盐酸二甲双胍与门冬胰岛素联合治疗对妊娠期糖尿病孕妇血清胱抑素C、同型半胱氨酸及母婴结局的影响

Effects of Deltamine in combination with insulin aspart on levels of cystatin C and homocystein in patients with gestational diabetes mellitus and maternal and neonatal outcomes

摘要:

目的  探讨盐酸二甲双胍与门冬胰岛素联合治疗对妊娠期糖尿病孕妇血清胱抑素C、同型半胱氨酸及母婴结局的影响，为临床治疗提供一定依据。方法  回顾性分析90例符合纳入标准的妊娠期糖尿病（GDM）孕妇，按治疗方法分为对照组43例与观察组47例。两组患者均给予饮食控制与运动疗法等常规治疗，对照组于常规治疗基础上给予门冬胰岛素治疗，观察组在常规治疗基础上给予盐酸二甲双胍联合门冬胰岛素治疗。记录并比较两组患者血糖指标、血清胱抑素C（Cys C）与同型半胱氨酸（HCY）水平及母婴结局。结果  两组治疗后FPG、1 hPG、2 hPG与HbA1c较治疗前均显著降低，差异有统计学意义（P <0.05）。观察组治疗后FPG、1 hPG、2 hPG与HbA1c均显著低于对照组，差异有统计学意义（P <0.05）。两组治疗后Cys C与HCY水平较治疗前均显著降低，差异有统计学意义（P <0.05）。观察组治疗后Cys C与HCY水平均显著低于对照组，差异有统计学意义（P <0.05）。观察组妊娠高血压病、羊水过多、早产及剖宫产发生率分别为10.6%、12.8%、0.0%及14.9%，均显著低于对照组，差异有统计学意义（P <0.05）。两组低血糖与蛋白尿等发生率差异无统计学意义（P >0.05）。观察组新生儿黄疸与巨大儿发生率分别为10.6%与8.5%，均显著低于对照组，差异有统计学意义（P <0.05）。结论  盐酸二甲双胍联合门冬胰岛素治疗GDM，可以较好地控制血糖水平，降低血清Cys C与HCY水平，并显著改善母婴结局，值得临床上进一步研究和推广。

Abstract:

Objective To investigate the clinical effects of Deltamine in combination with insulin aspart on the levels of cystatin C (Cys C) and homocystein (HCY) in patients with gestational diabetes mellitus (GDM) and maternal and neonatal outcomes. Methods Ninety cases of GDM meeting the inclusion criteria were collected and retrospectively analyzed. The patients were divided into control group (n = 43) and observation group (n = 47). Besides conventional treatments, the control group was treated with insulin aspart, and the observation group was treated with Deltamine in combination with insulin aspart. Then, the glucose-related indices, serum levels of Cys C and HCY and maternal and neonatal outcomes of the 2 groups were observed and compared. Results Fasting plasma glucose (FPG), 1-hour plasma glucose (1 hPG), 2-hour plasma glucose (2 hPG) and glycosylated hemoglobin (HbA1c) significantly decreased in both groups after treatments (P < 0.05). In comparison with the control group, FPG, 1 hPG, 2 hPG and HbA1c of the observation group were statistically lower (P < 0.05). Serum levels of Cys C and HCY significantly decreased in both groups after treatment (P < 0.05). After treatment, serum levels of Cys C and HCY of the observation group were statistically lower than those of the control group (P < 0.05). The incidence of pregnancy-induced hypertension, hydramnion, premature birth and caesarean in the observation group was 10.6%, 12.8%, 0.0% and 14.9% respectively, which was significantly lower than that of the control group (P < 0.05). The incidence of icterus neonatorum and giant baby in the observation was 10.6% and 8.5% respectively, which was significantly lower than that of the control group (P < 0.05). Conclusions Treatments of Deltamine in combination with insulin aspart could effectively control blood glucose level, decrease serum levels of Cys C and HCY in patients with GDM and improve maternal and neonatal outcomes.