格列本脲联合门冬胰岛素治疗妊娠期糖尿病临床观察
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摘要
目的探讨格列本脲联合门冬胰岛素治疗妊娠期糖尿病(GDM)的疗效及对母婴结局的影响。方法选取医院2015年10月至2017年10月收治的GDM患者61例,按随机数字表法分为观察组(31例)和对照组(30例)。两组患者均使用门冬胰岛素注射液治疗,观察组患者加用格列本脲片。结果治疗后,两组患者总胆红素(TBil)水平均升高,空腹血糖、餐后2 h血糖、糖化血红蛋白、总胆固醇(TC)、尿酸(UA)、尿微量蛋白(mAlb)水平均明显降低,且观察组显著优于对照组(P <0. 01);治疗后,观察组产妇GDM、羊水过多、低血糖、早产、剖宫产和巨大儿、新生儿黄疸发生率均明显低于对照组(P <0. 01)。结论格列本脲联合门冬胰岛素治疗GDM,可有效改善患者血糖和TC,TBil,UA,mAlb水平以及母婴结局。
Objective To investigate the effect of glibenclamide combined with insulin aspart in the treatment of gestational diabetes mellitus( GDM) and its effect on maternal and infant outcomes. Methods Totally 61 patients with GDM admitted to our hospital from October 2015 to October 2017 were selected and divided into the observation group( n = 31) and the control group( n = 30) by the random number table method. The patients in the two groups were treated with Insulin Aspart Injection,on this basis,the patients in the observation group were treated with Glibenclamide Tablets. Results After treatment, the levels of total bilirubin( TBil) were increased,while the levels of fibrinogen( FBG),2 h postprandial blood glucose( 2 h PG),glycosylated hemoglobin( HbA1 C),total cholesterol( TC),uric acid( UA),microalbuminuria( mAlb) were significantly decreased in the two groups,and those in the observation group were significantly better than those in the control group( P < 0. 05). After treatment,the incidence rates of GDM,polyhydramnios,hypoglycemia,premature delivery, cesarean section, macrosomia and neonatal jaundice in the observation group were significantly lower than those in the control group( P < 0. 01). Conclusion Glibenclamide combined with insulin aspart in the treatment of GDM can effectively improve blood sugar,TC,TBil,UA,mAlb levels and maternal and infant outcomes.
Objective To investigate the effect of glibenclamide combined with insulin aspart in the treatment of gestational diabetes mellitus( GDM) and its effect on maternal and infant outcomes. Methods Totally 61 patients with GDM admitted to our hospital from October 2015 to October 2017 were selected and divided into the observation group( n = 31) and the control group( n = 30) by the random number table method. The patients in the two groups were treated with Insulin Aspart Injection,on this basis,the patients in the observation group were treated with Glibenclamide Tablets. Results After treatment, the levels of total bilirubin( TBil) were increased,while the levels of fibrinogen( FBG),2 h postprandial blood glucose( 2 h PG),glycosylated hemoglobin( HbA1 C),total cholesterol( TC),uric acid( UA),microalbuminuria( mAlb) were significantly decreased in the two groups,and those in the observation group were significantly better than those in the control group( P < 0. 05). After treatment,the incidence rates of GDM,polyhydramnios,hypoglycemia,premature delivery, cesarean section, macrosomia and neonatal jaundice in the observation group were significantly lower than those in the control group( P < 0. 01). Conclusion Glibenclamide combined with insulin aspart in the treatment of GDM can effectively improve blood sugar,TC,TBil,UA,mAlb levels and maternal and infant outcomes.
引文
[1]潘正国.格列美脲治疗2型糖尿病的临床效果与药理作用分析[J].临床合理用药,2016,9(30):10-11.
[2] GROOP L,GROOP PH,STENMAN S,et al. Comparison of pharmacokinetics,metabolic effects and mechanisms of action of glyburide and glipizide during long-term treatment[J]. Diabetes Care,2016,10(6):671-678.
[3]徐先明,王红坤.孕前糖尿病围孕期咨询和评估及降糖药应用[J].中国实用妇科与产科杂志,2017,33(3):245-249.
[4] NACHUM Z,ZAFRAN N,SALIM R,et al. Glyburide Versus Metformin and Their Combination for the Treatment of Gestational Diabetes Mellitus:A Randomized Controlled Study[J]. Diabetes Care,2017,40(3):332.
[5]中华医学会围产医学分会妊娠合并糖尿病协作组.妊娠合并糖尿病诊治指南(2014)[J].中华妇产科杂志,2014,49(8):561-569.
[6] ELAHE M,MANSOUREH S,ZHILA H,et al. Comparison of Newborn Outcomes in Women with Gestational Diabetes Mellitus Treated with Metformin or Insulin:A Randomised Blinded Trial[J]. Int J Prev Med,2013,4(3):327-333.
[7] BALSELLS M,GARCAPATTERSON A,SOLI,et al. Glibenclamide,metformin,and insulin for the treatment of gestational diabetes:a systematic review and meta-analysis[J]. BMJ,2015,21(6):350-359.
