摘要
目的 探讨胰岛素、二甲双胍单独及联合治疗妊娠期糖尿病(GDM)的效果及对母婴结局的影响.方法 选取海南现代妇女儿童医院2019年9月至2022年9月收治的GDM患者,随机分为A、B、C三组各40例.三组均采取饮食、运动等基础措施,除基础干预外,A组采用二甲双胍治疗,B组采用胰岛素治疗,C组采用胰岛素、二甲双胍联合治疗.三组患者均连续治疗至分娩.比较三组的血糖水平、血糖波动指标水平、患者胰岛素抵抗指数(HOMA-IR)、血浆胰淀素(Amylin)、脂联素(ADPN)水平及同型半胱氨酸(HCY)、胱抑素C(Cys C)水平、母婴结局和不良反应的差异.结果 治疗后,C组患者空腹血糖(FBG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1C)水平,日内血糖平均波动幅度(MAGE)、血糖水平标准差(SDBG)、日内血糖平均绝对差(MODD)、HOMA-IR、HCY及Cys C水平均明显低于A组和B组(P＜0.05),而Amylin、ADPN水平均明显高于A组和B组(P＜0.05),以上指标A、B两组差异均无统计学意义(P＞0.05);C组母婴不良事件的发生率均明显低于A组和B组(P＜0.05).结论 胰岛素联合二甲双胍可减轻GDM患者胰岛素抵抗,降低血糖水平及血糖波动,减少不良母婴事件,且不会增加不良反应发生率,为GDM的临床用药提供了新的见解.
Abstract
Objective To explore the effect of insulin,metformin alone and in combination in the treatment of gestational diabetes mellitus(GDM)and the influence on maternal-infant outcomes.Methods Patients with GDM admitted to Hainan Modern Women and Children's Hospital from September 2019 to September 2022 were selected and randomly divided into groups,A,B and C,with 40 cases in each group.All three groups were given diet,exercise and other basic measures.In addition to basic intervention,group A was treated with metformin,and group B was treated with insulin,and group C was given insulin combined with metformin.Patients in the three groups were treated continuously until delivery.Blood glucose,blood glucose fluctuation indicators,homeostasis model assessment of HOMA-IR,plasma Amylin,adiponectin(ADPN),homocysteine(HCY),cystatin C(Cys C),maternal-infant outcomes and adverse reactions were compared among the three groups.Results After treatment,the fasting blood glucose(FBG),2 h postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbAlC),MAGE,SDBG,MODD,HOMA-IR,HCY and Cys C in group C were significantly lower than those in group A and group B(P＜0.05)while the levels of Amylin and ADPN were significantly higher than those in group A and group B(P＜0.05),but there were no significant differences in the above indicators between group A and group B(P＞0.05).The incidence rates of adverse maternal-infant events in group C were significantly lower than those in groups A and B(P＜0.05).Conclusion Insulin combined with metformin can relieve the insulin resistance,reduce the blood glucose and blood glucose fluctuation,and reduce the adverse maternal-infant events without increasing the incidence rates of adverse reactions,providing new insights for the clinical use of GDM.
NETL
NSTL
维普
万方数据