个体化营养干预联合益气养阴方对妊娠糖尿病病人血糖、血脂、胰岛β细胞功能指标的影响

Effects of individualized nutritional intervention combined with Yiqi Yangyin formula on blood glucose,blood lipids and pancreaticβ-cell function indexes in patients with gestational diabetes mellitus

目的探讨个体化营养干预联合益气养阴方对妊娠糖尿病(GDM)病人血糖波动、血脂指标、胰岛β细胞功能的影响。方法选择2018年1月至2019年12月邢台医学高等专科学校第二附属医院收治的120例GDM病人,采用随机数字表法将病人分为两组。对照组(60例)采用西医常规治疗联合益气养阴方治疗,观察组(60例)在对照组基础上增加个体化营养干预。观察两组治疗前后血糖波动、血脂指标和胰岛β细胞功能差异。结果两组治疗后日内平均血糖波动幅度(MAGE)、血糖水平标准差(SDBG)、平均餐后血糖波动幅度(MPPGE)、日间血糖波动幅度(MODD)、血清总胆固醇(TC)、载脂蛋白B(ApoB)、胰岛素抵抗指标[HOMA-IR(C-P)]均下降(P<0.05),载脂蛋白A1(ApoA1)、ApoA1/ApoB比值、精氨酸刺激3 min C肽(C-P)、C-P峰值/空腹C肽(FC-P)、胰岛β细胞功能指数[HOMA-β(C-P)]升高(P<0.05)。观察组治疗后MAGE[(3.62±0.51)mmol/L比(4.25±0.69)mmol/L]、SDBG[(1.91±0.16)mmol/L比(2.12±0.21)mmol/L]、MPPGE、MODD、血清TC、ApoB、HOMA-IR(C-P)低于对照组(P<0.05),ApoA1[(1.43±0.65)g/L比(1.12±0.36)g/L]、ApoA1/ApoB比值[(1.47±0.26)比(0.97±0.20)]、精氨酸刺激3 min C-P[(6.97±1.06)μg/L比(5.09±0.76)μg/L]、C-P峰值/FC-P[(2.91±0.85)比(1.91±0.72)]、HOMA-β(C-P)[(2.16±0.77)比(1.92±0.62)]高于对照组(P<0.05)。结论个体化营养干预联合益气养阴方更有助于维持妊娠期间血糖稳定,降低血脂水平,改善胰岛β细胞储备功能,降低胰岛素抵抗。

Objective To investigate the effects of individualized nutritional intervention combined with Yiqi Yangyin formula on blood glucose fluctuation,blood lipid index and pancreaticβ-cell function in patients with gestational diabetes mellitus(GDM).Methods A total of 120 patients with GDM admitted to the Second Affiliated Hospital of Xingtai Medical College from January 2018 to December 2019 were selected and divided into two groups by the random number table method.The control group(60 cases)was treated with conventional Western medicine treatment combined with Yiqi Yangyin formula,while the observation group(60 cases)was treated with additional individualized nutritional interventions on the basis of the control group.Differences in blood glucose fluctuation,blood lipid index and pancreaticβ-cell function between the two groups before and after treatment were observed.Results Mean postprandial glucose excursions(MAGE),standard deviation blood glucose(SDBG),mean postprandial glucose excursion(MPPGE),means of daily differences(MODD),total cholesterol(TC),apolipoprotein B(ApoB),and HOMA-IR(C-P)were all decreased(P<0.05),and apolipoprotein A1(ApoA1),ApoA1/ApoB ratio,arginine-stimulated 3 min c-peptide(C-P),peak C-P/fasting C-peptide(FC-P),and isletβ-cell function index[HOMA-β(C-P)]were increased(P<0.05).In the observation group,after treatment,MAGE[(3.62±0.51)mmol/L vs.(4.25±0.69)mmol/L],SDBG[(1.91±0.16)mmol/L vs.(2.12±0.21)mmol/L],MPPGE,MODD,serum TC,ApoB,HOMA-IR(C-P)were lower than those of the control group(P<0.05),and ApoA1[(1.43±0.65)g/L vs.(1.12±0.36)g/L],ApoA1/ApoB ratio[(1.47±0.26)vs.(0.97±0.20)],arginine-stimulated 3 min C-P[(6.97±1.06)μg/L vs.(5.09±0.76)μg/L],peak C-P/FC-P[(2.91±0.85)vs.(1.91±0.72)],and HOMA-β(C-P)[(2.16±0.77)vs.(1.92±0.62)]were higher than those of the control group(P<0.05).Conclusion The combination of individualized nutritional interventions with Yiqi Yangyin formula is more helpful in maintaining stable glucose,lowering blood lipid levels,improving pancreaticβ-cell reserve function,and reducing insulin resistance during pregnancy.