维生素D及二甲双胍用于妊娠期糖尿病患者的疗效及对妊娠结局和视黄醇结合蛋白4的影响

Therapeutic Effect of Vitamin D and Metformin in Patients with Gestation⁃al Diabetes Mellitus and Their Impact on Pregnancy Outcomes and Retinol⁃binding Protein 4

目的分析维生素D与二甲双胍对妊娠期糖尿病患者的治疗效果。方法筛选2023年3月至2024年3月收治的200例妊娠期糖尿病患者,按照随机数字表法分为对照组和观察组,每组100例。对照组接受二甲双胍治疗,观察组在对照组基础上配合维生素D治疗。比较2组糖代谢指标、肾功能、血清因子[肿瘤坏死因子-α(TNF-α)、视黄醇结合蛋白4(RBP4)、内脂素(visfatin)]及血脂指标[三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)],观察2组妊娠结局及不良反应。结果观察组治疗后空腹血糖、餐后2 h血糖、糖化血红蛋白、稳态模型胰岛素抵抗指数、TNF-α、RBP4、visfatin、TC、TG、LDL-C低于对照组,空腹胰岛素高于对照组(P<0.05)。治疗后,2组血肌酐、24 h尿蛋白总量及血尿素低于治疗前,且观察组低于对照组(P<0.05)。观察组巨大儿、产后出血、新生儿窒息发生率以及不良反应总发生率均低于对照组(P<0.05)。结论妊娠期糖尿病应用维生素D与二甲双胍共同治疗的效果更好,可维持糖代谢和血脂水平,调节肾功能,稳定RBP4水平,从而改善妊娠结局,并控制不良反应。

Objective To analyze the therapeutic effect of Vitamin D and Metformin in patients with gestational dia-betes mellitus(GDM).Methods A total of 200 patients with GDM admitted from March 2023 to March 2024 were selected and divided into the control group(n=100)and the observation group(n=100)according to random number table method.The control group received Metformin treatment,and the observation group was supplemented with Vitamin D treatment on the basis of the control group.Glucose metabolism indexes,renal function,serum factors[tumor necrosis factor-α(TNF-α),retinol-binding protein 4(RBP4)and visfatin]and lipid indexes[triacylglycerol(TG),total cholesterol(TC)and low-density lipoprotein cholesterol(LDL-C)]were compared between the two groups.Pregnancy outcome and adverse reactions were observed in the two groups.Results Fasting blood glucose,2 h postmeal blood glucose,glycated hemoglobin,steady-state model insulin resistance index,TNF-α,RBP4,visfatin,TC,TG and LDL-C in the observation group after treatment were lower than those in the control group,while fasting insulin was higher than that in the control group(P<0.05).After treatment,serum creatinine,24 h urinary protein and blood urea in the two groups were lower than those before treatment,which were lower in the observation group than in the control group(P<0.05).The incidence of macrosomia,postpartum hemorrhage,neonatal asphyxia and the total incidence of adverse reactions in the observation group were lower than those in the control group(P<0.05).Conclusion The combination of Vitamin D and Metformin in the treatment of GDM has a bet-ter effect,which can maintain the body's glucose metabolism and lipid levels,regulate kidney function,and stabilize RBP4 level,thereby improving the pregnancy outcome and controlling adverse reactions.