格列本脲与二甲双胍治疗妊娠期糖尿病效果及对妊娠结局影响

Curative effect of glibenclamide or metformin for treating women with gestational diabetes mellitus and its influence on the pregnancy outcomes

目的:探讨格列本脲与二甲双胍治疗妊娠期糖尿病(GDM)效果及对血糖控制达标时间、糖脂代谢、妊娠结局的影响。方法:选取2020年6月-2021年6月在本院诊治的经膳食运动治疗无效的GDM孕妇86例,分为两组各43例,分别口服格列本脲片治疗(格列本脲组)或盐酸二甲双胍片(二甲双胍组)治疗,两组均持续治疗12周。观察并比较两组血糖控制达标时间、糖脂代谢指标及妊娠结局。结果:治疗后两组空腹血糖(FPG)达标时间无差异(P>0.05),格列本脲组2 h血糖达标(5.37±3.72d)及FPG和2 h血糖均达标时间(6.15±3.13d)均短于二甲双胍组(6.95±2.51d、7.54±2.82d),两组血糖血脂指标均较治疗前有所改善(均P<0.05),两组2 h血糖、糖化血红蛋白(HbA1c)、高密度脂蛋白水平无差异(均P>0.05);格列本脲组FPG水平(4.84±0.72 mmol/L)低于二甲双胍组(5.01±0.31 mmol/L),总胆固醇、低密度脂蛋白水平高于二甲双胍组(均P<0.05)。两组剖宫产及新生儿巨大儿、高胆红素血症、转入NICU的发生率无差异(均P>0.05),格列本脲组妊娠期高血压(25.6%)及新生儿低血糖(25.6%)发生率高于二甲双胍组(9.3%、14.0%)(均P<0.05)。两组治疗期间均未出现严重不良反应。结论:格列本脲和二甲双胍均对GDM孕妇的血糖有较好的控制效果,但从妊娠结局考虑应首选二甲双胍治疗。

Objective:To explore the curative effect of glibenclamide or metformin for treating pregnant women with gestational diabetes mellitus(GDM),and to study their influence on the standard-reaching time of blood glucose control,glucose-lipid metabolism,and pregnancy outcomes of these women.Methods:A total of 86 pregnant women with GDM who had failed diet exercise therapy were enrolled and were divided into group A(43 cases with oral glibenclamide tablets continuously for 12 weeks)and group B(43 cases with oral metformin hydrochloride tablets continuously for 12 weeks)between June 2020 and June 2021.The standard-reaching time of blood glucose control,the glucose-lipid metabolism indexes levels,and the pregnancy outcomes of the women in the two groups were observed and were compared between the two groups.Results:After treatment,there was no significant difference in the standard-reaching time of fasting blood glucose(FPG)of the women between the two groups(P>0.05).The standardreaching time of 2 h blood glucose(5.37±3.72d),and the standard-reaching time of both 2 h blood glucose and FPG(6.15±3.13d)of the women in group A were shorter than those(6.95±2.51d and 7.54±2.82d)of the women in group B.The levels of blood glucose and lipid indexes of the women in the two groups after treatment had improved significantly(all P<0.05).There were no significant differences in the levels of 2h blood glucose,glycated hemoglobin(HbA1c),and high density lipoprotein of the women between the two groups(all P>0.05).The level of FPG(4.84±0.72 mmol/L)of the women in group A was significantly lower than that(5.01±0.31 mmol/L)of the women in group B,and the.levels of total cholesterol and low density lipoprotein of the women in group A were significantly higher than those of the women in group B(all P<0.05).There were no significant differences in the incidences of cesarean section of the women,macrosomia,neonatal hyperbilirubinemia,and neonates transfer to NICU between the two groups(all P>0.05).The incidences of pregnancy-induced hypertension(25.6%)of the women and the neonatal hypoglycemia(25.6%)in group A were significantly higher than those(9.3%and 14.0%)in group B(all P<0.05).There was no any case with serious adverse reaction during treatment in the two groups.Conclusion:Both glibenclamide and metformin are of good control effect on blood glucose of the pregnant women with GDM.However,metformin should be the first choice for these women in terms of their pregnancy outcomes.