不同剂量维生素D联合门冬胰岛素对妊娠期糖尿病患者血糖波动、胰岛素抵抗及妊娠结局的影响

Effects of different doses of vitamin D combined with insulin aspart on blood glucose fluctuation,insulin resistance and pregnancy outcome in patients with gestational diabetes mellitus

目的探究不同剂量维生素D联合门冬胰岛素对妊娠期糖尿病(GDM)患者血糖波动、胰岛素抵抗及妊娠结局的影响。方法以随机抽签法将113例GDM患者分为对照组(n=56,低剂量维生素D联合门冬胰岛素)与观察组(n=57,高剂量维生素D联合门冬胰岛素)。比较两组的治疗效果。结果治疗后,观察组的日间血糖平均绝对差(MODD)、平均血糖波动幅度(MAGE)、稳态模型评估-胰岛素抵抗指数(HOMA-IR)、空腹胰岛素(FINS)水平均低于对照组,胰岛素分泌指数(HOMA-β)、25羟基维生素D_(3)[25-(OH)D_(3)]水平均高于对照组(P<0.05)。观察组的不良妊娠结局总发生率低于对照组(P<0.05)。治疗后,观察组的三酰甘油(TG)、空腹血糖(FPG)、总胆固醇(TC)、餐后2 h血糖(2 h PG)水平均低于对照组(P<0.05)。结论高、低两种剂量维生素D联合门冬胰岛素治疗GDM均有满意的效果,但高剂量维生素D更能发挥稳定血糖、减少胰岛素抵抗及不良妊娠结局的作用。

Objective To explore the effects of different doses of vitamin D combined with insulin aspart on blood glucose fluctuation,insulin resistance and pregnancy outcome in patients with gestational diabetes mellitus(GDM).Methods One hundred and thirteen patients with GDM were divided into control group(n=56,low-dose vitamin D combined with insulin aspartic)and observation group(n=57,high-dose vitamin D combined with insulin aspartic)according to randomized picking method.The therapeutic effects of the two groups were compared.Results After treatment,the mean of daily differences(MODD),mean amplitude of glycemic excursions(MAGE),homeostasis model assessment-insulin resistance(HOMA-IR)and fasting insulin(FINS)levels in the observation group were lower than those in the control group,while the islet-βcell function index(HOMA-β)and 25-hydroxyvitamin D_(3)[25-(OH)D_(3)]level were higher than those in the control group(P<0.05).The total incidence of adverse pregnancy outcomes in the observation group was lower than that in the control group(P<0.05).After treatment,the levels of triglycerides(TG),fasting plasma glucose(FPG),total cholesterol(TC)and 2-hour postprandial plasma glucose(2 h PG)in the observation group were lower than those in the control group(P<0.05).Conclusion Both high and low-doses of vitamin D combined with insulin aspart in the treatment of GDM have satisfactory effects,but high-dose vitamin D can play a better role in stabilizing blood glucose,reducing insulin resistance and adverse pregnancy outcomes.