胰岛素治疗GDM对妊娠结局的改善及最佳干预时间研究

Effect of insulin treatment on pregnancy outcome and optimal intervention time in gestational diabetes mellitus

目的研究胰岛素治疗妊娠期糖尿病(GDM)对妊娠结局的改善作用及干预时间。方法回顾性分析东阳市人民医院2016年6月至2017年9月收治的90例GDM患者的临床资料,按照治疗方法不同分为两组,42例患者在<28周之前确诊并治疗(观察组),48例患者在≥28周确诊并治疗(对照组),比较两组的母儿结局。结果两组患者入院时空腹血糖(FBG)、餐后2h血糖(2hPBG)比较均无显著性差异(t值分别为0.088、0.457,均P>0.05),治疗后两组患者分娩后次日FBG、2hPBG均较入院时显著降低(t值分别为9.548、9.163、17.567、16.510,均P<0.05),且观察组患者分娩后次日FBG、2hPBG均较对照组显著降低(t值分别为3.364、4.231,均P<0.05)。观察组孕妇羊水过多发生率、妊娠总并发症的发生率均显著低于对照组(χ~2值分别为3.198、4.243,均P<0.05),两组患者酮症酸中毒、妊娠高血压发生率无显著性差异(χ~2=0.459,P>0.05)。观察组妊娠总不良结局发生率显著低于对照组(χ~2=4.508,P<0.05)。结论在孕周<28周内行胰岛素干预治疗,能显著提高GDM患者血糖控制效果,降低妊娠并发症,改善妊娠结局。

Objective To study the effect of insulin treatment on pregnancy outcome and intervention time in gestational diabetes mellitus （GDM）. Methods The clinical data of 90 GDM patients in People＇ s Hospital of Dongyang City from June 2016 to September 2017 were analyzed retrospectively. Patients were divided into two groups according to different treatment. There were 42 patients diagnosed and treated before 28 weeks （observation group） and 48 patients diagnosed and treated at or after 28 weeks （control group）. Maternal and fetal outcomes were compared between two groups. Results There was no significant difference in FBG- and 2hPBG between two groups （t value was 0.088 and 0.457, respectively, both P〉0.05）. FBG and 2hPBG on one day after delivery reduced significantly in both groups compared with those before admission （t value was 9.548, 9.163, 17.567 and 16.510, respectively, all P〈0.05）, and they were significantly reduced in the observation group compared with tHe control group after treatment （t value was 3.364 and 4.231, respectively, both P^0.05）. In the observation group the incidences of hydramnios and total complications of pregnancy were significantly increased compared with the control group （χ2value was 3. 198 and 4. 243, respectively, both P%0.05）, but there was no significant difference in the incidence of ketoacidosis and gestational hypertension between two groups （χ2= 0.459, /9 ;〉0.05）. The incidence of total adverse outcomes in the observation group was significantly lower than that in the control group （χ2 =4.508, P〈0.05）. Conclusion The insulin intervention treatment at gestational age 〈28 weeks can significantly improve the effect of blood glucose control, reduce pregnancy complications and improve pregnancy outcomes.