规范化治疗对妊娠期糖尿病患者血糖水平及妊娠结局的影响分析

Analysis of the Influence of Standardized Treatment on Blood Glucose Level and Pregnancy Outcome in Patients with Gestational Diabetes

目的探讨规范化治疗对妊娠期糖尿病(GDM)患者血糖水平、妊娠结局的影响。方法选择2018年1月—2020年1月收治的92例GDM患者作为研究对象,使用统计学软件SAS以随机数生成器模块随机分成两组,每组46例。对照组常规胰岛素治疗,观察组接受规范化治疗,比较两组患者血糖控制情况、胰岛素水平变化、脂联素与瘦素水平变化以及妊娠结局。结果两组患者治疗前血糖指标对比差异无统计学意义(t=0.799、0.182、0.194,P>0.05);治疗后观察组空腹血糖、餐后2 h血糖、糖化血红蛋白分别为(5.16±0.95)mmol/L、(6.25±1.15)mmol/L、(5.21±0.69)%均低于对照组(6.48±1.05)mmol/L、(7.58±1.22)mmol/L、(6.45±0.65)%,差异有统计学意义(t=6.323、5.380、8.872,P<0.05)。两组患者治疗前胰岛素水平(FINS)、胰岛抵抗指数(HOMA-IR)、胰岛功能指数(HOMA-β)对比差异无统计学意义(t=0.272、0.538、0.923,P>0.05);治疗后观察组FINS、HOMA-IR、HOMA-β分别为(8.25±0.65)mIU/L、(1.53±0.31)、(135.47±16.59),对照组分别为(8.32±0.68)mIU/L、(2.58±0.39)、(86.64±8.61),其中HOMA-IR、HOMA-β的对比有统计学意义(t=14.294、17.719,P<0.05)。两组患者治疗前脂联素、瘦素指标水平对比差异无统计学意义(t=0.210、0.270,P>0.05);治疗后观察组脂联素、瘦素分别为(54.39±8.41)mg/L、(3.45±0.58)μg/L,对照组分别为(43.69±7.62)mg/L、(4.65±0.69)μg/L,差异有统计学意义(t=6.395、9.029,P<0.05)。观察组产妇剖宫产、高血压、低血糖等的发生率相较于对照组差异无统计学意义(P>0.05)。观察组新生儿发生窒息、黄疸、呼吸窘迫综合征的总发生率低于对照组,差异有统计学意义(t=4.089,P<0.05)。结论GDM采用规范化治疗方案,血糖维持效果更理想,同时有利于患者胰岛功能和脂联素、瘦素的改善,对妊娠结局也有一定的积极影响。

Objective To investigate the effect of standardized treatment on blood glucose levels and pregnancy outcome in patients with gestational diabetes mellitus(GDM).Methods Ninety-two patients with GDM who were admitted from January 2018 to January 2020 were selected as the research objects,and statistical software SAS was used to randomly divide them into two groups with a random number generator module,with 46 cases in each group.The control group received regular insulin treatment,and the observation group received standardized treatment.The two groups of patients were compared with blood glucose control,changes in insulin levels,changes in adiponectin and leptin levels,and pregnancy outcomes.Results There was no significant difference in blood glucose index between the two groups before treatment(t=0.799,0.182,0.194,P>0.05).The blood glucose and glycosylated hemoglobin were(5.16±0.95)mmol/L,(6.25±1.15)mmol/L,(5.21±0.69)%,which were lower than(6.48±1.05)mmol/L,(7.58±1.22)mmol/L,(6.45±0.65)%(t=6.323,5.380,8.872,P<0.05).Before treatment,there was no significant difference in insulin level(fins),HOMA-IR and HOMA-βbetween the two groups(t=0.272,0.538,0.923,P>0.05);after treatment,fins,HOMA-IR and HOMA-βin the observation group were(8.25±0.65)mIU/L,(1.53±0.31)and(135.47±16.59),respectively,while those in the control group were(8.32±0.68)mIU/L,(2.53±0.39)and(86.64±8.61),respectively,and the comparison of HOMA-IR and HOMA-βwas statistically significant(t=14.294,17.719,P<0.05).There was no significant difference in the levels of adiponectin and leptin before treatment between the two groups(t=0.210,0.270,P>0.05);after treatment,the levels of adiponectin and leptin in the observation group were(54.39±8.41)mg/L,(3.45±0.58)μg/L and(43.69±7.62)mg/L,(4.65±0.69)μg/L respectively,the differences were statistically significant(t=6.395,9.029,P<0.05).There was no significant difference in the incidence of cesarean section,hypertension,hypoglycemia between the observation group and the control group(P>0.05).The total incidence of neonatal asphyxia,jaundice and respiratory distress syndrome in the observation group was lower than that in the control group(t=4.089,P<0.05).Conclusion GDM adopts a standardized treatment plan,and the effect of blood glucose maintenance is better.At the same time,it is beneficial to the improvement of pancreatic islet function,adiponectin and leptin,and it also has a certain positive effect on pregnancy outcome.