门冬胰岛素联合地特胰岛素治疗GDM患者的临床疗效研究

Curative effect of insulin aspart combined with insulin detemir in the treatment of GDM

目的:探究门冬胰岛素联合地特胰岛素治疗妊娠期糖尿病(GDM)患者的疗效。方法:按随机数字表法将湘南学院附属医院2019年8月至2023年8月收治的98例GDM患者分成对照组(49例)和观察组(49例)。对照组予以门冬胰岛素联合精蛋白生物合成人胰岛素治疗,观察组予以门冬胰岛素联合地特胰岛素治疗。比较两组疗效、血糖波动指标[24h内血糖波动标准差(SD)、日间平均绝对差(MODD)、最大波动幅度(LAGE)、平均波动幅度(MAGE)]、胰岛相关激素[C肽(C-P)、瘦素(LP)、内脂素(VF)、脂联素(APN)]、胰岛细胞功能[空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、敏感指数(ISI)、β细胞分泌功能(HOMA-β)]和妊娠结局的差异。结果:治疗后,观察组的总有效率高于对照组;两组SD、MODD、LAGE、MAGE均低于同组治疗前,且观察组低于对照组;两组C-P、APN、HOMA-β、ISI水平均高于同组治疗前,VF、LP、FINS、HOMA-IR水平均低于同组治疗前,且观察组改善程度优于对照组;观察组不良妊娠结局发生率低于对照组。结论:门冬胰岛素联合地特胰岛素对GDM患者的疗效显著,能有效减轻血糖波动,改善胰岛相关激素水平,促进胰岛细胞功能恢复,降低不良妊娠结局发生率。

Objective To explore the curative effect of insulin aspart combined with insulin detemir in patients with gestational diabetes mellitus(GDM).Methods According to random number table method,98 patients with GDM admitted to Affiliated Hospital of Xiangnan University were divided into control group(49 cases,insulin aspart+protamine biosynthetic human insulin)and observation group(49 cases,insulin aspart combined with insulin detemir)between August 2019 and August 2023.The curative effect,glucose fluctuation indexes[standard deviation of blood glucose fluctuation within 24h(SD),mean of daily differences(MODD),largest amplitude of glycemic excursions(LAGE),mean amplitude of glycemic excursions(MAGE)],islet related hormones[C-peptide(C-P),leptin(LP),visfatin(VF),adiponectin(APN)],islet cells function[fasting insulin(FINS),homeostasis model assessment insulin resistance(HOMA-IR),insulin sensitivity index(ISI),homeostasis model assessment insulin resistanceβ(HOMA-β)]and incidence of adverse pregnancy outcomes were compared between the two groups.Results After treatment,total response rate of observation group was higher than that of control group.After treatment,SD,MODD,LAGE and MAGE were decreased in both groups,which were lower in observation group than control group.After treatment,C-P,APN,HOMA-βand ISI were increased,while VF,LP,FINS and HOMA-IR were decreased in both groups,and the improvement was better in observation group than control group.The incidence of adverse pregnancy outcomes in observation group than control group was lower than that in control group.Conclusion Curative effect of insulin aspart combined with insulin detemir is significant on patients with GDM,which can effectively reduce blood glucose fluctuation,improve levels of islet related hormones,promote the recovery of islet cells function and reduce the incidence of adverse pregnancy outcomes.