．③There were statistically significant differences in the outcomes of neonatal hypoglycemia,premature rupture of membranes and preterm delivery in different fasting blood glucose groups（P<0.05）．There were statistically significant differences in neonatal hypoglycemia and premature rupture of membranes between different 2 hours postprandial blood glucose（P<0.05）. Conclusions BMI can affect the blood glucose screening results of 75g OGTT in the second trimester．The more abnormal blood glucose items in the 75g OGTT test,the greater the probability of adverse pregnancy outcome．Standardized exercise diet intervention and necessary drug intervention during pregnancy can improve the HbA_1c level in the third trimester．

目的 探讨远程药学管理模式联合延续护理在2型糖尿病（T2DM）合并冠状动脉病变患者居家用药中的应用效果。方法 选取2021年6月—2023年6月在广州医科大学附属第三医院诊治的200例T2DM合并冠状动脉病变患者为研究对象,根据干预方式不同分为常规组100例和研究组100例。常规组患者给予院内院外常规护理,研究组在常规组的基础上给予远程药学管理模式联合延续护理。评估患者用药依从性、饮食依从性、运动依从性、自我管理能力、生活质量[36条目简明健康量表（SF-36）]及心血管事件发生情况。结果 研究组用药、饮食、运动依从性均高于常规组（P<0.05）。相较于干预前,两组患者在干预后的自我管理机能、自我责任感、自我概念及健康知识分值均升高,且研究组高于常规组（P<0.05）。相较于干预前,两组患者在干预后的活力（VT）、精神健康（MH）、情感职能（RE）、躯体疼痛（BP）、生理功能（PF）、社会功能（SF）、生理职能（RP）、总体健康（GH）分值均升高,且研究组高于常规组（P<0.05）。研究组与常规组患者心血管不良事件发生率分别为2例（2.00%）、15例（15.09%）,研究组高于常规组（χ²=10.865,P<0.05）。结论 远程药学管理模式联合延续护理能够提高T2DM合并冠状动脉病变患者的用药管理依从性,提高患者自我管理能力,改善生活质量,降低不良心血管事件的发生率。

Objective To explore the application effect of remote pharmacy management mode combined with continuous nursing in the home medication of type 2 diabetes mellitus（T2DM）patients with coronary artery disease．Methods A total of 200 patients with T2DM complicated with coronary artery diseases who were diagnosed and treated in the Third Affiliated Hospital of Guangzhou Medical University from June 2021 to June 2023 were selected as the study subjects．They were divided into a conventional group of 100 patients and a study group of 100 patients based on different intervention methods．The patients in the conventional group received routine care both in and out of the hospital,while the study group received remote pharmaceutical management mode combined with continuous care on the basis of the conventional group．Patient medication compliance,dietary compliance,exercise compliance,self-management ability,quality of life[36 item concise health scale（SF-36）] and incidence of adverse cardiovascular events were assessed．Results The compliance of medication,diet and exercise in the study group were significantly higher than those in the conventional group（P<0.05）．Compared to before intervention,the self-management function,sense of responsibility,self-concept and health knowledge scores of both groups of patients were significantly increased after intervention,and the scores of the study group were significantly higher than those in the conventional group（P<0.05）．Compared to before intervention,the Vitality（VT）,Mental Health（MH）,Emotional Function（RE）,Physical Pain（BP）,Physiological Function（PF）,Social Function（SF）,Physiological Function（RP）and Overall Health（GH）scores of both groups of patients were significantly increased after intervention,and the scores of the study group was significantly higher than those of the conventional group（P<0.05）．The incidence of cardiovascular adverse events in the study group and the conventional group were 2 cases（2.00%）and 15 cases（15.09%）,respectively,with the study group significantly higher than the conventional group（χ²=10.865,P<0.05）．Conclusions The combination of remote pharmaceutical management mode and continuous care can significantly improve the medication management compliance of T2DM patients with coronary artery disease,improve their self-management ability,improve the quality of their life and reduce the incidence of adverse cardiovascular events．

