胰岛素不同注射时机对妊娠糖尿病患者糖脂代谢、血浆D-D、AT-Ⅲ水平、妊娠结局的影响及其相关性分析

Effects and correlation analysis of insulin injection timing on glucose and lipid metabolism, plasma D-D, AT-Ⅲ levels and pregnancy outcome in gestational diabetes mellitus patients

目的探讨胰岛素不同注射时机对妊娠糖尿病患者糖脂代谢、血浆D-二聚体(D-D)、抗凝血酶-Ⅲ(AT-Ⅲ)水平、妊娠结局的影响及其相关性分析。方法选取2019年10月至2022年10月赣州市妇幼保健院妇产科收治的92例妊娠糖尿病患者作为研究对象,根据孕龄的不同,将患者分为早期注射组(n=52,孕龄<32周时确诊并接受胰岛素注射治疗)、晚期注射组(n=40,孕龄≥32周时确诊并接受胰岛素注射治疗),治疗4周后比较两组患者的糖脂代谢、血浆D-D、AT-Ⅲ水平及妊娠结局并进行相关性分析。结果晚期注射组患者的空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)水高于早期注射组,差异有统计学意义(P<0.05)。晚期注射组的脂代谢指标中三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平高于早期注射组,差异有统计学意义(P<0.05)。晚期注射组高密度脂蛋白胆固醇(HDL-C)水平低于早期注射组,差异有统计学意义(P<0.05)。晚期注射组患者的血浆D-D、AT-Ⅲ水平高于早期注射组,差异有统计学意义(P<0.05)。晚期注射组妊娠不良结局总发生率高于早期注射组,差异有统计学意义(P<0.05)。Pearson相关性分析结果显示,2 h PG水平、HOMA-IR、FBG、HbA1c、FINS、TG、血浆D-D、AT-Ⅲ水平与胰岛素注射时机呈负相关(r=-0.723、-0.901、-0.473、-0.513、-0.804、-0.334、-0.702、-0.478,P<0.05);HDL-C、LDL-C水平与胰岛素注射时机无相关性(P>0.05)。结论妊娠早期进行胰岛素注射治疗的患者的糖脂代谢指标水平、血浆D-D、AT-Ⅲ水平低于晚期注射患者,且指标经相关性分析验证,早期注射出现不良妊娠结局的情况较少,妊娠早期注射胰岛素可以减少妊娠糖尿病患者产生的不良妊娠结局。

Objective To investigate the effects of different timing of insulin injection on glucose and lipid metabolism,plasma D-dimer(D-D),antithrombin-Ⅲ(AT-Ⅲ)level and pregnancy outcome in patients with gestational diabetes mellitus.Methods A total of 92 patients with gestational diabetes mellitus admitted to Department of Gynecology and Obstetrics of Ganzhou Women and Children's Health Care Hospital from October 2019 to October 2022 were selected as the research objects.According to their gestational age,the patients were divided into early injection group(n=52,diagnosed and received insulin injection treatment when gestational age<32 weeks)and late injection group(n=40,diagnosed and received insulin injection treatment when gestational age≥32 weeks),After 4 weeks of treatment,the glucose and lipid metabolism,plasma D-D,AT-Ⅲlevels and pregnancy outcomes of the two groups were compared and the correlation analysis was performed.Results The fasting blood glucose(FBG),two hours postprandial blood glucose(2 h PG),glycated hemoglobin(HbA1c),fasting insulin(FINS)and homeostasismodel assessment of insulin resistance(HOMA-IR)of patients in the late injection group were higher than those in the early injection group,and the differences were statistically significant(P<0.05). The levels of triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) in the late injection group were higher than those in the early injection group, and the differences were statistically significant (P<0.05). The level of high-density lipoprotein cholesterol (HDL-C) in the late injection group was lower than that in the early injection group, and the difference was statistically significant (P<0.05). The plasma levels of D-D and AT-Ⅲ in the late injection group were higher than those in the early injection group, and the difference were statistically significant (P<0.05). The total incidence of adverse pregnancy outcome in the late injection group was higher than that in the early injection group, and the difference was statistically significant (P<0.05). Pearson correlation analysis showed that, 2 h PG level, HOMA-IR, FBG, HbA1c, FINS, TG, plasma D-D and AT-Ⅲ levels were negatively correlated with the timing of insulin injection (r=-0.723, -0.901, -0.473, -0.513, -0.804, -0.334, -0.702, -0.478, P<0.05). There were no correlations between the levels of HDL-C and LDL-C and the timing of insulin injection (P>0.05). Conclusion The glucose and lipid metabolism indexes, plasma D-D and AT-Ⅲ levels of patients receiving insulin injection in early pregnancy are lower than those of patients receiving insulin injection in late pregnancy, and correlation analysis has verified that there are fewer adverse pregnancy outcomes in patients receiving insulin injection in early pregnancy, and insulin injection in early pregnancy can reduce adverse pregnancy outcomes in patients with gestational diabetes mellitus.