瑞格列奈联合格列本脲治疗妊娠期糖尿病的效果及对血清FBG、2 hPG、NGAL的影响

Efficacy of repaglinide combined with glyburide in the treatment of gestational diabetes mellitus and its effect on levels of FBG, 2 hPG and serum NGAL

摘要:

目的 探究瑞格列奈联合格列本脲治疗妊娠期糖尿病（GDM）的效果及对血清空腹血糖（FBG）、餐后2 h血糖（2 hPG）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）的影响。方法 选取2020年1月—2023年1月海南现代妇女儿童医院收治的GDM患者112例，以随机数字表法分为对照组（格列本脲治疗）和观察组（瑞格列奈联合格列本脲治疗），每组56例。比较两组治疗前后糖代谢指标［FBG、2 hPG、糖化血红蛋白（HbA1c）］和NGAL、同型半胱氨酸（Hcy）、胱抑素C（CysC）、Irisin、人源甘丙肽（GAL）水平，统计两组母婴结局。结果 观察组治疗前后FBG、2 hPG和HbA1c的差值均高于对照组（P <0.05）。观察组治疗前后血清GAL、Irisin水平的差值均大于对照组（P <0.05）。观察组治疗前后NGAL、Hcy和CysC水平的差值均高于对照组（P <0.05）。观察组与对照组产程延长、妊娠高血压、羊水过多、胎膜早破的发生率比较，差异均无统计学意义（P >0.05）；观察组早产儿、新生儿低血糖症的发生率均低于对照组（P <0.05）。结论 瑞格列奈联合格列本脲治疗可有效控制GDM患者血糖水平，下调血清NGAL、Hcy、CysC和GAL水平，上调血清Irisin水平，改善胰岛素抵抗，且安全性高，值得临床推荐。

关键词:妊娠期糖尿病;瑞格列奈;格列本脲;空腹血糖;餐后2 h血糖;中性粒细胞明胶酶相关脂质运载蛋白

Abstract:

Objective To explore the efficacy of repaglinide combined with glyburide in the treatment of gestational diabetes mellitus (GDM) and its effects on levels of fasting blood glucose (FBG), 2-hour postprandial glucose (2hPG) and serum neutrophil gelatinase-associated lipocalin (NGAL).Methods The 112 GDM patients admitted to our hospital from January 2020 to January 2023 were selected and divided into the control group (treatment with glyburide) and the observation group (treatment with repaglinide combined with glyburide) by the random number table method, with 56 cases in each group. Glucose metabolism indexes (FBG, 2hPG, HbA1c) and levels of NGAL, homocysteine (Hcy), cystatin C (CysC), irisin and galanin (GAL) before and after treatment were compared between the two groups, and maternal and infant outcomes were statistically analyzed.Results The differences of levels of FBG, 2 hPG, and HbA1c before and after treatment in the observation group were higher than those in the control group (P < 0.05). The differences of levels of serum GAL and irisin before and after treatment in the observation group were higher than those in the control group (P < 0.05). The differences of levels of NGAL, Hcy, and CysC before and after treatment in the observation group were higher than those in the control group (P < 0.05). There was no statistically significant difference in the overall incidence of prolonged labor, gestational hypertension, polyhydramnios, and premature rupture of membranes between the observation group and the control group (P > 0.05). The incidence of hypoglycemia in premature infants and newborns in the observation group was lower than that in the control group (P < 0.05).Conclusions Repaglinide combined with glyburide can effectively control blood glucose in patients with GDM, down-regulate serum levels of NGAL, Hcy, CysC and GAL, up-regulate the serum level of irisin, and improve the insulin resistance with a high safety profile, and should be recommended for clinical practice.

Key words:gestational diabetes mellitus;repaglinide;glyburide;fasting blood glucose;2-hour postprandial glucose;neutrophil gelatinase-associated lipocalin