目的 探讨产科监护室妊娠期糖尿病产妇泌乳启动延迟及影响因素,以期作为预防泌乳启动延迟的参考依据。方法 选择2021年1月—2023年5月期间医院产科监护室接收的妊娠期糖尿病产妇80例为研究对象,采用单因素和多因素分析产妇的年龄、体质指数、产次、定期复查血糖、妊娠期高血压、分娩方式、开奶时间、新生儿体质量、产后焦虑、产后抑郁、产后疲乏、吸吮次数等对泌乳启动延迟的影响。结果 妊娠期糖尿病产妇泌乳启动延迟33例,发生率41.25%;泌乳启动延迟产妇的年龄≥35岁者占51.52%、未定期复查血糖者占39.39%、合并妊娠期高血压者占54.55%、开奶时间≥6 h者占57.58%、产后焦虑者占30.0%、产后抑郁者占36.36%、产后疲乏者占36.36%、吸吮次数<6次者占60.61%,与非泌乳启动延迟产妇比较差异均有统计学意义（P<0.05）。两组孕前体质指数、产次、分娩方式、新生儿出生体质量比较差异无统计学意义（P>0.05）。年龄≥35岁、未定期复查血糖、合并妊娠期高血压、开奶时间≥6 h、产后焦虑、产后抑郁、产后疲乏、吸吮次数<6次为妊娠期糖尿病产妇泌乳启动延迟的危险因素（P<0.05）。结论 产科监护室妊娠期糖尿病产妇泌乳启动延迟发生率较高,主要受到年龄、未定期复查血糖、合并妊娠期高血压、开奶时间、产后心理状态、吸吮次数等因素影响,应重视健康教育和早期辅助干预,降低泌乳启动延迟发生率。

Objective To explore the delayed lactation initiation and its influencing factors of pregnant women with diabetes in the obstetric care unit,so as to provide a reference for preventing delayed lactation initiation．Methods A total of 80 pregnant women with diabetes who were received by the hospital obstetric care unit from January 2021 to May 2023 were selected as the research objects．The age,body mass index,parity,regular blood glucose recheck,pregnancy hypertension,delivery mode,starting time,neonatal weight,postpartum anxiety,postpartum depression,postpartum fatigue,sucking times and other factors that led to the delay of lactation initiation were analyzed by single factor and multi factor analysis．Results The onset of lactation was delayed in 33 pregnant women with diabetes,with an incidence of 41.25%．The age of postpartum women with delayed lactation initiation over 35 years old accounted for 51.52%,blood sugar was not regularly rechecked accounted for 39.39%,pregnancy induced hypertension accounted for 54.55%,lactation time over 6 hours accounted for 57.58%,postpartum anxiety accounted for 30.0%,postpartum depression accounted for 36.36%,postpartum fatigue accounted for 36.36%,and sucking frequency <6 times accounted for 60.61%,which were higher than that of non-delayed lactation initiation women（P<0.05）．There was no statistically significant difference between the two groups in terms of pre pre-pregnancy body mass index,parity,delivery method and newborn birth weight（P>0.05）．The risk factors of delayed lactation initiation in pregnant women with diabetes were age ≥ 35 years,no regular blood glucose review,hypertension during pregnancy,≥ 6 h of first milk expression time,postpartum anxiety,postpartum depression,postpartum fatigue and sucking times<6（P<0.05）．Conclusions The incidence of delayed lactation initiation in pregnant women with diabetes in the obstetric care unit is high,which is mainly affected by age,pregnancy induced hypertension,time of starting breast feeding,postpartum psychological state and sucking times．Health education and early auxiliary intervention should be emphasized to reduce the incidence of delayed lactation initiation．

目的 基于计划行为理论探讨妊娠期糖尿病（GDM）孕妇自我管理行为意向,为促进其孕期良好的自我管理提供依据。方法 运用质性研究中的现象学研究方法,对12例GDM孕妇进行深度半结构式访谈,并用Colaizzi七步内容分析法对主题进行归纳。结果 根据计划行为理论对主题进行归纳,共提炼出3种类别：①行为态度：认知不足,积极态度,消极态度;②主观规范：家庭影响,医护压力,人际压力;③知觉行为控制：知识技能获取受限,客观条件束缚共8个主题。结论 GDM患者在自我管理过程中存在对疾病认知不足的问题GDM,自我管理行为受到家庭、医护人员、人际关系等外界压力对自我管理态度的影响,且存在知识技能欠缺,客观条件制约多方面阻碍。医护人员应加强对GDM孕妇的自我管理教育,适时提供支持,提高其自我管理效率。

Objective To explore the self-management behavior intention of pregnant women with gestational diabetes mellitus（GDM）based on the theory of planned behavior,and to provide a basis for promoting good self-management during pregnancy. Methods Using the phenomenological research method in qualitative research,12 pregnant women with GDM were interviewed in an in-depth semi-structured interview,and then the themes were summarized by Colaizzi's seven-step content analysis. Results According to the theory of planned behavior,the themes were summarized into three categories and eight themes including（1）Behavioral Attitudes：cognition deficiency,positive attitude,and negative attitude,（2）Subjective norms：family influence,medical pressure,interpersonal pressure,and（3）Perceptual behavior control：self-management knowledge acquisition limitations,self-management Objective conditions constraint. Conclusions Most of the respondents have insufficient awareness of self-management of gestational diabetes,different patients have different attitudes towards self-management,and self-management behavior is affected by external pressures such as family,medical staff,and interpersonal relationships,and there are many obstacles due to a lack of knowledge and skills,Objective conditions．Medical staff should strengthen the self-management education of pregnant women with gestational diabetes,provide timely support,and improve their self-management efficiency．