二甲双胍联合胰岛素泵治疗妊娠期糖尿病 及对血清YKL-40、Irisin 水平的影响

Effect of Metformin combined with insulin pump on serum YKL-40 and irisin in patients with gestational diabetes mellitus

摘要:

目的 探讨二甲双胍联合胰岛素泵皮下注射治疗妊娠期糖尿病患者对其血清人软骨糖蛋白-39 （YKL-40）及鸢尾素（Irisin）水平的影响。方法 选取2015 年7 月—2017 年1 月贵州省人民医院收治的140 例妊娠期糖尿病（GDM）患者，依照随机数字表法分为观察组和对照组，每组70 例。观察组采用二甲双胍 联合胰岛素泵皮下注射治疗，对照组采用二甲双胍联合胰岛素皮下注射治疗，治疗12 周后，比较两组患者疗 效及血清YKL-40、Irisin 水平变化。结果 观察组治疗总有效率与对照组比较，差异有统计学意义（P <0.05）， 观察组高于对照组；观察组血糖达标时间、胰岛素用量、治疗后血糖相关指标（TC、TG、LDL-C、FPG、 FBG、HbAlc）及治疗后血清YKL-40 水平与对照组比较，差异均有统计学意义（P <0.05），观察组低于对照 组；观察组治疗后血清Irisin 水平与对照组比较，差异有统计学意义（P <0.05），观察组高于对照组；观察组 产妇妊娠结局异常率和新生儿异常结局发生率与对照组比较，差异有统计学意义（P <0.05），观察组均低于对 照组。结论 二甲双胍联合胰岛素泵皮下注射治疗GDM 患者疗效优于二甲双胍联合胰岛素皮下注射治疗，在 血糖控制和减少并发症方面疗效确切，并能降低血清YKL-40 水平，升高Irisin 水平，改善胰岛素抵抗和胰岛 β 细胞的功能，对于妊娠期糖尿病患者治疗具有重要价值。

Abstract:

Objective To explore the effect of Metformin combined with subcutaneous injection of insulin pump on serum YKL-40 protein and irisin in treatment of gestational diabetes mellitus (GDM). Methods Totally 140 cases of GDM patients admitted from July 2015 to January 2017 were randomly divided into an observation group (70 cases) and a control group (70 cases). The patients in the observation group were treated with Metformin combined with subcutaneous injection of insulin pump, while the patients in the control group were treated with Metformin combined with subcutaneous injection of insulin. After 12 weeks, the clinical efficacy and changes of serum YKL-40 protein and irisin levels were compared. Results The total effective rate of the observation group was higher than that of the control group (P < 0.05). The blood glucose compliance time in the observation group was shorter than that in the control group (P < 0.05). And the insulin dosage, blood glucose-related indicators (TC, TG, LDL-C, FPG, FBG and HbAlc) and serum YKL-40 protein level after treatment in the observation group were lower than those in the control group (P < 0.05). The serum irisin after treatment in the observation group was higher than that in the control group (P < 0.05). The incidence of abnormal pregnancy rate in the observation group was lower than that in the control group (P < 0.05), and the incidence of abnormal neonatal outcome rate in the observation group was lower than that in the control group (P < 0.05). Conclusions For the treatment of gestational diabetes, Metformin combined with subcutaneous injection of insulin pump is superior to Metformin combined with subcutaneous injection of insulin with significant effect in the control of blood sugar level and reduction of complications. It can reduce serum YKL-40 protein level, increase the level of irisin, improve insulin resistance and islet β-cell function,. and is of great value for the treatment of GDM.