维生素D联合诺和锐特充治疗GDM临床效果  

Clinical effect of vitamin D combined with insulin aspart injection for treating women with gestational diabetes mellitus

作　　者：张华俊 陈丽会[2] 肖飞 袁建娜 王薇 ZHANG Huajun;CHEN Lihui;XIAO Fei;YUAN Jianna;WANG Wei(Qinhuangdao Maternity and Child Health Care Hospital,Qinhuangdao,Hebei Province,066000;Hebei Chest Hospital,Shijiazhuang,Hebei Province)

机构地区：[1]河北省秦皇岛市妇幼保健院,066000 [2]河北省胸科医院

出　　处：《中国计划生育学杂志》2024年第7期1542-1547,共6页Chinese Journal of Family Planning

基　　金：2022年度河北省医学科学研究项目(20221621);2020年秦皇岛市市级科学技术研究与发展计划项目(202004A025)。

摘　　要：目的:探究维生素D联合诺和锐特充治疗妊娠期糖尿病(GDM)效果。方法:选取2020年1月-2023年1月本院收治的GDM患者114例,随机数表法分为胰岛组(n=57)和联合组(n=57),两组均给予诺和锐特充皮下注射治疗,联合组同时口服维生素D滴剂,均持续治疗至血糖达标,比较两组治疗前、分娩前血糖指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)]、胰岛素指标[空腹胰岛素(FINS)、胰岛素分泌指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)]、血脂指标(血浆脂肪酸、总胆固醇、甘油三酯)、同型半胱氨酸(Hcy)、Toll样受体4(TLR4)、血管细胞粘附分子(VCAM-1),随访母婴结局。结果:治疗后分娩前,两组FPG、2hPG、HbA1c均下降(P<0.05)但两组无差异(P>0.05),两组FINS、HOMA-IR均下降,HOMA-β均上升,且联合组指标(12.76±1.46μU/ml、2.98±0.23、89.52±8.10)改善优于胰岛组(12.87±1.52μU/ml、3.30±0.52、81.41±8.08),两组血脂指标均下降且联合组低于胰岛组,两组TLR4、VCAM-1、Hcy均下降且联合组(6.71±1.38 mU/L、43.63±7.47 ng/ml、8.47±1.85μmol/L)低于胰岛组(8.49±1.46 mU/L、52.47±7.63 ng/ml、11.21±2.76μmol/L)(均P<0.05);胰岛组与联合组不良母婴结局发生率(14.0%比8.8%)无差异(P>0.05)。结论:维生素D辅助诺和锐特充治疗GDM,有利于改善患者胰岛素抵抗及脂代谢功能,抑制Hcy等促炎因子表达,未增加不良母婴结局风险。Objective:To explore the clinical effect of vitamin D combined with insulin aspart injection(novorapid) for treating pregnant women with gestational diabetes mellitus(GDM).Methods:114 pregnant women with GDM were selected and were divided into two groups(57 cases in each group) by the random number table method from January2020 to January 2023.The women in the two groups were treated with insulin aspart injection continuously until the blood glucose reached the standard,while the women in the study group was given vitamin D additionally.The levels of blood glucose indicators,such as fasting plasma glucose(FPG),2h postprandial blood glucose(2hPG),and HbAlc,the insulin indicators,such as fasting insulin(FINS) level,and the values of homeostasis model assessment(HOMA)of islet β cell function and HOMA-insulin resistance(IR),the levels of blood lipids,such as plasua fatty acid,total cholesterol and triglyceride,the levels of homocysteine(Hcy),the Toll-like receptor 4(TLR4) and vascular cell adhesion molecule(VCAM-1) of the women before treatment and before delivery were compared between the two groups.The maternal and infant outcomes in the two groups were followed up.Results:The levels of FPG,2hPG and HbA1c after treatment of the women in the two groups before delivery had decreased significantly(P<0.05),but which of the women had no significant difference between the two groups(P>0.05).The FINS level and the HOMA-IR value of the women in the two groups after treatment had decreased significantly,and the HOMA-β value of the women in the two groups after treatment had increased significantly,and which(12.76±1.46μU/ml,2.98±0.23 and 89.52±8.10)of the women in the study group were significantly better than those(12.87±1.52μU/ml,3.30±6.52 and 81.41±8.08) of the women in the control group.The blood lipid indexes levels of the women in the two groups after treatment had decreased significantly,and which of the women in the study group were significantly lower than those of the women in the control group.The levels

关 键 词：妊娠期糖尿病 维生素D 诺和锐特充 胰岛素抵抗 血浆脂肪酸 同型半胱氨酸 糖化血红蛋白 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]