摘要
目的:探讨门冬胰岛素联合不同疗程双歧杆菌三联活菌肠胶囊对妊娠期糖尿病(GDM)患者胰岛素抵抗、脂代谢及妊娠结局的影响.方法:选取2021年1月至2023年5月该院收治的GDM患者400例,按照随机数字表法分为A、B、C组及对照组,每组100例.对照组患者予以门冬胰岛素治疗,A组患者予以门冬胰岛素联合短疗程双歧杆菌三联活菌肠溶胶囊(4周),B组患者予以门冬胰岛素联合中疗程双歧杆菌三联活菌肠溶胶囊(8周),C组患者予以门冬胰岛素联合长疗程双歧杆菌三联活菌肠溶胶囊(12周).观察四组患者治疗前后脂代谢指标、胰岛素抵抗的变化,随访两组患者的妊娠结局.结果:治疗后,四组患者空腹血糖(FBG)、餐后2 h血糖(2 hBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、三酰甘油(TG)、总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平低于治疗前,高密度脂蛋白胆固醇(HDL-C)水平高于治疗前,差异均有统计学意义(P＜0.05).组间比较显示,B组、C组患者治疗后的FINS、HOMA-IR、TG、TC和LDL-C水平低于A组、对照组,HDL-C水平高于A组、对照组,差异均有统计学意义(P＜0.05);四组患者FBG、2 hBG水平的差异均无统计学意义(P＞0.05);B组与C组、A组与对照组患者FINS、HOMA-IR、TG、TC和LDL-C水平比较,差异均无统计学意义(P＞0.05)o对照组、A组、B组和C组患者的不良妊娠结局发生率分别为 41.0％(41/100)、38.0％(38/100)、15.0％(15/100)和 17.0％(17/100),新生儿不 良结局发生率分别为 42.0％(42/100)、35.0％(35/100)、13.0％(13/100)和14.0％(14/100);与A组、对照组比较,B组、C组患者的不良妊娠结局、新生儿不良结局发生率更低,差异均有统计学意义(P＜0.05).结论:不同疗程的双歧杆菌三联活菌肠溶胶囊对GDM患者胰岛素抵抗、血脂代谢及妊娠结局的影响存在一定差异,其中用药8周为最佳用药疗程.
Abstract
OBJECTIVE:To probe into the effects of insulin aspart combined with different courses of Bifidobacterium triple viable enteric capsule on insulin resistance,lipid metabolism and delivery outcomes in patients with gestational diabetes mellitus(GDM).METHODS:Totally 400 patients with GDM admitted into the hospital from Jan.2021 to May 2023 were extracted to be divided into the group A,group B,group C and control group via the random number table method,with 100 cases in each group.The control group was treated with insulin aspart,the group A received insulin aspart combined with short-course Bifidobacterium triple viable enteric capsule(4 weeks),the group B was given insulin aspart combined with medium-course Bifidobacterium triple viable enteric capsule(8 weeks),and the group C was treated with insulin aspart combined with long-course Bifidobacterium triple viable enteric capsule(12 weeks).Changes of lipid metabolism,insulin resistance and delivery outcome were observed in four groups after treatment.RESULTS:After treatment,fasting blood glucose(FBG),2 h blood glucose(2 hBG),fasting insulin(FINS),homeostatic model assessment of insulin resistance(HOMA-IR),triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)in four groups were lower than those before treatment,and high-density lipoprotein cholesterol(HDL-C)was higher than those before treatment,with statistically significant differences(P＜0.05).Inter-group comparison showed that FINS,HOMA-IR,TG,TC,LDL-C in the group B and group C were lower than those in the group A and control group,HDL-C was higher than that in the group A and control group,with statistically significant differences(P＜0.05).There was no statistically significant difference among four groups in FBG and 2 hBG(P＞0.05).Difference in FINS,HOMA-IR,TG,TC,LDL-C between the group B and group C,the group A and control group were not statistically significant(P＞0.05).The incidence of poor pregnancy outcomes in control group,group A,group B and group C was respectively 41.0％(41/100),38.0％(38/100),15.0％(15/100)and 17.0％(17/100);the incidence of poor neonatal outcomes was respectively 42.0％(42/100),35.0％(35/100),13.0％(13/100)and 14.0％(14/100);compared with group A and control group,the incidence of poor pregnancy outcomes and neonatal outcomes in group B and group C was lower,with statistically significant difference(P＜0.05).CONCLUSIONS:There are some differences in insulin resistance,lipid metabolism and pregnancy outcome of patients with GDM with the same course of Bifidobacterium triple viable enteric capsule,among which 8 weeks of treatment is the best treatment course.
基金项目
河北省医学科学研究课题计划项目(20221505)
维普
万方数据