二甲双胍联合门冬胰岛素治疗妊娠中晚期糖尿病效果及对患者血清胎盘生长因子同型半胱氨酸胰岛素样生长因子-1的影响

Effect of metformin combined with menopausal insulin in the treatment of diabetes mellitus in middle and late pregnancy and its effect on patients′serum placental growth factor,homocysteine and insulin-like growth factor-1

目的探讨二甲双胍联合门冬胰岛素治疗妊娠中晚期糖尿病(GDM)的临床效果及对患者血清胎盘生长因子(PLGF)、同型半胱氨酸(Hcy)、胰岛素样生长因子-1(IGF-1)的影响。方法研究纳入2020年1月至2023年12月浙江省杭州市临平区妇幼保健院收治的中晚期GDM患者140例,按照不同干预方式和自愿原则分为对照组和观察组,每组70例。对照组予以门冬胰岛素治疗,观察组在对照组基础上予以二甲双胍治疗。比较2组的血清指标、血糖及胰岛功能改善情况、不良反应及妊娠结局。结果2组治疗后PLGF、IGF-1与治疗前相比升高,Hcy与治疗前相比下降,且观察组的PLGF(142±20)pg/ml、IGF-1(25.2±1.1)ng/ml高于对照组(133±20)pg/ml、(24.1±1.0)ng/ml,观察组的Hcy(8.0±2.3)μmol/L低于对照组(10.0±2.8)μmol/L(t=2.678、6.165、4.558,P<0.05)。2组治疗后空腹血糖(FPG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMEIR)与治疗前相比降低,且观察组(5.4±1.5)mmol/L、(5.7±1.0)%、(2.3±0.4)低于对照组(6.1±1.1)mmol/L、(6.1±0.8)%、(3.1±0.5)(t=2.933、2.820、10.912,P均<0.05)。2组低血糖、胃肠道不适、皮肤反应不良反应差异无统计学意义(10.0%和5.7%,χ2=0.888,P>0.05)。观察组出现早产、胎儿窘迫、巨大儿、新生儿低血糖的发生率(5.7%)低于对照组(17.1%,χ2=4.516,P<0.05)。结论在妊娠中晚期GDM中采取二甲双胍联合门冬胰岛素治疗可提高血清PLGF、IGF-1水平,降低血清Hcy及血糖水平,改善胰岛功能,减少早产、胎儿窘迫等不良妊娠结局发生情况,且安全可靠。

Objective To investigate the clinical effect of metformin combined with menthyl insulin in the treatment of mid-to late-gestational diabetes mellitus(GDM)and the effect on patients′serum placental growth factor(PLGF),homocysteine(Hcy),and insulin-like growth factor-1(IGF-1).Methods A total of 140 cases of middle and advanced GDM patients admitted to the Linping District Maternal and Child Health Care Hospital from January 2020 to December 2023 were included in the study.Based on different intervention methods and the principle of voluntariness,the patients were evenly divided into a control group and an observation group,with 70 patients in each group.The control group was treated with menthol insulin,and the observation group was treated with metformin on the basis of the control group.The serum markers,improvement in blood glucose and islet function,adverse reactions,and pregnancy outcomes were compared between the two groups.Results PLGF and IGF-1 increased and Hcy decreased in both groups compared with the pre-treatment period,and PLGF(142±20)pg/ml and IGF-1(25.2±1.1)ng/ml in the observation group were higher than those in the control group(133±20)pg/ml and(24.1±1.0)ng/ml,and Hcy(8.0±2.3)μmol/L in the observation group was lower than that in the control group(10.0±2.8)μmol/L low(t=2.678,6.165,4.558,all P<0.05).Fasting blood glucose(FPG),glycated haemoglobin(HbA1c),and insulin resistance index(HOME-IR)were lower in both groups after treatment compared with before treatment,and were lower in the observation group(5.4±1.5)mmol/L,(5.7±1.0)%,and(2.3±0.4)than in the control group(6.1±1.1)mmol/L,(6.1±0.8)%,(3.1±0.5)(t=2.933,2.820,10.912,all P<0.05).There was no significant difference between the two groups in terms of hypoglycaemia,gastrointestinal discomfort,skin reactions adverse reactions,10.0%compared to 5.7%(χ^(2)=0.888,P>0.05).The incidence of preterm delivery,fetal distress,macrosomia,and neonatal hypoglycaemia in the observation group was 5.7%lower than that in the control group 17.1%(χ^(2)=4.516,P<0.05).Conclusion Metformin combined with menthol insulin treatment in GDM in middle and late pregnancy can increase serum PLGF,IGF-1 levels,reduce serum Hcy and blood glucose levels,improve pancreatic islet function,reduce the incidence of preterm delivery,fetal distress and other adverse pregnancy outcomes,and is safe and reliable.