格列苯脲辅助“双C”方案对高龄妊娠糖尿病患者 血清FABP4、PAPP-A 表达的影响

Effect of glibenclamide-assisted “double C” regimen on expression of serum FABP4 and pregnancy-associated plasma protein A in patients with gestational diabetes mellitus

摘要:

目的 探讨格列苯脲辅助“双C”方案对高龄妊娠糖尿病（GDM）患者血清脂肪酸结合蛋白 质4（FABP4）、妊娠相关血浆蛋白A（PAPP-A）表达的影响，为高龄GDM 的临床治疗提供参考。方法 选 取2015 年1 月—2017 年12 月延安大学附属医院收治的120 例高龄GDM 患者作为研究对象，根据随机数字 表法将患者分为研究组和对照组，每组60 例。对照组采用“双C”方案治疗，研究组在对照组基础上使用 格列苯脲辅助治疗，比较两组患者治疗2 周后的血糖控制情况、新生儿及母体指标，并于治疗前后检测患者 FABP4、PAPP-A 表达水平。结果 研究组治疗后的糖化血红蛋白（HbAlc）、空腹血浆葡萄糖（FPG）、餐 后2 小时血糖（2 hPG）、血糖波动幅度、血糖达标时间及胰岛素平均用量低于对照组（P <0.05），两组患者 治疗前HbAlc、FPG、2 hPG、血糖波动幅度、血糖达标时间及胰岛素平均用量高于治疗后（P <0.05）。研究 组妊娠期高血压、产程延长低于对照组（P <0.05）。研究组的早产儿少与对照组，高胆红素血症及总发生率 低于对照组（P <0.05）。两组患者治疗后血清FABP4 水平较治疗前下降，PAPP-A 中位数倍数较治疗前增加 （P <0.05）。研究组血清FABP4 较对照组低，血清PAPP-A 中位数倍数较对照组增加（P <0.05）。两组患者不 良反应发生率比较，差异无统计学意义（P >0.05）。结论 格列本脲联合“双C”方案可有效改善GDM 患 者血糖水平和妊娠结局，同时可以通过降低血清FABP4，升高PAPP-A 水平，改善胰岛素抵抗，该方案安全 性高，值得临床推广应用。

Abstract:

Objective To investigate the effect of glibenclamide-assisted “double C” regimen on the expression of serum FABP4 and pregnancy-associated plasma protein A (PAPP-A) in patients with gestational diabetes mellitus, and to provide reference for the clinical treatment of gestational diabetes mellitus. Methods A total of 120 elderly gestational diabetes patients admitted to our hospital from January 2015 to December 2017 were enrolled. The randomized digital table method was used to divide patients into study group and control group, 60 cases each. The control group was treated with “double C” regimen, and the study group was treated with glibenclamide on the basis of the control group. The blood glucose control, neonatal and maternal indicators were compared between the two groups after 12 weeks of treatment, and serum FABPs and PAPP-A expression levels were detected before and after treatment. Results The difference of HbAlc, FPG, 2hPG, blood glucose fluctuation, blood glucose compliance time and insulin mean between the two groups was statistically significant, and the study group was higher than the control group (P < 0.05); the difference between the two groups of patients before and after treatment HbAlc, FPG, 2hPG, blood glucose fluctuation amplitude, blood glucose compliance time and insulin dosage were statistically significant (P < 0.05), and before treatment is higher than after treatment; the incidence of gestational hypertension, premature rupture of membranes, prolonged labor, preterm infants, hyperbilirubinemia and total newborn adverse events in the study group was significantly lower than that in the control group (P < 0.05). After treatment, the serum FABP4 level of the study group significantly lower than the control group, pregnancy-associated plasma protein A MoM level was significantly higher than the control group, both were statistically significant (P < 0.05). There were 2 cases and 3 cases of hypoglycemia in the study group and the control group, respectively, and the incidence of adverse hair loss was not statistically significant (P < 0.05). Conclusion Glibenclamide combined with “double C” regimen can effectively improve blood glucose levels and pregnancy outcomes in GDM patients, and can improve insulin resistance by lowering serum FABP4 levels and increasing PAPP-A levels, which is safe and worthy of clinical application.