胰岛素皮下泵持续注射治疗妊娠期糖尿病对血清氧化物质的影响
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摘要
目的探索胰岛素皮下泵持续注射治疗妊娠期糖尿病对血清氧化物质的影响。方法 2015年1月到2017年1月选择内分泌科住院和门诊的妊娠期糖尿病孕妇106例作为研究对象,根据随机信封抽签原则分为观察组与对照组,各53例。对照组给予二甲双胍治疗,观察组给予胰岛素皮下泵持续注射治疗,2组都治疗观察2周。结果 2组患者治疗后空腹血糖与餐后2 h血糖值均低于治疗前(P<0.01),但组间差异无统计学意义(P>0.05)。2组治疗后血清丙二醛(MDA)含量比治疗前明显下降(P<0.01),血清超氧化物歧化酶(SOD)含量比治疗前明显上升(P<0.01)。观察组治疗后血清MDA和SOD含量与对照组相比,差异也有统计学意义(P<0.05)。所有孕妇都顺利分娩,孕妇和围生儿均无死亡发生。其中观察组剖宫产23例,自然分娩30例;对照组剖宫产40例,自然分娩13例。2组对比差异有统计学意义(P<0.01)。观察组围生儿的窒息、巨大儿、低血糖和高胆红素血症等发病率均低于对照组围生儿(P<0.05)。结论胰岛素皮下泵持续注射治疗妊娠期糖尿病有利于维持正常降糖效果,并能调节血清氧化物质水平的表达变化,降低剖宫产率,提高自然分娩率,改善围生儿预后。
AIM To investigate the effects of continuous subcutaneous insulin pump injection on serum oxidizing substances in patients with gestational diabetes. METHODS From January 2015 to January 2017, 106 pregnant women with gestational diabetes who were admitted to the endocrinology department of our hospital were selected as subjects and were divided into the observation group and control group, with 53 cases in each group according to the random envelope lottery principle. The control group were treated with metformin, and the observation group were given subcutaneous pump for continuous injection of insulin. Both groups were treated for 2 weeks.RESULTS The fasting blood glucose and postprandial 2 h blood glucose levels of the 2 groups after treatment were lower than those before treatment(P<0.01), but there were no significant differences between the 2 groups(P>0.05). The levels of serum malondialdehyde(MDA) in the 2 groups after treatment were significantly lower than those before treatment(P<0.01), and the serum superoxide dismutase(SOD) levels after treatment were significantly higher than those before treatment(P<0.01). As compared with the control group, the differences in MDA and SOD levels were also statistically significant(P<0.05). All pregnant women gave delivery smoothly, and no death occurred in pregnant women and perinatal children. Among them, there were 23 cases of cesarean section and 30 cases of natural delivery in the observation group, and there were 40 cases of cesarean section and 13 cases of natural delivery in the control group. The difference between the 2 groups was significant(P<0.01). The incidence of asphyxia, macrosomia, hypoglycemia and hyperbilirubinemia in the observation group were lower than that in the control group(P<0.05). CONCLUSION Continuous injection of insulin subcutaneous pump for the treatment of gestational diabetes is beneficial to maintain normal hypoglycemic effect, and can regulate the expression changes of serum oxidized substances, reduce the rate of cesarean section and increase the rate of natural delivery, and improve the prognosis of perinatal children.
