胰岛素不同治疗方案对妊娠期糖尿病的影响

Effects of different insulin treatment regimens on gestational diabetes mellitus

目的对比胰岛素不同治疗方案治疗妊娠期糖尿病(GDM)的临床疗效,分析其对患者血清IRS-1、IRS-2水平及血糖控制、妊娠结局的影响。方法选取陕西中医药大学第二附属医院2017年2月至2019年2月收治的90例GDM患者作为研究对象,根据治疗方案的不同分为A、B组。A组采用短效联合长效胰岛素治疗,B组采用短效联合中效胰岛素治疗,每组各45例。比较12周后两组血糖水平、胰岛素指标、血清IRS-1、血清IRS-2水平及妊娠结局。结果治疗后,A组糖化血红蛋白(HbAlc)、餐后2h血糖(2hPG)、胰岛素抵抗指数(HOMA-IR)均低于B组,空腹胰岛素(FINS)高于B组,差异均有统计学意义(t值分别为2.080、8.146、17.965、34.141,均P<0.05);治疗后,A组IRS-1水平及IRS-1/2均高于B组,IRS-2水平显著低于B组,差异均有统计学意义(t值分别为2.036、2.153、2.140,P<0.05);两组剖宫产、妊娠期高血压疾病、新生儿低血糖、新生儿高胆红素血症发生率差异均无统计学意义(P>0.05)。结论短效胰岛素(门冬胰岛素)联合长效胰岛素(地特胰岛素)能够有效控制GDM患者血糖水平,调节IRS-1/IRS-2信号通路,改善机体胰岛素抵抗(IR)与糖代谢紊乱,值得进行临床推广。

Objective To compare the clinical efficacy of different insulin treatment regimens in the treatment of gestational diabetes mellitus(GDM),and to analyze the effects of insulin on serum IRS-1 and IRS-2 levels,blood glucose control and pregnancy outcome.Methods A total of 90 patients with GDM admitted to the Second Affiliated Hospital of Shaanxi University of Traditional Medicine from February 2017 to February 2019 were selected as the research subjects,and they were divided into groups A and B according to different treatment plans.Group A was treated with short-acting combined with long-acting insulin,and group B was treated with short-acting combined with medium-acting insulin,with 45 cases in each group.Blood glucose control level,insulin index,serum IRS-1,IRS-2 levels and pregnancy outcome were compared between the two groups after 12 weeks.Results After treatment,glycated hemoglobin and 2 h postprandial blood glucose and the insulin resistance index in group A were lower than those of group B,and the fasting insulin of group A was higher than that of group B,the differences were statistically significant(t=2.080,8.146,17.965 and 34.141,respectively,P<0.05).The IRS-1 and IRS-1/2 in group A were higher than those of group B,and IRS-2 was significantly lower than that of group B,the differences were statistically significant(t=2.036,2.153 and 0.035,respectively,P<0.05).There were no significant differences in the incidence of cesarean section,hypertension in pregnancy,neonatal hypoglycemia,and neonatal hyperbilirubinemia between the two groups(P>0.05).Conclusion Short-acting insulin(insulin aspart)combined with long-acting insulin(insulin detemir)can effectively control the blood glucose level in patients with GDM,regulate the IRS-1/IRS-2 signaling pathway and improve the body′s insulin resistance and glucose metabolism disorders,which is worthy of clinical promotion.