维生素D联合门冬胰岛素治疗妊娠糖尿病患者对胰岛素抵抗及母婴结局的影响

Effects of Vitamin D Combined with Insulin Aspart in the Treatment of Gestational Diabetes Mellitus on Insulin Resistance and Maternal and Infant Outcomes

目的 探究维生素D联合门冬胰岛素治疗妊娠糖尿病(gestational diabetes mellitus,GDM)患者对胰岛素抵抗及母婴结局的影响。方法 选取2022年1—8月到福建医科大学附属漳州市医院妇产科就诊的GDM患者94例为研究对象,根据治疗方案分为观察组(n=47)和对照组(n=47),对照组给予门冬胰岛素治疗,观察组给予维生素D+门冬胰岛素治疗。比较两组治疗后胰岛素用量、空腹血糖(fasting plasma glucose,FPG)达标时间、餐后2 h血糖(2-hour postprandial blood glucose,2 hPG)达标时间,比较两组患者治疗前后FPG、2 hPG、糖化血红蛋白(glycosylatedhemoglobin,HbA1c)、空腹胰岛素(fastinginsulin,FINS)、胰岛素抵抗指数(HOMA-insulin resistance,HOMA-IR)及胰岛素分泌指数(homeostasis model assessment-β,HOMA-β)水平,随访并记录不良母婴结局。结果 治疗后,观察组FPG达标时间、2 hPG达标时间、胰岛素用量均优于对照组,差异有统计学意义(P<0.05);观察组FPG、2 hPG、HbAlc均小于对照组,差异有统计学意义(P<0.05);观察组FINS、HOMA-β水平均高于对照组,HOMA-IR水平低于对照组,差异有统计学意义(P<0.05);观察组不良母婴结局发生率低于对照组(2.13%vs 17.02%),差异有统计学意义(P<0.05)。结论 维生素D联合门冬胰岛素可有效调节GDM患者血糖水平,改善胰岛抵抗状态,降低母婴不良结局发生风险。

Objective To explore the effect of vitamin D combined with insulin aspart on insulin resistance and maternal and fetal outcomes in patients with gestational diabetes mellitus(GDM).Methods 94 GDM patients who visited the Obstetrics and Gynecology Department of Zhangzhou Hospital Affiliated to Fujian Medical University from January to August 2022 were selected as the research subjects.According to the treatment plan,they were divided into observation group(n=47) and control group(n=47).The control group was given insulin aspart treatment,and the observation group was given vitamin D+insulin aspart treatment.The insulin dosage,fasting blood glucose(FPG) time to reach the target,and 2-hour postprandial blood glucose(2 hPG) time to reach the target were compared between the two groups.The levels of FPG,2 hPG,glycosylated hemoglobin(HbAlc),fasting insulin(FINS),HOMA-insulin resistance(HOMA-IR) and homeostasis model assessment-β(HOMA-β) were compared between the two groups before and after treatment,and adverse maternal and infant outcomes were followed up and recorded.Results After treatment,the time for FPG and 2 hPG to reach the target and the insulin dosage in the observation group were better than those in the control group,and the difference was statistically significant(P<0.05).The FPG,2 hPG and HbAlc in the observation group were all lower than those in the control group,and the difference was statistically significant(P<0.05).The levels of FINS and HOMA-β in the observation group were higher than those in the control group,and the levels of HOMA-IR was lower than that in the control group,and the difference was statistically significant(P<0.05).The incidence of adverse maternal and child outcomes in the observation group was lower than that in the control group(2.13% vs 17.02%),and the difference was statistically significant(P<0.05).Conclusion Vitamin D combined with insulin aspart can effectively regulate blood sugar levels in GDM patients,improve islet resistance,and reduce the risk of adverse maternal and fetal outcomes.