AIM To investigate the effects of continuous subcutaneous insulin pump injection on serum oxidizing substances in patients with gestational diabetes. METHODS From January 2015 to January 2017, 106 pregnant women with gestational diabetes who were admitted to the endocrinology department of our hospital were selected as subjects and were divided into the observation group and control group, with 53 cases in each group according to the random envelope lottery principle. The control group were treated with metformin, and the observation group were given subcutaneous pump for continuous injection of insulin. Both groups were treated for 2 weeks.RESULTS The fasting blood glucose and postprandial 2 h blood glucose levels of the 2 groups after treatment were lower than those before treatment(P<0.01), but there were no significant differences between the 2 groups(P>0.05). The levels of serum malondialdehyde(MDA) in the 2 groups after treatment were significantly lower than those before treatment(P<0.01), and the serum superoxide dismutase(SOD) levels after treatment were significantly higher than those before treatment(P<0.01). As compared with the control group, the differences in MDA and SOD levels were also statistically significant(P<0.05). All pregnant women gave delivery smoothly, and no death occurred in pregnant women and perinatal children. Among them, there were 23 cases of cesarean section and 30 cases of natural delivery in the observation group, and there were 40 cases of cesarean section and 13 cases of natural delivery in the control group. The difference between the 2 groups was significant(P<0.01). The incidence of asphyxia, macrosomia, hypoglycemia and hyperbilirubinemia in the observation group were lower than that in the control group(P<0.05). CONCLUSION Continuous injection of insulin subcutaneous pump for the treatment of gestational diabetes is beneficial to maintain normal hypoglycemic effect, and can regulate the expression changes of serum oxidized substances, reduce the rate of cesarean section and increase the rate of natural delivery, and improve the prognosis of perinatal children.
引文
[1] KEATING G M.Insulin detemir:a review of its use in the management of diabetes mellitus[J].Drugs,2012,72(17):2255.
[2] POOMALAR G K.Changing trends in management of gestational diabetes mellitus[J].World J Diabetes,2015,6(2):284.
[3] 吕诗诗,徐勇,刘霜,等.胰岛素类似物治疗妊娠期糖尿病的研究进展[J].临床荟萃,2015,2(15):228.
[4] HU Z G,TAN R S,JIN D,et al.A low glycemic index staple diet reduces postprandial glucose values in Asian women with gestational diabetes mellitus[J].J Investig Med,2014,62(8):975.
[5] 杨秋霞,方倩.胰岛素泵短期强化干预联合生物合成人胰岛素治疗妊娠期糖尿病的临床疗效及对母婴结局的影响[J].中国生化药物杂志,2016,36(9):135.
[6] TOLEDANO Y,HADAR E,HOD M.Safety of insulin analogues as compared with human insulin in pregnancy[J].Expert Opin Drug Saf,2016,15(7):963.
[7] YOU J Y,CHOI S J,ROH C R,et al.Pregnancy and neonatal outcomes in gestational diabetes treated with regular insulin or fast-acting insulin analogues[J].Gynecol Obstet Invest,2016,81(3):232.
[8] 胡文华,王伟伟.不同胰岛素给药方法对妊娠期糖尿病血糖控制的效果评价[J].中国基层医药,2016,23(7):1065.
[9] 方海兰,符琴.胰岛素泵治疗妊娠期糖尿病对孕妇及新生儿的影响分析[J].医学理论与实践,2016,29(7):929.
[10] KIM G J,KIM S B,JO S I,et al.Two cases of allergy to insulin in gestational diabetes[J].Endocrinol Metab (Seoul),2015,30(3):402.
[11] DEEPAKLAL M C,JOSEPH K,REKHA K,et al.Insulin aspart in patients with gestational diabetes mellitus and pregestational diabetes mellitus[J].Indian J Endocrinol Metab,2015,19(5):658.
[12] HERRERA K M,ROSENN B M,FOROUTAN J,et al.Randomized controlled trial of insulin detemir versus NPH for the treatment of pregnant women with diabetes[J].Am J Obstet Gynecol,2015,213(3):426.
[13] SIMMONS D.Safety considerations with pharmacological treatment of gestational diabetes mellitus[J].Drug Saf,2015,38(1):65.
[14] SAVVIDOU M D,SYNGELAKI A,BALAKITSAS N,et al.First-trimester uterine artery doppler examination in pregnancies complicated by gestational diabetes mellitus with or without pre-eclampsia[J].Ultrasound Obstet Gynecol,2013,42(13):525.
[15] HOD M,MATHIESEN E R,JOVANOVI L,et al.A randomized trial comparing perinatal outcomes using insulin detemir or neutral protamine hagedorn in type 1 diabetes[J].J Matern Fetal Neonatal Med,2014,27(1):7.
