门冬胰岛素联合二甲双胍在妊娠期糖尿病患者中的应用  

Application of insulin aspart and metformin in patients with gestational diabetes mellitus

作　　者：徐亚 周圣涛[1] 肖碧蓉 XU Ya;ZHOU Sheng-tao;XIAO Bi-rong(Department of Obstetrics,West China Women s and Children s Hospital,Sichuan University,Chengdu 610000,China;Department of Obstetrics,Deyang People's Hospital,Deyang 618000,China)

机构地区：[1]四川大学华西妇产儿童医院产科,四川成都610000 [2]四川省德阳市人民医院产科,四川德阳618000

出　　处：《实用医院临床杂志》2020年第3期155-158,共4页Practical Journal of Clinical Medicine

摘　　要：目的探讨门冬胰岛素与二甲双胍联合应用对妊娠期糖尿病(Gestational diabetes mellitus,GDM)患者血糖代谢、胰岛素抵抗、血清脂肪因子omentin-1、chemerin及胰高血糖样肽-1(Glucagon-like Peptide-1,GLP-1)水平的影响。方法收集2016年1月至2018年12月我院收治的GDM患者300例,依据治疗方法不同分为对照组(常规治疗+门冬胰岛素治疗,n=165例)和联合组(常规治疗+门冬胰岛素+二甲双胍治疗,n=135),比较两组空腹血糖(FPG)、餐后2 h血糖(P2hBG)、糖化血红蛋白(Hb A1c)、胰岛素抵抗指数(HOMA-IR)、GLP-1、血清omentin-1、chemerin水平、母婴结局及药物安全性。结果治疗后两组FPG、P2hBG、Hb A1c、HOMA-IR、chemerin较治疗前明显降低,且联合组FPG、P2hBG、Hb A1c、HOMA-IR、chemerin明显低于对照组,GLP-1、omentin-1较治疗前明显升高,但联合组GLP-1、omentin-1明显高于对照组,差异有统计学意义(P<0.05);联合组子痫前期、新生儿黄疸、巨大儿发生率明显低于对照组(P<0.05)。两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论门冬胰岛素与二甲双胍联合应用于GDM患者,可有效调节血糖代谢、胰岛素抵抗、血清omentin-1、chemerin及GLP-1水平,并明显改善母婴结局,且有一定药物安全性。Objective To investigate the effect of insulin aspart and metformin on blood glucose metabolism,insulin resistance,serum levels of omentin-1,chemerin and glucagon-like peptide-1(GLP-1)in patients with gestational diabetes mellitus(GDM).Methods A total of 300 GDM patients who were admitted to the hospitals from January 2016 to December 2018 were divided into the control group(routine treatment and insulin aspart,n=165)and the combination group(routine treatment and insulin aspart with metformin,n=135)according to different treatment methods.The glucose metabolism indexes such as fasting plasma glucose(FPG),postprandial 2 h blood glucose(P2 hBG),glycosylated hemoglobin(Hb A1 c),HOMA insulin resistance index(HOMA-IR),GLP-1,serum levels of omentin-1 and chemerin as well as maternal and neonatal outcomes and drug safety were compared between the two groups.Results After treatment,FPG,P2 hBG,Hb A1 c,HOMA-IR and chemerin were decreased when compared to before treatment in both groups,and FPG,P2 hBG,Hb A1 c and chemerin in the combination group were lower than those in the control group.GLP-1 and omentin-1 were higher than those before treatment and the indexes in the combined group were higher than those in the control group(P<0.05).The incidence rates of preeclampsia,neonatal jaundice and macrosomia in the combination group were significantly lower than those in the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion The application of insulin aspart combined with metformin in GDM patients can effectively regulate blood glucose metabolism,insulin resistance,serum levels of omentin-1,chemerin and GLP-1,and significantly improve the maternal and neonatal outcomes with certain drug safety.

关 键 词：妊娠期糖尿病 门冬胰岛素 二甲双胍 血糖代谢 胰岛素抵抗 

分 类 号：R714[医药卫生—妇产科学]