二甲双胍联合胰岛素改善妊娠期糖尿病患者妊娠结局的机制研究  

Study on the Mechanism of Metformin Combined with Insulin to Improve Pregnancy Outcome in Patients with Gestational Diabetes Mellitus

作　　者：杨秀莲[1] YANG Xiulian(Department of Obstetrics and Gynecology,Huizhou Third People's Hospital,Huizhou,Guangdong Province,516000 China)

机构地区：[1]惠州市第三人民医院妇产科,广东惠州516000

出　　处：《系统医学》2022年第24期169-172,共4页Systems Medicine

基　　金：惠州市科技计划项目(180521171745886)。

摘　　要：目的探讨二甲双胍联合胰岛素在妊娠糖尿病(gestational diabetes mellitus,GDM)中的应用价值。方法选取2015年1月—2021年10月惠州市第三人民医院收治的78例GDM患者为研究对象,采用随机数表法分为两组,每组39例。对照组采用胰岛素治疗,观察组在对照组用药基础上联合二甲双胍。观察两组血糖指标、实验室指标水平,记录妊娠结局和新生儿结局。结果用药后,观察组空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、胱抑素C(Cys-C)、同型半胱氨酸(Hcy)指标比对照组更低,脂肪因子网膜素-1(omentin-1)、胰高血糖素样肽-1(GLP-1)比对照组更高,差异有统计学意义(P<0.05)。观察组羊水过多、剖宫产、早产、巨大儿、新生儿窘迫发生率分别为2.56%、20.51%、7.69%、2.56%、5.13%,与对照组20.51%、43.59%、28.21%、23.08%、25.64比较,均明显更低,差异有统计学意义(χ^(2)=4.522、4.768、5.571、7.341、6.303,P<0.05)。结论二甲双胍联合胰岛素治疗GDM能降低HOMA-IR、Cys-C、Hcy,提高GLP-1和omentin-1,控制血糖水平,优化妊娠结局及新生儿结局。Objective To explore the value of metformin combined with insulin in gestational diabetes mellitus(GDM).Methods 78 patients with GDM admitted to the Third People's Hospital of Huizhou City from January 2015 to October 2021 were selected as the study subjects.They were divided into two groups by random number table method,with 39 patients in each group.The control group was treated with insulin,and the observation group was combined with metformin on the basis of the control group.The levels of glycemic indexes and laboratory indexes were observed in both groups,and pregnancy outcome and neonatal outcome were recorded.Results After medication,the fasting blood glucose(FPG),2h postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c),insulin resistance index(HOMA-IR),cystatin C(Cys-C),homocysteine(Hcy)indexes in the observation group were lower than those in the control group,and the adipokine omentin-1(omentin-1),glucagon-like peptide-1(GLP-1)indexes were higher than those in the control group,and the difference was statistically significant(P<0.05).The incidence rates of polyhydramnios,cesarean section,premature delivery,macrosomia and neonatal distress in the observation group were 2.56%,20.51%,7.69%,2.56%and 5.13%,respectively,which were significantly lower than those in the control group(20.51%,43.59%,28.21%,23.08%,25.64%),and the difference was statistically significant(χ^(2)=4.552,4.768,5.571,7.341,6.303,P<0.05).Conclusion Metformin combined with insulin for GDM can reduce HOMA-IR,Cys-C,and Hcy,increase GLP-1 and omentin-1,control blood glucose levels,and optimize pregnancy outcome and neonatal outcome.

关 键 词：妊娠糖尿病 二甲双胍 胰岛素 胰岛素抵抗 血糖 

分 类 号：R587.1[医药卫生—内分泌]