摘要
目的分析地特胰岛素(Det)、精蛋白生物合成人胰岛素(NPH)在妊娠糖尿病中应用对血糖及基础胰岛水平的干预效果。方法将符合本研究标准的妊娠合并糖尿病患者(80例)用随机数字表法分为两组。均给予门冬胰岛素,观察组加Det,对照组加NPH。对比两组治疗前后血糖水平及达标时间,对比两组7d时胰岛素使用情况、治疗前后空腹胰岛水平及胰岛B细胞功能。记录低血糖发生、治疗后体质量(BMI)及分娩结局。结果观察组血糖全部达标时间较对照组短,7 d时空腹血糖(FBG)、餐后2小时血糖(2 hPG)水平及治疗后2 hPG水平更低;治疗后观察组2hPG较对照组低;观察组Det用量较对照组NPH多,但每日注射次数较对照组少;观察组治疗7d时HOMA-B较对照组高,治疗后FINS、HOMA-B、MBCI高于对照组;观察组低血糖发生率(7.50%)低于对照组(20.00%)。差异均有统计学意义(P<0.05)。两组治疗后BMI及母婴分娩结局相关指标比较,差异均无统计学意义(P>0.05)。结论以上两种胰岛素均能有效控制妊娠合并糖尿病血糖,维持胰岛素水平,但地特胰岛素效果更明显,安全性更高。
Objective To analyze the intervention effects of Insulin Detemir Injection( Det) and Isophane Protamine Biosynthetic Human Insulin Injection( NPH) on the level of blood glucose and basal islets in gestational diabetes mellitus. Methods Patients with gestational diabetes mellitus( n = 80) who met the criterias of this study were divided into observation group and control group by random number table. Insulin was provided to the two groups. The observation group and the control group were also given Det and NPH,respectively. The blood glucose level and the time to reach the standard before and after treatment between the two groups were compared. The situation of insulin usage at the 7 thday,fasting insulin level( FINS),and pancreatic islet B-cell function before and after treatment between the two groups were also compared. The occurrence of hypoglycemia,body mass index( BMI) after treatment and the delivery outcomes were recorded. Results All of the time of blood glucose reaching the standard of the observation group was shorter than that of the control group. The fasting blood glucose( FBG) at the 7 thday and the level of 2 hours' postprandial blood glucose( 2 hPG) before and after treatment in the observation group were lower than that in the control group. Although the dosage of Det in the observation group was more than the dosage of NPH in the control group,the number of daily injections in observation group was less than in the control group. The HOMA-B at the 7 thday,the FINS、HOMA-B、MBCI after treatment in the observation group were higher than in the control group. The incidence of hypoglycemia in the observation group( 7. 50%) was lower than that of the control group( 20. 00%). The difference was statistically significant( P < 0. 05). After treatment,there was no statistical difference in BMI and the related indicators of maternal and child delivery outcomes between the two groups( P > 0. 05). Conclusion The above two kinds of insulin can effectively control the blood sugar of pregnant women with diabetes and maintain the insulin level.However,the detemir effect is more obvious and its safety is higher.
引文
[1]刘开平,沈国清,周晓芳,等.地特胰岛素联合瑞格列奈治疗2型糖尿病的临床对照研究[J].中国临床药理学杂志,2015,22(5):330-332.
[2]Sugiyama T,Nagao K,Metoki H,et al.Pregnancy outcomes of gestational diabetes mellitus according to pregestational BMI in a retrospective multiinstitutional study in Japan[J].Endocrine Journal,2014,61(4):373-380.
[3]计静,韩蓁,米阳,等.地特胰岛素联合门冬胰岛素治疗妊娠合并糖尿病患者的安全性及有效性研究[J].中国糖尿病杂志,2017,25(4):325-329.
[4]黄文森.地特胰岛素与甘精胰岛素治疗老年2型糖尿病的疗效对比[J].中国老年学杂志,2014,24(15):4212-4214.
[5]蒙光义,王冬晓,庞家莲,等.区别于血糖测定角度评价地特胰岛素治疗2型糖尿病的临床疗效[J].中国医院药学杂志,2014,34(19):1659-1662.
[6]吴军.2型糖尿病超重或肥胖患者口服降糖药联合地特胰岛素的临床研究[J].重庆医学,2014,17(24):3236-3238.
[7]杨慧霞.地特胰岛素在妊娠合并糖尿病管理中的应用[J].中国糖尿病杂志,2015,17(4):381-384.
[8]孟宪杰,李莉,常绍菊,等.地特胰岛素联合复方丹参滴丸对2型糖尿病合并冠心病病人炎性因子水平、调控因子活性和胰岛素抵抗的影响[J].中西医结合心脑血管病杂志,2017,15(9):1093-1096.
[9]Bao Wei Yeung,Edwina,Tobias,et al.Long-term risk of type 2 diabetes mellitus in relation to BMI and weight change among women with a history of gestational diabetes mellitus:a prospective cohort study[J].Diabetologia:Clinical and Experimental Diabetes and Metabolism=Organ of the European Association for the Study of Diabetes(EASD),2015,58(6):1212-1219.
[10]郭连雨,钟国连,吴建,等.地特胰岛素和甘精胰岛素治疗2型糖尿病的成本-效果分析[J].中国医院药学杂志,2014,34(13):1121-1125.
[11]廖丽娅,邓红艳,韦煊,等.地特胰岛素联合二甲双胍治疗对新诊断2型糖尿病胰岛功能及高敏C反应蛋白的影响[J].中国现代医学杂志,2015,25(13):66-68.
[12]张映,柯正华.甘精胰岛素对比地特胰岛素治疗中国2型糖尿病的系统评价[J].中国糖尿病杂志,2016,24(6):517-523.
[13]王郡,周慧敏,董斌,等.精蛋白生物合成人胰岛素注射液(预混30R)强化治疗初发2型糖尿病的临床研究[J].中国药房,2016,27(32):4522-4524.
[14]李瑞莲.诺和灵N联合二甲双胍对2型糖尿病患者血糖、C肽及CRP的影响[J].现代中西医结合杂志,2014,23(11):1207-1209.
[15]Xiang,Anny H,Black,et al.Racial and ethnic disparities in extremes of fetal growth after gestational diabetes mellitus[J].Diabetologia:Clinical and Experimental Diabetes and Metabolism=Organ of the European Association for the Study of Diabetes(EASD),2015,58(2):272-281.
