维生素D滴剂联合门冬胰岛素治疗妊娠期糖尿病的疗效及对血清1,25(OH)_(2)D_(3)、RBP_(4)水平的影响  

Effect of vitamin D drops combined with insulin aspart in the treatment of gestational diabetes mellitus and its influence on serum 1, 25(OH)_(2)D_(3) and RBP4 levels

作　　者：李云霞 高倩 张颜 葛新苗 郝雅芹 王冰 Li Yunxia;Gao Qian;Zhang Yan;Ge Xinmiao;Hao Yaqin;Wang Bing(Department of Obstetrics,Baoding Second Central Hospital,Baoding 072750,China;Department of Obstetrics and Gynecology,Gaobeidian Hospital,Baoding 074099,China)

机构地区：[1]保定市第二中心医院产科,保定072750 [2]高碑店市医院妇产科,保定074099

出　　处：《中国医师杂志》2023年第8期1181-1186,共6页Journal of Chinese Physician

基　　金：河北省医学科学研究重点课题计划(20181515)。

摘　　要：目的探讨维生素D滴剂联合门冬胰岛素治疗妊娠期糖尿病(GDM)的临床疗效以及对患者血清1,25-二羟维生素D3[1,25(OH)_(2)D_(3)]、视黄醇结合蛋白4(RBP4)水平的影响。方法选取保定市第二中心医院2019年3月至2021年3月收治的94例GDM患者,使用随机数字表法将其分成观察组与对照组各47例。其中对照组皮下注射门冬胰岛素治疗,在此基础上,观察组口服维生素D滴剂治疗。连续治疗4周后观察两组血糖控制效果和不良反应情况。比较治疗前后两组糖代谢指标[空腹血糖(FPG)、餐后2 h血糖(2 h PG)、胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数(HOMA-β)]及血清1,25(OH)_(2)D_(3)、RBP4、脂蛋白相关磷脂酶A2(Lp-PLA2)和血管细胞黏附分子-1(VCAM-1)水平。所有患者均随访至妊娠结束,统计两组母婴不良结局情况。结果观察组FPG和2 h PG的达标时间及两者全部达标的时间均显著短于对照组(均P<0.05)。观察组黎明现象、低血糖发生率与对照组比较差异无统计学意义(均P>0.05)。两组治疗后FPG、2 h PG较治疗前均显著降低(均P<0.05);但治疗后,组间比较差异无统计学意义(均P>0.05)。与治疗前对比,两组治疗后HOMA-IR均显著下降(均P<0.05),HOMA-β则均显著升高(均P<0.05);且均以观察组改善更显著(均P<0.05)。观察组治疗后血清1,25(OH)_(2)D_(3)水平较治疗前显著上升(P<0.05),但对照组治疗前后无明显改变(P>0.05)。两组治疗后血清RBP4、Lp-PLA2和VCAM-1水平较治疗前均显著下降(均P<0.05);且治疗后,观察组血清RBP4、Lp-PLA2和VCAM-1水平低于对照组(均P<0.05)。观察组产妇不良结局及新生儿不良结局发生率分别为14.9%(7/47)、10.6%(5/47),均低于对照组[34.0%(16/47)、27.7%(13/47)](均P<0.05)。94例患者中出现8例低血糖(观察组3例,对照组5例),无其他不良事件发生。结论维生素D滴剂联合门冬胰岛素治疗GDM能安全、有效、快速且平稳地控制患者血糖,改善IR�Objective To investigate the clinical efficacy of vitamin D drops combined with insulin aspart in the treatment of gestational diabetes mellitus(GDM),and the effect of vitamin D drops on the serum levels of 1,25 dihydroxyvitamin D3[1,25(OH)_(2)D_(3)]and retinol binding protein 4(RBP4).Methods A total of 94 GDM patients admitted to the Baoding Second Central Hospital from March 2019 to March 2021 were selected and randomly divided into an observation group and a control group with 47 cases each using a random number table method.The control group received subcutaneous injection of insulin aspartate for treatment,while the observation group received oral vitamin D drops for treatment.After 4 weeks of continuous treatment,the blood glucose control effect and adverse reactions were observed in both groups.The glucose metabolism indicators of the two groups were compared before and after treatment,including fasting blood glucose(FPG),2-hour postprandial blood glucose(2-hour PG),insulin resistance index(HOMA-IR),and pancreatic isletsβCell Function Index(HOMA-β)and serum levels of 1,25(OH)_(2)D_(3),RBP4,lipoprotein related phospholipase A2(Lp-PLA2),and vascular cell adhesion molecule-1(VCAM-1).All patients were followed up until the end of pregnancy,and Statistical analysis was conducted on the adverse outcomes of two groups of mothers and infants.Results The time to reach the standard for FPG and 2-hour PG in the observation group,as well as the time for both to reach the standard were significantly shorter than those in the control group(all P<0.05).There was no statistically significant difference in the incidence of dawn phenomenon and hypoglycemia between the observation group and the control group(all P>0.05).After treatment,FPG and 2-hour PG in both groups were significantly reduced compared to those before treatment(all P<0.05);However,after treatment,there was no statistically significant difference between the groups(all P>0.05).Compared with before treatment,HOMA-IR in both groups significantly decreased(al

关 键 词：糖尿病 妊娠 维生素D 门冬胰岛素 1 25-二羟维生素D3 视黄醇结合蛋白4 

分 类 号：R714.256[医药卫生—妇产科学]