盐酸二甲双胍、生物合成人胰岛素r联合门冬胰岛素治疗妊娠期糖尿病的疗效及妊娠结局比较

摘要

目的 探讨盐酸二甲双胍、生物合成人胰岛素联合门冬胰岛素治疗妊娠期糖尿病(GDM)的疗效及其对妊娠结局的影响.方法 选取2015年3月至2016年12月于深圳市龙华人民医院产一科收治的GDM患者136例,本研究采取回顾性研究的方式,根据治疗方式的不同将其分为A组(盐酸二甲双胍联合门冬胰岛素组)48例、B组(生物合成人胰岛素联合门冬胰岛素组)46例和C组(单纯门冬胰岛素组)42例,均持续用药直至分娩,记录三组患者治疗过程中的血糖情况[主要包括空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)]、胰岛β细胞功能相关指标[主要包括空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)、胰岛素敏感指数(ISI)]、外周血清氧化相关物质[主要包括谷胱甘肽过氧化物酶(GSH-PX)、超氧化物歧化酶(SOD)、活性氧类物质(ROS)、丙二醛(MDA)],妊娠结局以及不良反应发生情况并进行比较.结果 与治疗前相比较,治疗后三组患者的FBG、2 hPG、HbA1c相均明显降低,A组、B组患者的FBG、2 hPG及HbA1c均明显低于C组,差异均有统计学意义(P<0.05);A组患者的FBG、2 hPG及HbA1c与B组比较差异均无统计学意义(P>0.05);与治疗前相比较,治疗后三组患者的FINS、HOMA-IR、ROS明显降低,而HOMA-β、ISI、GSH-PX、SOD明显升高,A组患者FINS、HOMA-IR、HOMA-β及ISI改善情况明显优于B组、C组,差异均有统计学意义(P<0.05);治疗后B组、C组患者的FINS、HOMA-IR、HOMA-β及ISI差异不明显,差异均无统计学意义(P>0.05);仅B组患者治疗后MDA指标显著降低,差异有统计学意义(P<0.05);A组和B组患者的妊娠结局中剖宫产发生率等指标均明显小于C组,差异均有统计学意义(P<0.05);A组患者的剖宫产、胎盘早剥、新生儿窒息、低体重儿、黄疸、死亡发生率略低于B组,胎儿窘迫、产后出血发生率略高于B组,但差异均无统计学意义(P>0.05).结论 盐酸二甲双胍、生物合成人胰岛素联合门冬胰岛素均可有效控制GDM患者血糖,妊娠结局无明显差异,但盐酸二甲双胍联合门冬胰岛素在胰岛β细胞功能相关指标改善方面具有明显优势,值得推广应用.%Objective To explore the efficacy and pregnancy outcome of metformin hydrochloride, biosynthet-ic human insulin combined with insulin aspart in the treatment of gestational diabetes mellitus (GDM). Methods A to-tal of 136 GDM patients, who admitted to Department of Obstetrics of Longhua District People's Hospital of Shenzhen City from Mar. 2015 to Dec. 2016, were selected and divided into A group (metformin hydrochloride combined with in-sulin aspart group, n=48), B group (biosynthetic human insulin combined with insulin aspart group, n=46) and C group (insulin aspart group, n=42) according to random number table method. The study was conducted in the retrospective way. The conditions of blood glucose (including fasting blood glucose [FBG], 2-hour plasma glucose [2 hPG], hemoglo-bin A1c [HbA1c]), islet beta cell function related indicators (including fasting insulin [FINS], homeostasis model assess-ment insulin resistance [HOMA-IR], homeostasis model assessment insulin resistanceβ[HOMA-β], insulin sensitivity index [ISI]), peripheral serum oxidation related substances (including glutathione peroxidase [GSH-PX], superoxide dis-mutase [SOD], reactive oxygen species [ROS], malondialdehyde [MDA]), pregnancy outcome and the incidence of ad-verse reactions of three groups during the treatment were recorded and compared. Results Compared with before the treatment, the FBG, 2 hPG and HbA1c of the three groups of patients were significantly reduced after the treatment, and the FBG, 2 hPG and HbA1c of patients in A and B group were significantly lower than C group (P<0.05). The FBG, 2 hPG and HbA1c of patients in the A group compared with the B group were not significantly different (P>0.05). Compared with before the treatment, the FINS, HOMA-IR and ROS of the patients in three groups decreased significant-ly after the treatment, while HOMA-β, ISI, GSH-PX, SOD of the patients in three groups increased significantly. The im-provement of FINS, HOMA-IR, HOMA-βand ISI of patients in A group was significantly better than that in B and C group (P<0.05). The difference of FINS, HOMA-IR, HOMA-βand ISI after treatment in B and C group were not signifi-cant (P>0.05). Only the MDA of the B group significantly reduced after the treatment (P<0.05). The incidence rate of ce-sarean section of patients in A and B group were significantly lower than that in C group (P<0.05). The cesarean section, placental abruption, neonatal asphyxia, low birth weight, jaundice, death rate of patients in the A group were slightly low-er than group B, and fetal distress, postpartum hemorrhage rate were slightly higher than those in B group (P>0.05). Conclusion Metformin hydrochloride and biosynthetic human insulin combined with insulin aspart can effectively con-trol the blood glucose of GDM, with no significant difference in the pregnancy outcome, while metformin hydrochloride combined with insulin aspart has the significant advantage in isletβcell function index improvement, which is worthy of clinical application.