二甲双胍联合胰岛素对妊娠期糖尿病患者YKL-40、Irisin、胎盘钙化、脐动脉血流动力学及分娩结局影响

Effects of metformin combined with insulin on the YKL-40,Irisin, placental calcification, umbilical arterial hemodynamics and delivery outcomes of patients with gestational diabetes mellitus

目的探讨二甲双胍联合胰岛素对妊娠期糖尿病(gestational diabetes mellitus,GDM)患者血清人软骨糖蛋白-39(YKL-40)、鸢尾素(Irisin)、胎盘钙化、脐动脉血流动力学及分娩结局影响。方法选取2018年3月至2019年5月西安医学院第二附属医院诊治的106例GMD患者作为研究对象。随机数表法分为观察组和对照组各53例。观察组给予二甲双胍联合胰岛素治疗,对照组给予胰岛素治疗,观察两组患者治疗前后血糖情况、血清YKL-40和Irisin水平变化、胎盘钙化情况、脐动脉血流动力学水平及分娩结局。结果治疗后,观察组血糖水平均低于对照组,差异具有统计学意义(P<0.05),观察组YKL-40水平低于对照组、Irisin水平高于对照组,差异具有统计学意义(P<0.05),观察组胎盘钙化率7.55%低于对照组22.64%,差异具有统计学意义(P<0.05),观察组脐动脉血流动力学指标均低于对照组,差异具有统计学意义(P<0.05);观察组产妇孕周(39.27±1.01)周高于对照组(38.51±0.53)周,观察组早产率5.66%低于对照组20.75%,差异具有统计学意义(P<0.05);观察组新生儿血糖低于对照组新生儿,差异具有统计学意义(P<0.05)。结论二甲双胍联合胰岛素治疗GMD患者可有效改善血糖和脐带血流动力学水平,提高Irisin水平,降低YKL-40水平、胎盘钙化率、早产率和降低新生儿血糖水平,改善分娩结局。

Objective To explore the effects of metformin combined with insulin on the serum human cartilage glycoprotein-39(YKL-40), Irisin, placental calcification, umbilical arterial hemodynamics and delivery outcomes of patients with gestational diabetes mellitus(GDM). Methods 106 GDM patients who were admitted to the hospital from March 2018 to May 2019 were enrolled and divided into observation group and control group by random number table method, 53 cases in each group. The control group was treated with insulin, while observation group was treated with metformin and insulin. The changes in levels of blood glucose, serum YKL-40 and Irisin before and after treatment, as well as the placental calcification, umbilical arterial hemodynamics and delivery outcomes in both groups were observed. Results After treatment, the blood glucose level and the level of YKL-40 in the observation group were lower than those of the control group, while level of Irisin was higher than that in control group, all with statistically significant differences(all P<0.05). After treatment, the placental calcification rate in the observation group was lower than that in the control group(7.55% vs 22.64%), and the levels of hemodynamics indexes in the observation group were lower than those in the control group, all with statistically significant differences(all P<0.05). The gestational week of the observation group was higher than that of control group [(39.27±1.01) weeks vs(38.51±0.53) weeks], while premature birth rate was lower than of control group(5.66% vs 20.75%), all with statistically significant differences(all P<0.05). The neonatal blood glucose of observation group was lower than that of control group(P<0.05). Conclusions Metformin combined with insulin in treatment of GDM patients can effectively reduce levels of blood glucose, hemodynamics and YKL-40, increase Irisin level, reduce placental calcification rate and premature birth rate and level of neonatal blood glucose, thus improving delivery outcomes.