饮食运动干预对超重和肥胖多囊卵巢综合征患者干预效果的研究

发布时间：2018-01-04 21:31

本文关键词：饮食运动干预对超重和肥胖多囊卵巢综合征患者干预效果的研究　出处：《北京协和医学院》2016年硕士论文　论文类型：学位论文

【摘要】：背景：多囊卵巢综合征是青春期及育龄期妇女最常见的内分泌紊乱性疾病之一。其不仅涉及生殖系统,还会引起多种代谢异常,包括糖代谢异常、脂代谢异常、心血管疾病危险因素增加等,特别是超重和肥胖的患者。国外研究证实饮食运动干预可以有效改善超重和肥胖多囊卵巢综合征的疾病状况。国内目前对多囊卵巢综合征患者进行生活方式干预的研究较少,且并无系统性、个体化的干预方法,患者很难坚持,失访率较高。因此,有必要探讨系统性、个体化的饮食运动干预对超重和肥胖多囊卵巢综合征患者的干预效果,为今后该人群的相关研究提供可借鉴的依据。目的：探讨饮食运动干预对超重和肥胖多囊卵巢综合征患者人体测量指标的干预效果；对糖代谢指标的干预效果；对性激素水平的干预效果；对血脂水平的干预效果。评价饮食运动干预过程的有效性。方法：本研究属于类实验性研究。于2015年3月～2016年4采用便利抽样方法,选取在北京协和医院妇科内分泌门诊就诊的超重和肥胖多囊卵巢综合征患者,共74例。按就诊时间分为干预组和对照组各37例。在常规诊疗基础上,对干预组研究对象进行饮食运动干预,干预内容包括制定符合个体化的饮食运动方案、督促方案实施及定期收集饮食运动日记。干预形式包括门诊干预、电话随访、微信平台随访。门诊干预4次,每次30-40min;微信平台沟通督导每周一次；电话督导每两周一次；患者饮食运动日记每周记录4天。对照组给予常规治疗与护理。研究对象分别在干预前、干预4周、干预8周、干预12周、干预16周测量体重、体重指数、腰围、臀围、腰臀比：在干预前、干预8周、干预16周时测量促黄体生成素、睾酮、促黄体生成素/促卵泡激素、空腹血糖、空腹胰岛素、胰岛素抵抗指数、血脂。在干预后采用“饮食运动干预过程评价问卷”对干预过程进行评价。结果：共对66例研究对象完成全部资料收集,其中干预组34例,对照组32例。干预组体重、BMI干预前后差值低于对照组,两组的差异有统计学意义(P0.05)；干预组腰围、臀围、腰臀比、促黄体生成素、睾酮、空腹血糖、空腹胰岛素、胰岛素抵抗指数、总胆固醇、甘油三酯、低密度脂蛋白胆固醇比明显低于对照组,两组的差异有统计学意义(P0.05);干预组促黄体生成素/卵泡刺激素低于对照组,但差异无统计学意义(P0.05)；干预组高密度脂蛋白胆固醇高于对照组,但差异无统计学意义(P0.05)。约94.1%的研究对象对本次干预内容、干预方法及干预时间表示满意或非常满意。结论：饮食运动干预可有效降低超重和肥胖多囊卵巢综合征患者人体测量指标、促黄体生成素、睾酮、糖代谢指标总胆固醇、甘油三酯、低密度脂蛋白胆固醇；对促黄体生成素/卵泡刺激素、高密度脂蛋白胆固醇的干预效果需要进一步验证。另外,本次干预的干预方式、内容和时间得到了大部分研究对象的认可。
[Abstract]:Background: polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in puberty and childbearing age women. It not only involves the reproductive system but also causes many metabolic abnormalities including abnormal glucose metabolism and lipid metabolism. Cardiovascular disease risk factors increased. Especially overweight and obese patients. Foreign studies have confirmed that diet and exercise intervention can effectively improve the disease status of overweight and obesity polycystic ovary syndrome. Less research has been done. And there is no systematic, individualized intervention, patients are difficult to adhere to, the rate of missing visits is high. Therefore, it is necessary to explore the systemic. Effects of individualized diet and exercise intervention on overweight and obese patients with polycystic ovary syndrome. Objective: to explore the effect of diet and exercise intervention on the anthropometric indexes of overweight and obese patients with polycystic ovary syndrome (PCOS). Intervention effect on glucose metabolism index; Intervention effect on sex hormone level; To evaluate the effectiveness of diet and exercise intervention. Methods: this study is a kind of experimental study. From March 2015 to 2016, convenient sampling method was used. A total of 74 patients with overweight and obese polycystic ovary syndrome (PCOS) were selected from gynecological endocrine clinic of Peking Union Hospital. According to the time of treatment, they were divided into intervention group (n = 37) and control group (n = 37), on the basis of routine diagnosis and treatment. Dietary exercise intervention was carried out on the subjects of the intervention group. The intervention included the establishment of individualized diet and exercise program, the supervision of the implementation of the program and the regular collection of dietary exercise diaries. The intervention included outpatient intervention. Telephone follow-up, WeChat platform follow-up, outpatient intervention 4 times, each 30-40 minutes; WeChat platform communication supervision once a week; Telephone supervisor once every two weeks; Diet and exercise diaries of the patients were recorded 4 days a week. The control group was given routine treatment and nursing. The subjects of the study were measured body weight and body mass index after intervention for 4 weeks, 8 weeks, 12 weeks and 16 weeks respectively. Waist circumference, hip circumference, waist-to-hip ratio: before intervention, 8 weeks of intervention, 16 weeks of intervention to measure luteinizing hormone, testosterone, luteinizing hormone / follicle hormone, fasting blood glucose, fasting insulin, insulin resistance index. Blood lipids. The intervention process was evaluated by "Diet exercise intervention process Evaluation questionnaire". Results: a total of 66 subjects completed the data collection, including 34 cases in the intervention group. The difference of body weight and BMI in the intervention group was lower than that in the control group before and after intervention, and the difference between the two groups was statistically significant (P 0.05). The waist circumference, hip circumference, waist-to-hip ratio, luteinizing hormone, testosterone, fasting blood glucose, fasting insulin, insulin resistance index, total cholesterol, triglyceride, low density lipoprotein cholesterol ratio in the intervention group were significantly lower than those in the control group. The difference between the two groups was statistically significant (P 0.05). Luteinizing hormone / follicle stimulating hormone in the intervention group was lower than that in the control group, but the difference was not statistically significant (P 0.05). The high density lipoprotein cholesterol in the intervention group was higher than that in the control group, but the difference was not statistically significant (P 0.05). About 94.1% of the subjects were involved in the intervention. Conclusion: diet and exercise intervention can effectively reduce the anthropometric indexes luteinizing hormone and testosterone in overweight and obese patients with polycystic ovary syndrome. Total cholesterol, triglyceride, low density lipoprotein cholesterol; The intervention effect of luteinizing hormone / follicle stimulating hormone and high density lipoprotein cholesterol needs to be further verified.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R473.71

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