二甲双胍联合门冬胰岛素治疗A2型GDM孕妇患者的临床研究  

Clinical trial of metformin combined with insulin aspart in the treatment of pregnant women with type A2 GDM

作　　者：朱萍[1] 张素霞[1] 宋敏[1] ZHU Ping;ZHANG Su-xia;SONG Min(Department of Obstetrics,Jinan Maternal and Child Health Hospital,Jinan250001,Shandong Province,China)

机构地区：[1]济南市妇幼保健院产科,山东济南250001

出　　处：《中国临床药理学杂志》2024年第18期2680-2684,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的探讨二甲双胍联合门冬胰岛素治疗A2型妊娠糖尿病(GDM)孕妇患者的临床疗效。方法将A2型GDM孕妇按具体用药情况分为对照组和试验组。对照组皮下注射0.5~1.0U·kg^(-1)·d^(-1)门冬胰岛素;试验组在对照组基础上口服二甲双胍0.25g(bid),均用药至分娩后。比较2组患者临床疗效,比较治疗后的空腹血糖(FPG)、空腹胰岛素(FINS)、餐后2h血糖(2hPBG)、胰岛β细胞功能(HOMA-β)、胰岛素抵抗指数(HOMA-IR)、胰岛素用量,进行安全性评价,统计妊娠结局。结果试验组和对照组分别纳入31例和37例。治疗后,试验组和对照组的总有效率分别为64.52%(20例/31例)和86.49%(32例/37例),在统计学上差异有统计学意义(P<0.05)。治疗后,对照组和试验组FPG分别为(5.04±0.86)和(4.16±0.90)mmol·L^(-1),2hPBG分别为(7.51±1.12)和(5.76±0.93)mmol·L^(-1),FINS分别为(12.97±1.03)和(17.34±1.79)mU·L^(-1),HOMA-β分别为393.04±56.93和225.19±35.47,HOMA-IR分别为2.40±0.17和3.87±0.28,胰岛素用量分别为(33.71±4.62)和(26.95±3.47)U·kg^(-1)·d^(-1)。2组间比较,在统计学上差异均有统计学意义(均P<0.05)。试验组和对照组剖宫产发生率分别为18.92%和51.61%;巨大儿发生率分别为2.70%和19.35%,在统计学上差异均有统计学意义(均P<0.05)。试验组和对照组药物不良反应发生率分别为18.92%和9.68%,在统计学上差异无统计学意义(P>0.05)。结论二甲双胍联合门冬胰岛素可有效提高A2型GDM孕妇控糖疗效,降低血糖水平,减少胰岛素用量,改善妊娠结局。Objective To explore the clinical curative effect of metformin combined with insulin aspart in pregnant women with type A2gestational diabetes mellitus(GDM).Methods According to different medication methods,pregnant women with type A2 GDM were divided into control group[subcutaneous injection of insulin aspart(0.5-1.0U·kg^(-2)·d^(-1))immediately before three meals a day]and treatment group(oral 0.25 g metformin with meals on basis of control group).All pregnant women were treated till delivery.The clinical curative effect,fasting plasma glucose(FPG),fasting insulin(FINS),2 h postprandial blood glucose(2 h PBG),homeostasis model assessment-β(HOMA-β),homeostatic model assessment of insulin resistance(HOMA-IR)and insulin dosage after 2 weeks of treatment,safety evaluation and pregnancy outcomes were compared between the two groups.Results There were 31 cases in treatment group and 37 cases in control group.The difference in total response rate between control group and treatment group was statistically significant[64.52%(20 cases/31 cases)vs 86.49%(32 cases/37 cases),P<0.05].After treatment,FPG levels in treatment group and control group were(5.04±0.86)and(4.16±0.90)mmol·L^(-1),2 h PBG levels were(7.51±1.12)and(5.76±0.93)mmol·L^(-1),FINS levels were(12.97±1.03)and(17.34±1.79)mU·L^(-1),HOMA-βlevels were393.04±56.93 and 225.19±35.47,HOMA-IR levels were 2.40±0.17 and 3.87±0.28,insulin dosages were(33.71±4.62)and(26.95±3.47)U·kg^(-1)·d^(-1),the differences were statistically significant(all P<0.05).The differences in incidence of cesarean section and macrosomia between treatment group and control group were statistically significant(48.39%,2.70%vs 51.61%,19.35%,P<0.05),but the difference in incidence of adverse reactions was not statistically significant(18.92%vs 9.68%,P>0.05).Conclusion Metformin combined with insulin aspart before three meals can effectively improve glucose control effect,lower blood glucose level,reduce insulin dosage and improve pregnancy outcomes in pregnant women with type A2

关 键 词：二甲双胍 门冬胰岛素 妊娠糖尿病 空腹血糖 妊娠结局 

分 类 号：R97[医药卫生—药品]