不同类型胰岛素治疗妊娠期糖尿病的效果及对妊娠结局的影响  

Effect of different types of insulin in treating gestational diabetes mellitus and influence on pregnancy outcomes

作　　者：陈海燕 严晓瑞 潘娜娜 徐运川 CHEN Hai-yan;YAN Xiao-rui;PAN Na-na;XU Yun-chuan(Department of Obstetrics and Gynaecology,Lu'an Hospital of Anhui Medical University,Lu'an People's Hospital,Lu'an 237005,Anhui,China)

机构地区：[1]安徽医科大学附属六安医院·六安市人民医院妇产科,安徽六安237005

出　　处：《川北医学院学报》2024年第4期555-558,共4页Journal of North Sichuan Medical College

摘　　要：目的:探讨不同胰岛素治疗妊娠期糖尿病(GDM)的效果及对妊娠结局的影响。方法:选取104例GDM患者为研究对象,按照治疗方式不同分为对照组和研究组,每组各52例。对照组患者给予门冬胰岛素治疗;研究组患者给予门冬胰岛素+地特胰岛素治疗,两组均连续治疗至分娩前。比较两组患者治疗疗效;治疗前及治疗7 d后两组血糖控制情况[空腹血糖(FPG)、餐后2小时血糖(2 hPG)]、血糖达标时间(FPG达标、2 hPG达标、FPG和2 hPG均达标)、血糖波动情况;治疗前及治疗1、4及8周后两组生化指标[糖化血红蛋白(HbA1c)水平、胱抑素C(Cys-C)、超氧化物歧化酶(SOD)水平];妊娠结局和不良反应发生情况,随访至分娩结局。结果:治疗后,两组FPG、2 hPG均低于治疗前,研究组较对照组下降明显(P<0.05);研究组FPG达标、2 hPG达标及FPG和2 hPG均达标时间均短于观察组(P<0.05)。两组血糖波动情况,SDBG及PPGE比较,差异无统计学意义(P>0.05)。治疗1、4、8周后,研究组HbA1c水平均低于对照组(P<0.05)。两组患者Cys-C水平无统计学差异(P>0.05),研究组患者SOD水平高于对照组(P<0.05)。两组不良妊娠结局及不良反应发生率无统计学差异(P>0.05),但研究组新生儿低血糖及剖宫产率高于对照组(P<0.05)。结论:门冬胰岛素联合地特胰岛素治疗GDM更快有效控制患者血糖,改善妊娠结局,减轻氧化应激反应与肾损伤,治疗GDM更有优势。Objective:To explore the effect of different types of insulin in the treatment of gestational diabetes mellitus(GDM)and the influence on pregnancy outcomes.Methods:104 patients with GDM were divided into control group(insulin aspart)and study group(insulin aspart+insulin detemir)according to different treatment methods,52 cases in each group.Both groups were treated continuously until delivery.At baseline and 7days after treament,the two groups were compared for blood glucose control[fasting blood glucose(FPG),2 h postprandial blood glucose(2 hPG)],the time to achieve glycemic target(FPG and 2 hPG alone or both)and glycemic fluctuation.The efficacy,glycated hemoglobin(HbAlc)levels,biochemical indicators[cystatin C(Cys-C),and superoxide dismutase(SOD)levels]before treatment and after 1,4 and 8 weeks of treatment,pregnancy outcomes and adverse reactions were compared between the two groups.Results:After treatment,FPG and 2 hPG in both groups were lower than before treatment,and the study group was significantly lower than the control group(P<0.05).The time to reach FPG and 2 hPG target,either alone or both,were shorter in the study group than in the control group(P<0.05).Two groups of blood glucose fluctuations,SDBG and PPGE contrast,there was no significant difference(P>0.05).After treatment for one week,four weeks and eight weeks,the levels of HbAlc in study group were lower than those in control group(P<0.05),and the time of blood glucose reaching the standard was shorter than that in control group(P<0.05).There was no statistical significance in Cys-C level between both groups(P>0.05),and the study group had higher SOD level(P<0.05).The adverse pregnancy outcomes and adverse reactions revealed no statistical differences(P>0.05),but the rates of hypoglycemia and cesarean section were higher in study group(P<0.05).Conclusion:Insulin aspart combined with insulin detemir has significant eficacy in the treatment of GDM.It can effectively control the blood glucose of pa-tients,improve the pregnancy outcomes,reduce ox

关 键 词：妊娠期糖尿病 长效胰岛素 短效胰岛素 血糖 妊娠结局 

分 类 号：R714.25[医药卫生—妇产科学]