加味四君子汤联合胰岛素治疗气阴两虚型妊娠期糖尿病的效果及对母婴结局的影响

Effect of modified Sijunzi Decoction combined with insulin in the treatment of gestational diabetes mellitus with deficiency of Qi and Yin and its influence on maternal and infant outcomes

目的探究加味四君子汤联合胰岛素治疗气阴两虚型妊娠期糖尿病(GDM)的效果及对母婴结局的影响。方法选取2020年1月至2021年8月空军军医大学第一附属医院综合诊疗科收治的90例气阴两虚型GDM患者为研究对象,按随机数表法分为观察组和对照组,每组45例,对照组患者采用胰岛素配合饮食控制的常规疗法,观察组在此基础上加用加味四君子汤口服治疗,治疗持续3个月。治疗结束后比较两组患者的治疗前后的中医症候积分、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)及分泌指数(HOMA-β)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)和糖化血红蛋白(HbA1c)、丙二醛(MDA)、一氧化氮(NO)、超氧化物歧化酶(SOD);对全部患者进行随访,随访时间至分娩后3个月,统计两组患者的妊娠结局以及产后不良事件的发生情况。结果治疗后,两组患者的主症积分、次症及舌脉积分、总分较治疗前均下降,且观察组明显低于对照组,差异均有统计学意义(P<0.05);治疗后,两组患者的HOMA-IR、FINS均下降,HOMA-β较治疗前均上升,且观察组较对照组变化更明显,差异均具有统计学意义(P<0.05);治疗后,两组患者的FBG、2 hPG、HbA1c、MDA、NO较治疗前均下降,且观察组明显低于对照组,与此同时,SOD水平均上升,且观察组明显高于对照组,差异均有统计学意义(P<0.05);此外,观察组患者的总不良母婴结局发生率为8.89%,明显低于对照组的24.44%,差异有统计学意义(P<0.05)。结论采用加味四君子汤配合胰岛素治疗可以提高气阴两虚型GDM患者的血糖控制效果、改善胰岛功能、优化母婴结局,具有较高的应用价值。

Objective To explore the effect of modified Sijunzi Decoction combined with insulin in the treatment of gestational diabetes mellitus(GDM)with deficiency of Qi and Yin and its influence on maternal and infant outcomes.Methods A total of 90 GDM patients with deficiency of Qi and Yin admitted to the Department of Comprehensive Clinic,the First Affiliated Hospital of Air Force Military Medical University from January 2020 to August 2021 were selected as the research objects.According to the random number table method,they were divided into an observation group and a control group,with 45 patients in each group.Patients in the control group received the conventional therapy of insulin combined with diet control,and the patients in the observation group were additionally treated with Jiawei Sijunzi decoction on the basis of the control group,orally for 3 months.After treatment,TCM syndrome score,fasting insulin(FINS),homeostasis model assessment insulin resistance(HOMA-IR)and HOMA-β Cell Secretion Index(HOMA-β),fasting blood glucose(FPG),2 hours postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c),malondialdehyde(MDA),nitric oxide(NO),and superoxide dismutase(SOD)before and after treatment were compared between the two groups.All patients were followed up for 3 months after delivery,and the pregnancy outcome and the occurrence of adverse events after delivery were counted.Results After treatment,the main disease score,secondary disease score,tongue and pulse score,and total score of two groups were decreased compared with those before treatment,and the scores in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).After treatment,HOMA-IR and FINS decreased in the two groups and the HOMA-βincreased compared with those before treatment,and the changes in the observation group were more significant than those in the control group,with statistically significant differences(P<0.05).After treatment,FBG,2 hPG,HbA1c,MDA,and NO in two groups were decreased compared with before treatment,and the levels in the observation group were significantly lower than those in the control group;meanwhile,SOD level was increased,and the level in the observation group was significantly higher than that in the control group,with statistically significant differences(P<0.05).In addition,the incidence of total adverse maternal and infant outcomes in the observation group was 8.89%,which was significantly lower than 24.44%in the control group(P<0.05).Conclusion Modified Sijunzi Decoction combined with insulin therapy can improve the effect of blood glucose control,improve islet function,optimize maternal and infant outcomes in GDM patients with deficiency of Qi and Yin,which has high application value.