胰岛素两种给药方式对高龄妊娠期糖尿病患者相关指标的影响比较

Comparison of the Effects of 2 Kinds of Administration Routes of Insulin on Related Indexes of Advanced Age Patients with Gestational Diabetes Mellitus

目的:比较多次皮下给予胰岛素与胰岛素泵持续皮下给予胰岛素对高龄妊娠期糖尿病(GDM)患者相关指标的影响。方法:回顾性分析120例高龄GDM患者资料,按用药方式的不同分为A组(60例)和B组(60例)。A组患者给予门冬胰岛素注射液初始剂量0.5 U/(kg·d),根据空腹血糖(FPG)和餐后2 h血糖(2hPG)调整剂量,于三餐前皮下注射+精蛋白生物合成人胰岛素注射液初始剂量0.5 U/(kg·d),根据FPG和2hPG调整剂量,每日睡前皮下注射。B组患者给予门冬胰岛素注射液初始剂量0.5 U/(kg·d),加入胰岛素泵,以每日胰岛素总量的40%作为基础泵注量,如血糖控制效果不佳则追加总量的60%,根据FPG和2hPG调整剂量。两组疗程均为4周。观察两组患者血糖达标时间和胰岛素用量,治疗前后FPG、2hPG、糖化血红蛋白(HbA1c)、同型半胱氨酸(Hcy)、胱抑素C(Cys-C)水平,患者及新生儿并发症发生情况。结果:B组患者血糖达标时间显著短于A组,胰岛素用量及低血糖、早产、羊水过多、妊娠期高血压发生率均显著低于A组,差异均有统计学意义(P<0.05)。B组新生儿呼吸窘迫综合征发生率显著低于A组,差异有统计学意义(P<0.05);但两组巨大儿、畸形发生率比较,差异均无统计学意义(P>0.05)。治疗后,两组患者FPG、2hPG、Hb A1c、Hcy、Cys-C水平均显著低于同组治疗前,且B组显著低于A组,差异均有统计学意义(P<0.05)。结论:胰岛素泵持续皮下给予胰岛素在有效控制高龄GDM患者血糖水平、降低胰岛素用量、下调Hcy和Cys-C水平、减少母婴并发症的发生方面均显著优于多次皮下给予胰岛素。

OBJECTIVE： To compare the effects of repeated subcutaneous insulin administration vs. insulin pump continuous subcutaneous administration on related indexes of advanced age patients with gestational diabetes mellitus （GDM）. METHODS： In retrospective study, 120 advanced age patients with GDM were randomly divided into group A （60 cases） and group B （60 cases）. Group A was given Insulin aspart injection with initial dose of 0.5 U/（kg.d） subcutaneously before meal, adjusted according to fasting blood glucose （FPG） and postprandial 2 h blood glucose （2 hPG）, and then given Isophane protamine biosynthetic human insu- lin injection with initial dose of 0.5 U/（kg. d） subcutaneously at bedtime, adjusted according to FPG and 2 hPG. Group B was given Insulin aspart injection with initial dose of 0.5 U/（kg. d） added into insulin pump using 40% of total daily insulin as basic pump, increasing to 60% of total daily insulin if blood glucose control was poor, adjusted according to FPG and 2 hPG. Treatment course of 2 groups lasted for 4 weeks. The time of blood glucose reaching target, the amount of insulin were observed in 2 groups, and the levels of FPG, 2 hPG, HbAlc, Hey and Cys-C before and after treatment, the occurrence of patients and neonates compli- cations. RESULTS： The time of blood glucose reaching standard in group B was significantly shorter than group A; the amount of insulin, the incidence of hypoglycemia, premature birth, excessive amniotic fluid and gestational hypertension in group B were sig- nificantly lower than group A, with statistical significance （P〈0.05）. The incidence of neonatal respiratory distress syndrome in group B was significantly lower than group A, with statistical significance （P〈0.05） ;but there was no statistical significance in the incidence of giant baby and malformation between 2 groups （P〉0.05）. After treatment, the levels of FPG, 2 hPG, HbAlc, Hey and Cys-C in 2 groups were significantly lower than before treatment, and the group B was significantly lower than the group A, with statistical significance（P〈0.05）. CONCLUSIONS： The insulin pump continuous subcutaneous administration is significantly better than repeated subcutaneous insulin administration in respects of controlling glucose level, reducing the amount of insulin, the levels of Cys-C and Hey, maternal and neonatal complications.