妊娠期糖耐量异常患者用短效人胰岛素治疗的益处

A Clinical Survey of Insulin Treatment in Patients with Gestational Impaired Glucose Tolerance(GIGT)

目的 :探讨短效人胰岛素治疗对妊娠期糖耐量异常 (GIGT)患者及其婴儿是否有益。方法 :用OGTT筛选出GIGT患者 10 8例后分为GIGT胰岛素治疗 (GIGT IT)组和GIGT对照 (GIGT C)组 ,每组 5 4例。前者予短效人胰岛素皮下注射 ,后者仅予饮食治疗。随访妊娠结局。结果 :①GIGT IT组母婴患病率分别为妊娠高血压综合征3 70 %、羊水过多 5 .5 6 %、胎膜早破 3.70 %、手术产 5 .5 6 %、巨胎 5 .5 6 %、无死胎 ,而GIGT C组则相应为 14 .81%、2 4 .0 7%、12 .96 %、31.4 8%、37.0 4 %、5 .5 6 % ,两组间各病患病率分别比较 ,差异均有显著性意义 (P <0 .0 5或P<0 .0 1) ;②当妊娠期空腹血糖 (FPG)在 3.33～ 4 .4 4mmol/L、餐后 2h血糖 (PG 2h)在 4 .4 5～ 5 .5 6mmol/L、糖化血红蛋白 (HbAC) 4～ 6 %时 ,母婴患病率最低 ,而低血糖反应很少发生 ;③妊娠期PG2h、HbAC水平与新生儿体重呈显著正相关 (分别r=0 .5 12 5 ,0 .5 6 79,均P <0 .0 0 1)。结论 :GIGT患者母婴患病率增高 ,使用短效人胰岛素治疗并尽可能使血糖正常化 。

Objective:To evaluate the effect of insulin treatment for pregnancy outcome in patients with GIGT. Methods:108 patients with GIGT screened out from 716 pregnancy women by OGTT were divided into GIGT insulin treatment group(GIGT IT) and GIGT control group(GIGT C) randomly. Each group contained 54 patients. GIGT IT group were treated with insulin subcutaneous injection on the basis of dietary treatment,GIGT C group were only treated with diet. The outcome of pregnancy were then investigated. Results:① The morbidity of hypertensive state of pregnancy,polyhydramnios,premature rupture of membrane,cesarean section,fetal macrosomia,and fetal death were 3.70%, 5.56%,3.70%, 5.56%,0.oo% respectively in GIGT IT group; and 14.81%,24.07%,12.96 %,31.48%,37.04%,5.56% respectively in GIGT C group. There existed significant difference in morbidities of the complications of mother and neonate between two groups ( P <0.05,or P <0.01);②When FPG was 3.33～4.44 mmol/L,PG2h4.44～5.56 mmol/L,HbA c 4～6%,the morbidities of various complications of mother and neonate were the lowest, and hypoglucemia hardly occured in the gestational women; ③There was postive PG2h and HbAc birth weight correlations shown by this study. between PG2h 、 HbA c and birth weight of newborns ( r =0 5125,0.5679, respectively, both P <0.001). Conclusions:GIGT may increase the morbidities of the complications of mother and neonate during pregnancy. These morbidities of complications could be reduced significantly with insulin subcutaneous injection,the optimal plasma glucose levels during pregnancy may be FPG 3.33～4.44 mmol/L,PG2h4.44～5.56 mmol/L,HbA C 4～6%.