二甲双胍联合胰岛素治疗妊娠期糖尿病临床观察  

Clinical Observation of Metformin Combined with Insulin in the Treatment of Gestational Diabetes Mellitus

作　　者：段艳芳 何文慧 秦业强 刘风伟 赵金梅 姚晓玲 DUAN Yanfang;HE Wenhui;QIN Yeqiang;LIU Fengwei;ZHAO Jinmei;YAO Xiaoling(Cangzhou People′s Hospital,Cangzhou,Hebei,China 061000)

机构地区：[1]河北省沧州市人民医院,河北沧州061000

出　　处：《中国药业》2025年第5期96-100,共5页China Pharmaceuticals

基　　金：2020年度河北省医学科学研究课题计划项目[20200291]。

摘　　要：目的 探讨二甲双胍联合胰岛素治疗妊娠期糖尿病(GDM)的临床疗效,以及对患者核因子-κB(NF-κB)炎性信号通路及趋化素(chemerin)、网膜素-1(omentin-1)水平的影响。方法 选取医院2019年1月至2021年12月收治的GDM患者400例,按随机数字表法分为观察组和对照组,各200例。两组患者均予常规治疗,在此基础上,对照组患者予胰岛素,观察组患者联用胰岛素和二甲双胍,两组患者均连续治疗28 d。结果 观察组总有效率为93.50%,显著高于对照组的81.00%(P <0.05);治疗后,两组患者的空腹血糖、餐后2 h血糖、糖化血红蛋白及白细胞介素1β、肿瘤坏死因子-α、白细胞介素6、NF-κB p50基因和蛋白表达、NF-κB p65基因和蛋白表达、chemerin水平均显著降低(P <0.05),omentin-1水平均显著升高(P <0.05),且观察组均显著优于对照组(P <0.05)。观察组的不良妊娠结局总发生率为10.00%,显著低于对照组的23.00%(P <0.05)。结论 二甲双胍联合胰岛素治疗GDM的临床疗效良好,可降低患者的血糖及NF-κB炎性信号通路活化所释放的炎性因子、脂肪因子水平,减轻炎性反应,改善母婴妊娠结局和预后。Objective To investigate the clinical efficacy of metformin combined with insulin in the treatment of gestational diabetes mellitus(GDM),and the effect on the inflammatory signaling pathway of nuclear factorκB(NF-κB)and the levels of chemokine and omentin-1 in patients with GDM.Methods A total of 400 patients with GDM admitted to the hospital from January 2019 to December 2021 were selected and randomly divided into the observation group and the control group by the random number table method,with 200 cases in each group.The patients in the two groups received routine treatment.On this basis,the patients in the control group were treated with insulin,while the patients in the observation group were treated with insulin combined with metformin.Both groups were continuously treated for 28 d.Results The total effective rate in the observation group was 93.50%,which was significantly higher than 81.00%in the control group(P<0.05).After treatment,the fasting blood glucose(FBG),2 h postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1C),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),NF-κB p50 gene and protein expression,NF-κB p65 gene and protein expression,and chemerin levels in the two groups significantly reduced(P<0.05),while the levels of omentin-1 in the two groups significantly increased(P<0.05),and those in the observation group were significantly better than those in the control group(P<0.05).The total incidence of adverse pregnancy outcomes in the observation group was 10.00%,which was significantly lower than 23.00%in the control group(P<0.05).Conclusion Metformin combined with insulin has good clinical efficacy in the treatment of GDM,which can reduce the levels of blood glucose,inflammatory factors and adipokines released by the activation of NF-κB inflammatory signaling pathway,alleviate inflammatory reactions,and improve maternal and infant pregnancy outcomes and prognosis.

关 键 词：二甲双胍 胰岛素 妊娠期糖尿病 核因子-κB炎性信号通路 血糖 妊娠结局 

分 类 号：R969.4[医药卫生—药理学] R977.15[医药卫生—药学]