门冬胰岛素联合高剂量维生素D对妊娠期糖尿病患者甲状旁腺激素胰岛素敏感性和母婴结局的影响分析

摘要

Objective:To study the effect of high dose of vitamin D injection combined with injection of insulin aspart on the parathyroid hormone level, insulin sensitivity and maternal and infant outcomes in the treatment of gestational diabetes mellitus ( GDM) . Methods:238 gestational diabetes patients selected as ob-ject were divided them into two groups, called control group ( n=109 cases) and research group ( n=129 ca-ses) by digital table. The patients of control group were treated by insulin aspart combined with low dose of vi-tamin D, while the patients of research group were treated by insulin aspart combined with high dose of vitamin D. the parathyroid hormone related indexes , insulin sensitivity related indexes, vitamin D level, maternal and infant outcomes and incidence of hypoglycemia during pregnancy of two groups were compared. Results: The iPTH, product of calcium and phosphorus , phosphorus, calcium of two groups before treatment had no statis-tically difference (P>0.05),after treating four weeks the iPTH, product of calcium and phosphorus, phos-phorus of research group were much less than control group ( P<0.05) ,the calcium of two groups had no sta-tistically difference ( P>0.05) . The iPTH, product of calcium and phosphorus, phosphorus of two groups after four weeks' treatment were all much less than pre-treatment respectively (P<0.05),while calcium of two groups after treatment had no statistically difference with pre-treatment respectively (P>0.05). The FPG, FINS, 2hPG of two groups before treatment had no statistically difference ( P>0.05);the FPG, FINS, 2hPG of research group had no statistically difference with control group ( P>0.05);The FPG, FINS, 2hPG of two groups after four weeks' treatment were all much less than pre-treatment respectively ( P<0.05) . The HOMA-βand HOMA-IR of two groups before treatment had no statistically difference ( P>0.05) , the HOMA-βof re-search group after treatment was much higher than control group. HOMA-IR much less than control group ( P<0.05) . The HOMA-βand HOMA-IR of two groups after four weeks' treatment were all much less than pre-treatment respectively ( P<0.05) . The vitamin D level of two groups before treatment had no statistically differ-ence ( P>0.05) . The moderate lack rate of research group after treatment was less than control group ( P<0. 05) . The normal rate of research group after treatment was more than control group( P<0.05);the slight lack rate of research group after treatment of two groups had no statistically difference (P>0.05). The moderate lack rate and slight lack rate of two groups after four weeks' treatment were all much less than pre-treatment respectively ( P<0.05);normal rate was much higher than pre-treatment respectively ( P<0.05) . The rate of maternal and infant outcomes and hypoglycemia of research group was 20. 93%, while control group was 31. 19%;they had statistically difference ( P<0.05) . Conclusion:High dose of vitamin D injection combined with injection of insulin aspart in the treatment of GDM can prevent the occurrence of physiological hyperparathy-roidism in late pregnant period ,increase the insulin sensitivity, effectively control blood sugar and improve the deficiency degree of vitamin D, and definite effect, decrease maternal and neonatal complications rate, which is worthy of being clinically promoted.%目的:研究妊娠期糖尿病患者治疗中门冬胰岛素联合高剂量维生素D对甲状旁腺激素、胰岛素敏感性和母婴结局的影响.方法:选择2014年5月至2016年7月就诊于我院的GDM患者238例作为研究对象,将所有患者随机分为两组,即研究组(n=129例)和对照组(n=109例).对照组患者给予门冬胰岛素联合低剂量维生素D进行治疗,研究组患者给予门冬胰岛素联合高剂量维生素D进行治疗,对比两组患者的甲状旁腺激素功能相关指标、胰岛素敏感性相关指标、维生素D水平、母婴并发症及孕期低血糖发生情况.结果:两组患者治疗前iP TH、钙磷乘积、血磷、血钙等指标对比差异无统计学意义(P>0.05),治疗后4周后研究组患者的iPTH、钙磷乘积、血磷等指标均低于对照组,且有统计学差异(P<0.05),研究组血钙与对照组对比差异无统计学意义(P>0.05),治疗4周后两组患者的iPTH、钙磷乘积、血磷等指标均低于各自治疗前,且差异有统计学(P<0.05),而两组血钙水平与各自治疗前对比差异无统计学意义(P>0.05).两组患者治疗前FPG、FINS、2hPG等指标对比差异无统计学意义(P>0.05),治疗后4周后研究组患者的FPG、FINS、2hPG等指标与对照组对比,差异无统计学意义(P>0.05),而治疗后两组患者FPG、FINS、2hPG等指标均低于各自治疗前(P<0.05).两组患者治疗前HOMA-β和HOMA-IR对比无显著性差异(P>0.05),研究组治疗后HOMA-β高于对照组,HOMA-IR低于对照组,且差异有统计学意义(P<0.05),且两组患者治疗后HOMA-β和HOMA-IR均低于各自治疗前(P<0.05).两组患者治疗前维生素D各水平差异无统计学意义(P>0.05),治疗后研究组维生素D中度缺乏比例低于对照组,差异有统计学意义(P<0.05),治疗后研究组维生素D正常水平比例高于对照组,且差异有统计学意义(P<0.05),维生素D轻度缺乏比例两组对比差异无统计学意义(P>0.05).两组患者治疗后中度缺乏和轻度缺乏比例低于各自治疗前,且差异有统计学意义(P<0.05),正常水平比例高于各自治疗前,且差异有统计学意义(P<0.05).研究组患者治疗后母婴并发症及低血糖发生率为20.93%,低于对照组31.19%,且差异有统计学意义(P<0.05).结论:GDM患者治疗中门冬胰岛素联合高剂量维生素D可预防孕晚期"生理性甲状旁腺机能亢进"的发生,提高胰岛素敏感性,有效控制血糖,改善维生素D缺乏程度,疗效确切,减少母婴并发症和低血糖的发生率,值得临床推广.