探讨孕期个体化营养指导对多囊卵巢综合症（PCOS）患者的妊娠结局及糖脂代谢的影响及意义。

选择2010年1月至2013年3月在南京医科大学附属无锡妇幼保健院妇产科确诊为PCOS并妊娠成功者68例为研究对象。按照是否接受个体化营养指导，将其分为干预组（n＝36）和对照组（n＝32），比较分析两组的母婴结局和糖脂代谢差异。对两组受试者于孕龄为32~ 36孕周进行75 g口服葡萄糖耐量检查（OGTT）及胰岛素（INS）释放试验，比较两组空腹血糖（FPG）、空腹胰岛素（FINS）水平与稳态模型的胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β）及OGTT血糖曲线下面积（A UC_glu）、OGTT胰岛素曲线下面积（AUC_INS ）。同时比较两组受试者分娩前总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白-胆固醇（LDL-C）、高密度脂蛋白-胆固醇（HDL-C）水平和分娩时羊水过多、巨大儿和低出生体质量儿发生率（本研究遵循的程序符合南京医科大学附属无锡市妇幼保健院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象的知情同意，并与之签署临床研究知情同意书）。两组受试者的年龄、分娩孕周、孕前体质量指数（BMI）、孕前FPG等一般资料比较，差异无统计学意义（P>0.05）。

干预组与对照组的妊娠期糖尿病（GDM）和巨大儿发生率分别为（22.2% vs． 46.9%；8.3% vs．31.3%），两组比较，差异有统计学意义（P<0.05）；羊水过多和低出生体质量儿发生率分别为（2.8% vs．6.3%；0vs．9.4%），两组比较，差异均无统计学意义（P>0.05）。干预组与对照组的TC比较[（6.36 ± 1.97）mmol／L vs．（6.43 ± 2.01）mmol／L]，差异均无统计学意义（P>0.05），而TG、LDL-C及HDL-C比较[（1.17 ± 0.05）mmol／L vs．（2.31 ± 0.14）mmol/ L；（3.45 ± 0.16）mmol／L vs．（4.38 ± 0.23）mmol/ L；（1.93 ± 0.18) mmol／L vs．（1.18 ± 0.21）mmol／L]，差异有统计学意义（P<0.05）。干预组和对照组FPG、FINS、HOMA-IR及HOMA-β比较[（4.39 ± 0.56）mmol／L vs．（4.53 ± 0.67）mmol/ L；（6.35 ± 4.92）mIU／L vs．（7.82 ± 4.39）mIU/ L；（1.34 ± 0.87）vs．（1.67 ± 0.98）；（132.8 ± 87.8）vs． （171.5 ± 99.8）]，差异无统计学意义（P>0.05）。干预组和对照组的AUC_glu[（20.14 ± 3.79）mmol/ Lh vs． （23.36 ± 5.18）mmol／Lh]和AUC_INS [（163.7 ± 71.80）mU／Lh vs．（230.5 ± 130.32）mU／Lh]比较，差异有统计学意义（P<0.01）。

PCOS患者于孕期接受营养指导可改善其孕期糖脂代谢，降低GDM和巨大儿发生率。

To explore the effects and significance of individualized nutrition guidance of patients with polycystic ovary syndrome (PCOS) during pregnancy.

Between January 2010 and March 2013, sixty eight pregnant women who were diagnosed as PCOS in Wuxi Maternal and Child Health Hospital Affiliated to Nanjing Medical University were recruited into the study. They were divided into intervention group (n =36) and control group (n =32) . Intervention group accepted individualized nutritional guidance, and control group follow the traditional nutritional guidance. The complications and pregnancy outcomes were compared between two groups. Two groups both underwent 75 g oral glucose tolerance test (OGTT) and insulin - releasing test during 32-36 pregnancy weeks . Fasting plasma glucose (FPG) , fasting plasma insulin (FINS) , homeostasis model assessment-insulin resistance (HOMA-IR) , HOMA-β, area under curve of glucose (AUC_glu) and area under curve of insulin (AUC_INS) were calculated. Lipid level including total cholesterol(TC) , triglyceride (TG) , high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C) were examined between two group. The significant differences were not found between two groups on age, delivery weeks, body mass index (BMI) before pregnancy, FPG. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Wuxi Matemal and Child Health Hospital Affiliated to Nanjing Medical University. Informed consent was obtained from all participates.

The incidence rates of GDM and macrosomia of two groups were 22.2%, 46.9% and 8.3%, 31.3%, with significant differences (P<0.05) , but the incidence rates of hydramnios and low birth weight were 2.8%, 6.3% and 0, 9.4%, with no significant differences (P>0.05) ．There had no significant differences between two groups on TC [(6.36 ± 1.97) mmol/ L vs． (6.43 ± 2.01) mmol/ L, P>0.05], but had significant differences on TG [(1.17 ± 0.05) mmol/ L vs． (2.31 ± 0.14) mmol/ L], LDL[(3.45 ± 0.16) mmol/ L vs．(4.38 ± 0.23) mmol/ L], and HDL[(1.93 ± 0.18) mmol/ L vs．(1.18 ± 0.21) mmol/ L, P<0.05]．There also had no significant differences (P>0.05) between two groups on FPG [(4.39 ± 0.56) mmol/ L vs．(4.53 ± 0.67) mmol/ L], FINS [(6.35 ± 4.92) mU/ L vs．(7.82 ± 4.39) mU/ L], HOMA-IR(1.34 ± 0.87 vs． 1.67 ± 0.98) , HOMA-β(132.8 ± 87.8 vs． 171.5 ± 99.8) , and there had significant differences between two groups on AUC_glu [(20.14 ± 3.79) mmol/ Lh vs．(23.36 ± 5.18) mmol/ Lh, P<0.01] and AUC_INS [(163.7 ± 71.80) mU/ Lh vs． (230.5 ± 130.32) mU/ Lh, P<0.01].

The individualized nutritional guidance of patients with PCOS during pregnancy may improve glucose and lipid metabolism, decrease the pregnancy complications such as GDM and macrosomia.