摘要
目的 探讨精蛋白生物合成人胰岛素、地特胰岛素分别联合门冬胰岛素对妊娠期糖尿病(GDM)孕妇糖脂代谢及母婴结局的影响,以期为临床治疗提供参考.方法 本研究选取2021年1月-2023年12月遂宁市中医院收治的120例GDM孕妇为研究对象.采用随机数字表法将孕妇分为观察组与对照组,每组60例.2组孕妇均给予门冬胰岛素治疗.对照组孕妇在门冬胰岛素应用基础上给予精蛋白生物合成人胰岛素治疗;观察组孕妇在门冬胰岛素应用基础上联合地特胰岛素治疗.2组孕妇均以治疗2周为1个疗程,比较治疗前、治疗4个疗程时的血糖控制情况[空腹血糖(FPG)、糖化血红蛋白(HbA1c)、餐后2h血糖(2hFPG)]、血脂水平[总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]及胰岛素相关指标[胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)、空腹胰岛素水平(FINs)]水平变化.比较2组孕妇低血糖事件发生情况及母婴结局.结果 治疗前,2组孕妇FPG、2h-PBG、HbAlc水平比较,差异无统计学意义(P＞0.05).治疗4个疗程时,2组孕妇FPG、2h-PBG、HbAle水平均低于治疗前,且观察组低于对照组,差异均有统计学意义(P＜0.05).治疗前,2组孕妇TC、LDL-C、HDL-C水平比较,差异无统计学意义(P＞0.05).治疗4个疗程时,2组孕妇TC、LDL-C水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P＜0.05).治疗4个疗程时,2组孕妇HDL-C水平均高于治疗前,且观察组高于对照组,差异均有统计学意义(P＜0.05).治疗前,2组孕妇HOMA-IR、HOMA-β、FINs水平比较,差异无统计学意义(P＞0.05).治疗4个疗程时,2组孕妇HOMA-IR及FINs水平均低于治疗前,且观察组低于对照组,差异均有统计学意义(P＜0.05).治疗4个疗程时,2组孕妇HOMA-β水平均高于治疗前,且观察组高于对照组,差异均有统计学意义(P＜0.05).2组孕妇低血糖事件发生率比较,差异无统计学意义(P＞0.05).2组孕妇剖宫产、胎膜早破发生率及总发生率比较,差异均无统计学意义(P＞0.05).2组新生儿早产、高胆红素血症、巨大儿发生率及总发生率比较,差异均无统计学意义(P＞0.05).结论 地特胰岛素联合门冬胰岛素可有效改善GDM孕妇血糖、血脂水平,恢复胰岛β细胞功能,提高临床疗效,且不增加低血糖及不良妊娠结局风险,值得推广.
Abstract
Objective To explore the impact of protamine biosynthetic human insulin and insulin detemir combined with insu-lin aspart on the glycometabolism and maternal and infant outcomes in pregnant women with gestational diabetes mellitus(GDM),in order to provide a reference for clinical treatment.Methods This study selected 120 GDM pregnant worhen ad-mitted to Suining Municipal Hospital from January 2021 to December 2023 as research participants.pregnant worhen were randomly assigned to an observation group and a control group,with 60 cases in each group.Both groups of pregnant women were treated with insulin aspart.The control group was treated with protamine biosynthetic human insulin in addi-tion to insulin aspart;the observation group was treated with insulin detemir in addition to insulin aspart.Both groups of pregnant women were treated for 2 weeks as one course,and the changes in blood glucose control levels[fasting plasma glu-cose(FPG),glycated hemoglobin(HbA1c),2-hour postprandial blood glucose(2hFPG)],blood lipid level indicators[to-tal cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)],and in-sulin-related indicators[homeostasis model assessment of insulin resistance(HOMA-IR),homeostasis model assessment of β-cell function(HOMA-β),fasting insulin(FINs)]were compared before and after 4 courses of treatment.The incidence of hy-poglycemic events and maternal and infant outcomes in the two groups of pregnant women was compared.Results Before treatment,there was no statistically significant difference in FPG,2h-PBG,or HbA1c levels between the two groups of pregnant women(P＞0.05).After 4 courses of treatment,the levels of FPG,2h-PBG,and HbA1c in both groups of preg-nant women were lower than before treatment,and the observation group was lower than the control group,with statistical-ly significant differences(P＜0.05).Before treatment,no significant differences were found in TC,LDL-C,or HDL-C lev-els between the two groups of pregnant women(P＞0.05).After 4 courses of treatment,the levels of TC,and LDL-C in both groups of pregnant women were significantly lower than before treatment,and the observation group was significantly lower than the control group(P＜0.05).After 4 courses of treatment,the levels of HDL-C in both groups of pregnant women were significantly higher than before treatment,and the observation group was significantly higher than the control group(P＜0.05).Before treatment,no statistically significant differences were observed in HOMA-IR,HOMA-β,or FINs levels between the two groups of pregnant women(P＞0.05).After 4 courses of treatment,the levels of HOMA-IR and FINs in both groups of pregnant women were significantly lower than before treatment,and the observation group was significantly lower than the control group(P＜0.05).After 4 courses of treatment,the levels of HOMA-β in both groups of pregnant women were significantly higher than before treatment,and the observation group was significantly higher than the control group(P＜0.05).No statistically significant difference was noted in the incidence of hypoglycemic events be-tween the two groups of pregnant women(P＞0.05).No statistically significant differences were found in the incidence of cesarean section,premature rupture of membranes,and total incidence between the two groups of pregnant women(P＞0.05).No statistically significant differences were observed in the incidence of preterm birth,hyperbilirubinemia,macroso-mia,and total incidence in the two groups of newborns(P＞0.05).Conclusion Insulin detemir combined with insulin as-part can effectively strengthen the blood glucose and blood lipid levels in GDM pregnant women,restore the function of pan-creatic β-cells,promote clinical efficacy,and does not increase the risk of hypoglycemia and adverse pregnancy outcomes,justifying a wider promotion.
维普
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