[8]曾雅畅,李慕军.格列本脲治疗妊娠期糖尿病临床进展[J].中国实用妇科与产科杂志,2013,29(7):590-594.
[9] YOGEV Y,MELAMED N,CHEN R,et al. Glyburide in gestational diabetes-prediction of treatment failure[J]. J Matern Fetal Neonatal Med,2011,24(6):842-846.
[10]胡丽梅,秦淑芬,姜保慧,等.葛根素联合门冬胰岛素治疗妊娠期糖尿病的临床观察及对妊娠结局的影响[J].河北医药,2016,38(20):3084-3087.
[11] ROSENN BM. The glyburide report card[J]. J Matern Fetal Neonatal Med,2010,23(3):219-223.
[12]姚玉娟,苏娜,陈娜,等.麦味地黄汤加减治疗妊娠期糖尿病60例疗效观察[J].国际中医中药杂志,2013,35(3):287-288.
[13] POLLEX EK,FEIG DS,KOREN G. Oral hypoglycemic therapy:understanding the mechanisms of transplacental transfer[J].Matern Fetal Neonatal Med,2010,23(3):224-228.
[14] HEBERT MF,MA X,NARAHARISETTI SB,et al. Are We Optimizing Gestational Diabetes Treatment With Glyburide? The Pharmacologic Basis for Better Clinical Practice[J]. Clin Pharmacol Ther,2009,85(6):607-614.
[15] JOY S,ROMAN A,ISTWAN N,et al. The effect of maternal obesity on pregnancy outcomes of women with gestational diabetes controlled with diet only,glyburide,or insulin[J]. Am J Perinatol,2012,29(8):643-648.
[16]卢丹华,石展鹰,王颖楠.血清胆固醇、总胆红素、尿酸和尿微量蛋白在妊娠期糖尿病患者中的临床意义[J].中国妇幼保健,2015,30(7):1034-1036.
[2] GROOP L,GROOP PH,STENMAN S,et al. Comparison of pharmacokinetics,metabolic effects and mechanisms of action of glyburide and glipizide during long-term treatment[J]. Diabetes Care,2016,10(6):671-678.
[3]徐先明,王红坤.孕前糖尿病围孕期咨询和评估及降糖药应用[J].中国实用妇科与产科杂志,2017,33(3):245-249.
[4] NACHUM Z,ZAFRAN N,SALIM R,et al. Glyburide Versus Metformin and Their Combination for the Treatment of Gestational Diabetes Mellitus:A Randomized Controlled Study[J]. Diabetes Care,2017,40(3):332.
[5]中华医学会围产医学分会妊娠合并糖尿病协作组.妊娠合并糖尿病诊治指南(2014)[J].中华妇产科杂志,2014,49(8):561-569.
[6] ELAHE M,MANSOUREH S,ZHILA H,et al. Comparison of Newborn Outcomes in Women with Gestational Diabetes Mellitus Treated with Metformin or Insulin:A Randomised Blinded Trial[J]. Int J Prev Med,2013,4(3):327-333.
[7] BALSELLS M,GARCAPATTERSON A,SOLI,et al. Glibenclamide,metformin,and insulin for the treatment of gestational diabetes:a systematic review and meta-analysis[J]. BMJ,2015,21(6):350-359.
[8]曾雅畅,李慕军.格列本脲治疗妊娠期糖尿病临床进展[J].中国实用妇科与产科杂志,2013,29(7):590-594.
[9] YOGEV Y,MELAMED N,CHEN R,et al. Glyburide in gestational diabetes-prediction of treatment failure[J]. J Matern Fetal Neonatal Med,2011,24(6):842-846.
[10]胡丽梅,秦淑芬,姜保慧,等.葛根素联合门冬胰岛素治疗妊娠期糖尿病的临床观察及对妊娠结局的影响[J].河北医药,2016,38(20):3084-3087.
[11] ROSENN BM. The glyburide report card[J]. J Matern Fetal Neonatal Med,2010,23(3):219-223.
[12]姚玉娟,苏娜,陈娜,等.麦味地黄汤加减治疗妊娠期糖尿病60例疗效观察[J].国际中医中药杂志,2013,35(3):287-288.
[13] POLLEX EK,FEIG DS,KOREN G. Oral hypoglycemic therapy:understanding the mechanisms of transplacental transfer[J].Matern Fetal Neonatal Med,2010,23(3):224-228.
[14] HEBERT MF,MA X,NARAHARISETTI SB,et al. Are We Optimizing Gestational Diabetes Treatment With Glyburide? The Pharmacologic Basis for Better Clinical Practice[J]. Clin Pharmacol Ther,2009,85(6):607-614.
[15] JOY S,ROMAN A,ISTWAN N,et al. The effect of maternal obesity on pregnancy outcomes of women with gestational diabetes controlled with diet only,glyburide,or insulin[J]. Am J Perinatol,2012,29(8):643-648.
[16]卢丹华,石展鹰,王颖楠.血清胆固醇、总胆红素、尿酸和尿微量蛋白在妊娠期糖尿病患者中的临床意义[J].中国妇幼保健,2015,30(7):1034-1036.