抗阻运动联合胰岛素对妊娠期糖尿病患者代谢指标、炎症因子、脂联素和瘦素水平的影响

Effects of resistance exercise combined with insulin on metabolic indexes, inflammatory factors, adiponectin and leptin levels in patients with gestational diabetes mellitus

目的探究抗阻运动联合胰岛素对妊娠期糖尿病(GDM)患者代谢指标、炎症因子、脂联素、瘦素水平的影响。方法前瞻性选取2019年1月至2022年1月西部战区总医院收治的200例GDM患者为研究对象,按照随机数字表法将其分为对照组和观察组,经剔除后,最终每组各纳入98例。对照组予以胰岛素治疗,观察组予以抗阻运动联合胰岛素治疗,两组均连续干预直至分娩。比较两组治疗前、治疗3个月后外周静脉血中糖化血红蛋白(HbA1c)及血清空腹血糖、餐后2 h血糖(2 hPG)、甘油三酯、总胆固醇、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、脂联素、瘦素水平。结果观察组治疗3个月后空腹血糖、2 hPG、HbA1c及血清甘油三酯、总胆固醇、IL-6、TNF-α、hs-CRP水平分别为(4.84±1.16)mmol/L、(6.29±1.23)mmol/L、(4.83±0.89)%、(1.66±0.44)mmol/L、(3.12±0.59)mmol/L、(95.76±15.32)mg/L、(3.06±0.71)ng/L、(6.39±1.24)mg/L,均明显低于对照组[(5.37±1.32)mmol/L、(7.51±1.36)mmol/L、(5.68±1.02)%、(2.29±0.60)mmol/L、(3.84±0.68)mmol/L、(117.04±21.26)mg/L、(4.11±1.05)ng/L、(9.78±2.15)mg/L],差异均有统计学意义(P<0.05)。观察组治疗3个月后血清脂联素水平为(10.58±3.42)ng/mL,高于对照组[(8.51±2.63)ng/mL],血清瘦素水平为(1.43±0.32)μg/mL,低于对照组[(1.70±0.39)μg/mL],差异均有统计学意义(P<0.05)。观察组剖宫产率、巨大儿发生率为20.41%、2.04%,均明显低于对照组(37.76%、9.18%),差异均有统计学意义(P<0.05)。结论抗阻运动联合胰岛素可有效降低GDM患者血糖、血脂及炎症因子水平,上调脂联素并下调瘦素表达,有利于降低剖宫产率、巨大儿发生率。

Objective To explore the effect of resistance exercise combined with insulin on metabolic indexes,inflammatory factor and adiponectin,leptin levels in patients with gestational diabetes mellitus(GDM).Methods A total of 200 GDM patients admitted to General Hospital of the Western Theater from January 2019 to January 2022 were prospectively selected as the research objects and randomly divided into the control group and the observation group according to the random number table method.After elimination,98 cases were included in each group.The control group was treated with insulin,and the observation group was treated with resistance exercise combined with insulin.The levels of glycosylated hemoglobin(HbA1c),fasting plasma glucose(FPG),2 h postprandial blood glucose(2 hPG),triglyceride(TG),total cholesterol(TC),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP),adiponectin and leptin were compared between the two groups before treatment and 3 months after treatment.Results The levels of fasting blood glucose,2 hPG,HbA1c,serum triglycerides,total cholesterol,IL-6,TNF-αand hs-CRP in the observation group after 3 months of treatment were(4.84±1.16)mmol/L,(6.29±1.23)mmol/L,(4.83±0.89)%,(1.66±0.44)mmol/L,(3.12±0.59)mmol/L,(95.76±15.32)mg/L,(3.06±0.71)ng/L,(6.39±1.24)mg/L,respectively,which were significantly lower than those in the control group[(5.37±1.32)mmol/L,(7.51±1.36)mmol/L,(5.68±1.02)%,(2.29±0.60)mmol/L,(3.84±0.68)mmol/L,(117.04±21.26)mg/L,(4.11±1.05)ng/L,(9.78±2.15)mg/L],the differences were statistically significant(P<0.05).After 3 months of treatment,the level of serum adiponectin in the observation group was(10.58±3.42)ng/mL,which was higher than that in the control group[(8.51±2.63)ng/mL],the level of serum leptin was(1.43±0.32)mg/mL,which was lower than that in the control group[(1.70±0.39)mg/mL],the differences were statistically significant(P<0.05).The cesarean section rate and the incidence of macrosomia in the observation group were 20.41%,2.04%,which were significantly lower than those in the control group(37.76%,9.18%),the differences were statistically significant(P<0.05).Conclusion Resistance exercise combined with insulin can effectively reduce the levels of blood glucose,blood lipids and inflammatory factors in GDM patients,up-regulate adiponectin and down-regulate leptin expression,which is beneficial to reduce the cesarean section rate and the incidence of macrosomia.