维生素D联合“双C”方案对妊娠期糖尿病的疗效及作用机制

Effect and mechanism of Vitamin D combined with double-C for treating pregnant women with gestational diabetes mellitus

目的:探讨维生素D(VitD)联合动态白糖监测胰岛素泵皮下输注方案治疗妊娠期糖尿病(GDM)的临床疗效及其作用机制。方法:选择GDM患者106例随机分组,观察组(n=53)采用VitD联合"双C"方案治疗,对照组(n=53)采用"双C"方案治疗。比较两组血糖控制效果、血糖达标时间、胰岛素用量,治疗前后测定胰岛素抵抗指数(HOMA-IR)、肿瘤坏死因子α(TNF-α)、脂联素(APN)、内脂素(visfatin)、视黄醇结合蛋白4(RBP4)。结果:治疗后,两组空腹血糖、餐后2h血糖、低血糖及黎明现象发生率比较无统计学差异(P>0.05),但观察组的糖化血红蛋白(HbAlc)、空腹胰岛素(FINS)、HOMA-IR及血糖波动幅度均低于对照组,血糖达标时间、胰岛素用量低于对照组(均P<0.05);观察组血清TNF-α、visfatin、RBP4低于对照组,APN高于对照组(均P<0.05)。结论:VitD联合"双C"方案治疗GDM,可通过上调APN和下调TNF-α、visfatin、RBP4而产生GDM保护作用,提高治疗效果。

Objective:To investigate the clinical efficacy and mechanism of vitamin D(VitD)combined with double-C regimen for treating pregnant women with gestational diabetes mellitus(GDM).Methods:106 pregnant women with GDM were randomly divided into observation group(n=53)and control group(n=53).The pregnant women in observation group received VitD combined with double C therapy,and the pregnant women in control group received double C therapy only.The blood glucose control effect,time of blood glucose returned to normal,dosage of insulin used of pregnant women was compared between the two groups.The homeostasis model insulin resistance index(HOMA IR),and levels of tumor necrosis factor-α(TNF-α),adiponectin(APN),visfatin,retinol binding protein 4(RBP4)of all included pregnant women were measured before and after treatment.Results:After treatment,there were no significant different in levels of fasting blood glucose(FBG)and postprandial 2h blood glucose(2h PG),the incidence of hypoglycemia,and rate of dawn phenomenon of pregnant women between the two groups(P>0.05),while the levels of lycosylated hemoglobin hbalc(HbAlc)and fasting insulin(FINS),HOMA-IR,and rang of blood glucose fluctuations of pregnant women in observation group were significant lower than those of pregnant women in control group(P<0.05).And the time of blood glucose returned to normal and dosage of insulin used of pregnant women in observation group were significant lower than those of pregnant women in control group(P<0.05).After treatment,the serum levels of TNF-α,visfatin and RBP4 of pregnant women in observation group were significant lower than those of pregnant women in control group,while APN level of pregnant women in observation group was significant higher than that of pregnant women in control group(P<0.05).Conclusion:VitD combined with double-C therapy for treating pregnant women with GDM can improve clinical efficacy by up regulating APN and down regulating TNF-α,visfatin and RBP4.