二甲双胍和胰岛素在妊娠糖尿病患者中的疗效对比观察及对新生儿的影响研究

Comparison of the effects of metformin and insulin in gestational diabetes mellitus patients and the influence on neonatal

目的观察二甲双胍和胰岛素在妊娠糖尿病患者的临床治疗效果及对新生儿的影响。方法取2012年8月至2016年10月医院收治妊娠期糖尿病患者60例,采用随机数字方法分为对照组(n=30)和观察组(n=30)。对照组采用胰岛素治疗,观察组在对照组基础上联合二甲双胍治疗,比较2组临床疗效及对新生儿的影响。结果观察组治疗后空腹血糖、餐后2h血糖、餐后4h血糖水平,低于对照组,差异有统计学意义(P<0.05);观察组平均糖化血红蛋白水平,高于对照组,差异有统计学意义(P<0.05);观察组治疗后新生儿窒息、胎儿窘迫、呼吸窘迫、巨大胎儿及早产发生率低于对照组,差异有统计学意义(P<0.05);2组治疗前胱抑素C(Cys C)及同型半胱氨酸(Hcy)水平比较差异无统计学意义(P>0.05);观察组治疗后CysC及Hcy水平低于对照组,差异有统计学意义(P<0.05);观察组治疗后血糖达标所需时间短于对照组,差异有统计学意义(P<0.05);观察组胰岛素用量少于对照组,差异有统计学意义(P<0.05)。结论与胰岛素治疗相比,妊娠糖尿病患者采用二甲双胍治疗效果理想,能改善新生儿结局,值得推广应用。

Objective To observe the clinical effect of metformin and insulin in gestational diabetes mellitus（DM） patients and their effects on neonates. Methods From August 2012 to October 2 016,60 patients with gestational diabetes mellitus wer e divided into control group（n= 30） and observation group（n= 30） by random number method. The control group was treated with insulin and the observation group was treated with metformin on the basis of the control group. The clinical effect and the effect on neo-natal were compared between the two groups. Results T h e level of glycosylated hemoglobin in the observation group w a s higher than that in the control group（P〈0 . 05）. In the observation group,the levels of fasting plasma glucose,postprandial blood glucose 2 hours after meals and 4 hours postprandial blood glucose were lower than those in the control group（P〈0 . 05）. There were no sig-nificant differences in the levels of CysC and Hey between the two groups before treatment（P〉0. 05）. The incidence of fetal dis-tress ,respiratory distress, macrosomia and the incidence of premature delivery were significantly lower than those of the control group（P〈0 . 05）. The amount of insulin in the observation group was less than that in the control group（P〈0 . 05）. The level ofCysC and Hey in the observation group was significantly lower than that in the control group（P〈0 . 05）. Conclusion Compared with insulin therapy, metformin could improve the outcome of neonatal patients, which might be worthy to be popularized and used in the treatment of gestational diabetes mellitus.