二甲双胍联合门冬胰岛素治疗妊娠期糖尿病的疗效及对患者血清胱抑素C、同型半胱氨酸水平的影响  

Curative effect of metformin combined with insulin aspart in treatment of gestational diabetes mellitus and the impact on the levels of serum cystatin C and homocysteine

作　　者：耿慧[1] 丁霄雁 段彼得[1] 

机构地区：[1]淄博市中心医院产科,山东淄博255036

出　　处：《中国妇幼保健》2018年第4期796-799,共4页Maternal and Child Health Care of China

摘　　要：目的探讨二甲双胍联合门冬胰岛素治疗妊娠期糖尿病(GDM)的疗效及对患者血清胱抑素C(Cys C)、同型半胱氨酸(Hcy)水平的影响。方法选取该院2015年8月-2016年10月间收治的GDM孕妇94例为研究对象,采用随机数字法将其分为观察组和对照组,每组各47例。两组患者均接受常规糖尿病饮食和运动训练,同时皮下注射门冬胰岛素治疗,在此基础上,观察组患者口服二甲双胍治疗。比较两组患者治疗前后血糖指标、血清Cys C、Hcy水平,同时比较孕妇并发症和围生儿结局。结果治疗后,观察组的空腹血糖(FPG)、餐后2 h血糖(2 hPG)及糖化血红蛋白(Hb A1c)水平[(4.03±0.49)mmol/L、(5.92±0.57)mmol/L、(5.12±0.58)%]均明显低于对照组[(4.82±0.68)mmol/L、(8.16±0.83)mmol/L、(6.44±0.76)%],差异有统计学意义(均P<0.01),血清Cys C、Hcy水平[(0.74±0.13)mg/L、(7.75±2.13)μmol/L]均明显低于对照组[(0.97±0.19)mg/L、(9.78±2.69)μmol/L],差异有统计学意义(均P<0.01);观察组的妊娠期高血压疾病、低血糖、早产、酮症酸中毒、剖宫产、蛋白尿及羊水过多等并发症发生率(8.51%、4.26%、0.00%、0.00%、12.76%、2.13%、12.76%)均明显低于对照组(27.66%、12.76%、12.76%、8.51%、36.17%、14.89%、31.91%),差异有统计学意义(均P<0.05),巨大儿、新生儿黄疸、新生儿低血糖、新生儿呼吸窘迫综合征等不良围生儿结局发生率(8.51%、10.64%、2.13%、4.26%)均明显低于对照组(34.04%、31.91%、14.89%、14.89%),差异有统计学意义(均P<0.05)。结论二甲双胍联合门冬胰岛素治疗GDM的临床疗效显著,能有效控制血糖水平,改善母婴妊娠结局,治疗安全性较高。Objective To explore the curative effect of metformin combined with insulin aspart in treatment of gestational diabetes mellitus（ GDM） and the impact on the levels of serum cystatin C（ CysC） and homocysteine（ Hcy）. Methods Ninety-four GDM pregnant women treated in Zibo Central Hospital from August 2015 to October 2016 were selected and randomly divided into control group and observation group,47 patients in each group. The patients in the two groups received routine diet,exercise,and subcutaneous injection of insulin aspart. Based on the routine therapy,the patients in observation group were treated by oral administration of metformin. The levels of blood glucose,serum Cys C and Hcy before and after treatment in the two groups were compared. The maternal complications and perinatal outcomes were also compared between the two groups. Results After treatment,the levels of fasting plasma glucose（ FPG）,2-hour postprandial blood glucose（ 2 h PG）,and glycosylated hemoglobin（ Hb A1 c） in observation group were（ 4. 03 ± 0. 49） mmol/L,（ 5. 92 ±0. 57） mmol/L,and（ 5. 12 ± 0. 58） %,respectively,which were statistically significantly lower than those in control group [（ 4. 82 ±0. 68） mmol/L,（ 8. 16±0. 83） mmol/L,（ 6. 44±0. 76） % ]（ all P〈0. 01）. The levels of serum CysC and Hcy in observation group were（ 0. 74±0. 13） mg/L and（ 7. 75 ± 2. 13） μmol/L,respectively,which were statistically significantly lower than those in control group[（ 0. 97±0. 19） mg/L and（ 9. 78±2. 69） μmol/L]（ both P〈0. 01）. The incidence rates of hypertensive disorder complicating pregnancy,hypoglycemia,premature delivery,ketoacidosis,cesarean section,proteinuria,and polyhydramnios in observation group were 8. 51%,4. 26%,0. 00%,0. 00%,12. 76%,2. 13%,and 12. 76%,respectively,which were statistically significantly lower than those in control group（ 27. 66%,12. 76%,12. 76%,8. 51%,36. 17%,14. 89%,31. 91%）（ all P〈0. 05）. The incidence rates of macrosomia,neonatal j

关 键 词：二甲双胍 门冬胰岛素 妊娠期糖尿病 胱抑素C 同型半胱氨酸 母婴结局 

分 类 号：R714[医药卫生—妇产科学]