二甲双胍联合门冬胰岛素治疗GDM对患者妊娠结局及Nesfatin-1、Irisin水平影响

Effects of metformin combined with insulin aspart for treating pregnant women with gestational diabetes mellitus on their pregnancy outcomes and their levels of nesfatin-1 and irisin

目的:探讨二甲双胍联合门冬胰岛素治疗妊娠期糖尿病(GDM)对患者妊娠结局及血清人新饱食分子蛋白1(Nesfatin-1)和血清鸢尾素(Irisin)水平的影响。方法:应用随机双盲对照研究方法,将选取的2018年1月-2019年1月在本院接受治疗的GDM患者120例应用随机数字表法分组,对照组60例注射门冬胰岛素治疗,观察组60例加用盐酸二甲双胍口服,检测两组治疗前后糖代谢指标、胰岛β细胞功能指标及血清Nesfatin-1、Irisin水平,比较两组妊娠结局和不良反应发生情况。结果:两组治疗后空腹血糖、餐后2h血糖、糖化血红蛋白均较治疗前降低,且观察组低于对照组(P<0.05);空腹胰岛素、胰岛素抵抗指数均较治疗前降低,胰岛素分泌指数、胰岛素敏感指数较治疗前升高,且观察组变化幅度大于对照组(均P<0.05)。观察组剖宫产、羊水过多和早产率,以及巨大儿、新生儿黄疸、新生儿低血糖发生率均低于对照组(均P<0.05)。两组不良反应发生率(21.7%、15.0%)无差异(P>0.05)。治疗后两组血清Nesfatin-1水平低于治疗前、Irisin水平高于治疗前,且观察组(1.33±0.19μg/L、7.59±1.30mmol/L)与对照组(1.71±0.25μg/L、6.74±1.63mmol/L)有差异(P<0.05)。结论:二甲双胍联合门冬胰岛素治疗GDM,能更好控制患者血糖水平,并通过降低血清Nesfatin-1水平和升高Irisin水平来改善胰岛素抵抗和胰岛β细胞功能相关指标,减少不良母婴结局发生,治疗效果更佳且安全性高。

Objective:To investigate the effects of metformin combined with insulin aspart for treating pregnant women with gestational diabetes mellitus(GDM)on their pregnancy outcomes and their levels of nesfatin-1and irisin.Methods:In this random and double-blind control trial,120pregnant women with GDM were selected and randomly divided into the control group(n=60)and observation group(n=60)by random number table method from January 2018to January 2019.The women in the control group were treated with insulin aspart,while the women in the observation group were treated with metformin.The indexes of metabolic blood glucose,isletβcell function index,and serum nesfatin-1and Irisin levels of the women in the two groups were detected.The pregnancy outcomes and adverse reactions situation of the women were compared between the two groups.Results:After treatment,the levels of fasting blood glucose,2hpostprandial blood glucose,and hba1cof the women in the two groups had decreased significantly,and which of the women in the observation group were significantly lower than those of the women in the control group(P<0.05).The fasting insulin level and insulin resistance index value of the women in the two groups after treatment had decreased significantly,and the values of insulin secretion index and insulin sensitivity index of the women in the two groups after treatment had increased significantly,and the degrees of the change of which of the women in the observation group were significantly more than those of the women in the control group(all P<0.05).The rates of cesarean section,hyperhydramnios,and premature delivery of the women,and the rates of macrosomia,neonatal jaundice,and neonatal hypoglycemia in the observation group were significantly lower than those of the women in the control group(all P<0.05).There was no significant difference in the incidence of adverse reactions(21.7%vs.15.0%)of the women between the two groups(P>0.05).After treatment,the level of serum nesfatin-1of the women in the two groups had decreased significantly,and the level of serum Irisin of the women in the two groups had increased significantly,and the levels of serum nesfatin-1and Irisin(1.33±0.19μg/L and 7.59±1.30mmol/L)of the women in the observation group had significant different from those(1.71±0.25μg/L and 6.74±1.63mmol/L)of the women in the control group(P<0.05).Conclusion:Metformin combined with insulin aspart for treating the pregnant women with GDM can better control their blood glucose level,improve their insulin resistance and isletβcell function related indicators,and reduce the occurrence of adverse maternal and neonatal outcomes by increasing the serum nesfatin-1level and increasing the irisin level,which has better therapeutic effect with higher safety.