应用基因重组人胰岛素治疗妊娠期糖尿病32例分析

Treatment of gestational diabetes mellitus with gene-recombinant insulin.

目的 观察妊娠期糖尿病应用基因重组人胰岛素 (RI)治疗前后其血糖变化及对母儿预后的影响。方法 3 2 2例妊娠期血糖异常者均经饮食控制 ,其中 2 84例 ( 88 2 0 % )经饮食治疗有效 ,6例 ( 1 86% )加用运动锻炼 ,3 2例 ( 9 94 % )需加用胰岛素治疗 ,其胰岛素用量按BMI正常者于妊娠中期 0 3～ 0 5U×DBW (理想体重 ) ,妊娠晚期 0 5～ 0 7U×DBW ,根据治疗后血糖情况及相关病情将此 3 2例患者分为A、B两组 ;其中A组 17例经胰岛素治疗血糖控制满意 ,B组 15例因胰岛素应用较晚或治疗不规范致血糖控制不满意。结果 胰岛素治疗前后血糖水平变化均极显著 (P <0 0 0 1)。在胰岛素治疗过程中 ,2例发生一过性血糖偏低 ,无其他副反应发生。B组因孕期血糖控制不良 ,母儿并发症明显增高 ,尤其是巨大儿发生率高达 4 0 % (P <0 0 5 ) ,因头盆不称而行剖宫产 ,两组相比亦有显著差异 ( P <0 0 5 )。结论 妊娠期糖尿病凡具有胰岛素治疗指征者 ,应及时合理的使用人胰岛素治疗 ,使血糖维持正常化 。

Objective To observe the changes of blood glucose level and the effects on the pregnant outcome in gestational diabetes mellitus patients after the treatment of gene recombinant insulin.Methods Three hundred and twenty two pregnant women with abnormal blood sugar were treated under diet control, of which, 284(88 20%) were effective, 6(1 86%) combined with physical exercise, while insulin treatment were needed in another 32(9 94%) of being not well controlled. The insulin dosage administered depended on BMI and was modified accordingly, for those with BMI within normal range, 0 3～0 5U×DBW and 0 5～0 7U×DBW were used during second and thind trimester respectively. Thirty two patients were further divided into two groups according to blood glucose level after treatment. Seventeen patients with satisfactory control were categorized as group A, while 15 cases as group B who were unsatisfactorily controlled either due to untimely or unregular administration of insulin treatment.Results Significant changes were found in both groups before and after insulin treatment (P<0 001). Transient hypoglycemia were observed in two cases.Maternal fetal complications increased obviously in Group B, the incidence of macrosomia being as high as 40%(P<0 05).There was also significant difference of the incidence of cesarean section rate between the two groups (P<0 05).Conclusion Insulin should be used timely and properly for GDM when indicated. Maintenance of normal blood glucose concentration is mandatory for the decrease of maternal fetal complications.