二甲双胍联合胰岛素对妊娠糖尿病患者妊娠结局及血清Omentin-1、Betatrophin水平的影响

Effects of metformin combined with insulin on pregnancy outcome and serum levels of Omentin-1 and Betaprophin in patients with gestational diabetes

目的探讨二甲双胍联合胰岛素对妊娠糖尿病(GDM)患者妊娠结局及血清中网膜素1(Omentin-1)、促代谢因子(Betatrophin)水平的影响。方法前瞻性纳入2019年1月至2021年12月沧州市人民医院收治的GDM患者400例作为研究对象,按随机数字表法将其分为观察组和对照组,每组各200例。两组均接受知识宣讲、饮食摄入控制、运动训练。对照组给予胰岛素注射液皮下注射,于餐前15~30 min注射,初次剂量0.2~0.3 U/(kg·d),3次/d。观察组在对照组基础上联合二甲双胍(1次/d,0.5 g/次)治疗。两组均治疗3周。比较两组血糖指标[空腹血糖、餐后2 h血糖(2 hPG)、糖化血红蛋白(GHb)],另外评估其氧化应激指标[晚期糖基化终末产物(AGEs)、血管细胞黏附分子-1(VCAM-1)、谷胱甘肽过氧化物酶(CSH-PX)]以及血清Omentin-1、Betatrophin水平,并比较两组不良妊娠结局。结果治疗后,两组空腹血糖、2 hPG、GHb水平均较治疗前降低,且观察组空腹血糖、2 hPG、GHb水平分别为(3.85±1.01)mmol/L、(6.12±0.86)mmol/L、(5.02±0.59)%,均低于对照组[(4.65±1.26)mmol/L、(7.85±1.22)mmol/L、(6.52±0.56)%],差异均有统计学意义(P<0.05)。治疗后,两组VCAM-1、AGEs水平均较治疗前降低,GSH-PX水平均较治疗前升高,且观察组VCAM-1、AGEs水平分别为(39.64±3.51)、(37.59±4.15)ng/L,均低于对照组[(52.15±4.02)、(42.59±5.06)ng/L],GSH-PX水平为(29.85±4.03)μmol/L,高于对照组[(21.86±3.46)μmol/L],差异均有统计学意义(P<0.05)。治疗后,两组血清Omentin-1、Betatrophin水平均较治疗前降低,观察组血清Omentin-1水平为(174.56±34.59)ng/mL,高于对照组[(151.58±36.45)ng/mL],Betatrophin水平为(572.56±85.49)pg/mL,低于对照组[(701.23±98.56)pg/mL],差异均有统计学意义(P<0.05)。观察组不良妊娠结局发生率为12.00%,低于对照组(19.50%),差异有统计学意义(P<0.05)。结论二甲双胍联合胰岛素治疗GDM不仅能有效改善患者血糖指标以及氧化应激指标,还能改善其血清Omentin-1、Betatrophin水平,具备安全性。

Objective To investigate the effect of metformin combined with insulin on the pregnancy outcome and the levels of omentin-1 and betatrophin in serum adipose tissue in patients with gestational diabetes mellitus(GDM).Methods A prospective study was conducted on 400 cases of GDM admitted to Cangzhou People's Hospital from January 2019 to December 2021.They were divided into the observation group and the control group using a random number table method,with 200 cases in each group.Both groups received knowledge lectures,dietary intake control,and exercise training.The control group was given subcutaneous injection of insulin injection,15-30 minutes before meals,with an initial dose of 0.2-0.3 U/(kg·d),three times a day.The observation group received metformin(once a day,0.5 g/time)in combination with the control group.Both groups were treated for 3 weeks.The blood glucose indicators[fasting blood glucose,2-hour postprandial glucose(2 hPG),and glycosylated hemoglobin(GHb)],and evaluate their oxidative stress indicators[advanced glycation end products(AGEs),vascular cell adhesion molecule-1(VCAM-1),glutathione peroxidase(CSH-PX)],as well as levels of serum Omentin-1 and Betaprohin were compared between two groups.Finally,the adverse pregnancy outcomes was compared between the two groups.Results After treatment,the levels of fasting blood glucose,2 hPG,and GHb in two groups were lower than those before treatment,while the fasting blood glucose,2 hPG,and GHb levels in the observation group were(3.85±1.01)mmol/L,(6.12±0.86)mmol/L,and(5.02±0.59)%,respectively,which were lower than those in the control group[(4.65±1.26)mmol/L,(7.85±1.22)mmol/L,and(6.52±0.56)%],and the differences were statistically significant(P<0.05).After treatment,the levels of VCAM-1 and AGEs in two groups were lower than those before treatment,and the levels of GSH-PX were higher than those before treatment,the levels of VCAM-1 and AGEs in the observation group were(39.64±3.51)and(37.59±4.15)ng/L,respectively,which were lower than those in the control group[(52.15±4.02)and(42.59±5.06)ng/L],and the levels of GSH-PX was(29.85±4.03)μmol/L,which was higher than that of the control group[(21.86±3.46)]μmol/L,the differences were statistically significant(P<0.05).After treatment,the levels of serum Omentin-1 and Betatrophin in two groups were lower than those before treatment,and the level of serum Omentin-1 in the observation group was(174.56±34.59)ng/mL,which was higher than that in the control group[(151.58±36.45)ng/mL],and the level of serum Betatrophin was(572.56±85.49)pg/mL,which was lower than that in the control group[(701.23±98.56)pg/mL],the differences were statistically significant(P<0.05).The incidence of adverse pregnancy outcomes in the observation group was 12.00%,which was lower than that of the control group(19.50%),the difference was statistically significant(P<0.05).Conclusion The combination of metformin and insulin in the treatment of GDM can not only effectively improve patients'blood glucose and oxidative stress indicators,but also improve their serum levels of Omentin-1 and Betatrophin,which is safe.