门冬胰岛素联合营养和运动干预在妊娠期糖尿病患者中的临床效果分析

Clinical efficacy of insulin aspart combined with nutrition and exercise intervention in treatment of gestational diabetes mellitus

目的观察门冬胰岛素联合营养、运动干预在妊娠期糖尿病(GDM)患者中的应用效果。方法选取2020年1~12月产科收治的GDM患者60例为研究对象,随机分为2组,每组30例。对照组给予皮下注射门冬胰岛素治疗,联合组在对照组基础上给予营养、运动干预。比较2组糖脂代谢指标[空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)]、胰岛素敏感性、胰岛β细胞功能、炎性因子[白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、C-反应蛋白(CRP)]、脂肪因子(瘦素、内脂素、脂联素)、氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)]、负性情绪及不良妊娠结局。结果干预前2组FPG、2 hPG、HbA1c、TC、TG、LDL-C、HOMA-IR、HOMA-β、IL-6、TNF-α、CRP、瘦素、内脂素、脂联素、MDA、SOD、SAS评分、SDS评分比较差异无统计学意义(P>0.05);干预后2组FPG、2 hPG、HbA1c、TC、TG、LDL-C、HOMA-IR、IL-6、TNF-α、CRP、瘦素、内脂素、MDA、SAS评分、SDS评分均显著低于治疗前,HOMA-β、脂联素、SOD均显著高于治疗前,差异有统计学意义(P<0.05),且联合组FPG、2 hPG、HbA1c、TC、TG、LDL-C、HOMA-IR、IL-6、TNF-α、CRP、瘦素、内脂素、MDA、SAS评分、SDS评分低于对照组,HOMA-β、脂联素、SOD高于对照组,差异有统计学意义(P<0.05)。联合组剖宫产、早产、产后出血、胎膜早破、新生儿窒息、巨大儿发生率低于对照组,差异有统计学意义(P<0.05)。结论门冬胰岛素联合营养、运动干预应用于GDM患者能够有效控制糖脂代谢指标、炎性因子、脂肪因子及氧化应激指标,改善妊娠结局。

Objective To investigate the clinical efficacy of insulin aspart combined with nutrition and exercise intervention in treatment of gestational diabetes mellitus(GMD).Methods A total of 60 patients with GDM who were treated in our hospital from January 2020 to December 2020 were enrolled in the study,who were randomly divided into two groups,with 30 cases in each group.The patients in control group were treated by subcutaneous injection of insulin aspart,however,those in combination treatment group,on the basis of control group,were treated by nutrition and exercise intervention.The glucose and lipid metabolism indexes(FPG,2 hPG,HbA1c,TC,TG and LDL-C),insulin sensitivity,isletsβcell function,inflammation cytokines(IL-6,TNF-αand CRP),adipokines(leptin,visfatin and adiponectin),oxidative stress index(SOD and MDA),negative emotion and adverse pregnancy outcomes were observed and compared between the wto groups.Results Before intervention,there were no significant differences in the levels of FPG,2 hPG,HbA1c,TC,TG,LDL-C,HOMA-IR,HOMA-β,IL-6,TNF-α,CRP,leptin,visfatin,adiponectin,MDA,SOD,SAS scores and SDS scores between the two groups(P>0.05).After intervention,the levels of FPG,2 hPG,HbA1c,TC,TG,LDL-C,HOMA-IR,IL-6,TNF-α,CRP,leptin,visfatin,MDA,SAS scores and SDS scores in both groups were significantly decreased,but,the levels of HOMA-β,adiponectin and SOD were significantly increased(P<0.05),moreover,the decrease degree and increase degree in combination treatment group were more significant than those in control group(P<0.05).In addition the incidence rates of adverse pregnancy outcomes in combination treatment group were significantly lower than those in control group(P<0.05).Conclusion Insulin aspart combined with nutrition and exercise intervention has significant effects in treatment of GDM,which can regulate and control the glucose and lipid metabolism indexes of patients,inflammation cytokines,adipokines and oxidative stress index,so as to improve the pregnancy outcomes.