[16] OKEIGWE I,YEATON-MASSEY A,KIM S,et al.U-500R and aspart insulin for the treatment of severe insulin resistance in pregnancy associated with pregestational diabetes[J].J Perinatol,2013,33(3):235.
[17] 王倩,折瑞莲,高宇.妊娠期糖尿病患者经胰岛素泵持续皮下输注胰岛素法治疗的临床效果观察[J].临床医学,2016,36(5):96.
[18] 吉金萍,张元元,王天成,等.妊娠期糖尿病对妊娠结局及新生儿的影响[J].新乡医学院学报,2015,32(12):1101.
[2] POOMALAR G K.Changing trends in management of gestational diabetes mellitus[J].World J Diabetes,2015,6(2):284.
[3] 吕诗诗,徐勇,刘霜,等.胰岛素类似物治疗妊娠期糖尿病的研究进展[J].临床荟萃,2015,2(15):228.
[4] HU Z G,TAN R S,JIN D,et al.A low glycemic index staple diet reduces postprandial glucose values in Asian women with gestational diabetes mellitus[J].J Investig Med,2014,62(8):975.
[5] 杨秋霞,方倩.胰岛素泵短期强化干预联合生物合成人胰岛素治疗妊娠期糖尿病的临床疗效及对母婴结局的影响[J].中国生化药物杂志,2016,36(9):135.
[6] TOLEDANO Y,HADAR E,HOD M.Safety of insulin analogues as compared with human insulin in pregnancy[J].Expert Opin Drug Saf,2016,15(7):963.
[7] YOU J Y,CHOI S J,ROH C R,et al.Pregnancy and neonatal outcomes in gestational diabetes treated with regular insulin or fast-acting insulin analogues[J].Gynecol Obstet Invest,2016,81(3):232.
[8] 胡文华,王伟伟.不同胰岛素给药方法对妊娠期糖尿病血糖控制的效果评价[J].中国基层医药,2016,23(7):1065.
[9] 方海兰,符琴.胰岛素泵治疗妊娠期糖尿病对孕妇及新生儿的影响分析[J].医学理论与实践,2016,29(7):929.
[10] KIM G J,KIM S B,JO S I,et al.Two cases of allergy to insulin in gestational diabetes[J].Endocrinol Metab (Seoul),2015,30(3):402.
[11] DEEPAKLAL M C,JOSEPH K,REKHA K,et al.Insulin aspart in patients with gestational diabetes mellitus and pregestational diabetes mellitus[J].Indian J Endocrinol Metab,2015,19(5):658.
[12] HERRERA K M,ROSENN B M,FOROUTAN J,et al.Randomized controlled trial of insulin detemir versus NPH for the treatment of pregnant women with diabetes[J].Am J Obstet Gynecol,2015,213(3):426.
[13] SIMMONS D.Safety considerations with pharmacological treatment of gestational diabetes mellitus[J].Drug Saf,2015,38(1):65.
[14] SAVVIDOU M D,SYNGELAKI A,BALAKITSAS N,et al.First-trimester uterine artery doppler examination in pregnancies complicated by gestational diabetes mellitus with or without pre-eclampsia[J].Ultrasound Obstet Gynecol,2013,42(13):525.
[15] HOD M,MATHIESEN E R,JOVANOVI L,et al.A randomized trial comparing perinatal outcomes using insulin detemir or neutral protamine hagedorn in type 1 diabetes[J].J Matern Fetal Neonatal Med,2014,27(1):7.
[16] OKEIGWE I,YEATON-MASSEY A,KIM S,et al.U-500R and aspart insulin for the treatment of severe insulin resistance in pregnancy associated with pregestational diabetes[J].J Perinatol,2013,33(3):235.
[17] 王倩,折瑞莲,高宇.妊娠期糖尿病患者经胰岛素泵持续皮下输注胰岛素法治疗的临床效果观察[J].临床医学,2016,36(5):96.
[18] 吉金萍,张元元,王天成,等.妊娠期糖尿病对妊娠结局及新生儿的影响[J].新乡医学院学报,2015,32(12):1101.