二甲双胍治疗妊娠期糖尿病的效果及对TBIL、UA、mA1b和血糖水平的影响
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摘要
目的分析二甲双胍治疗妊娠期糖尿病的效果及对总胆红素(TBIL)、尿酸(UA)、尿微量蛋白(m A1b)、血糖水平的影响。方法选取2015年7月-2017年6月攀枝花学院附属医院收治的妊娠期糖尿病患者136例为研究对象,随机分为观察组和对照组,每组各68例。观察组采用二甲双胍口服、对照组采用皮下注射门冬胰岛素。比较两组患者治疗前后空腹血糖、餐后2 h血糖、糖化血红蛋白(Hb A1C)水平,TBIL、UA、m A1b水平及治疗后妊娠结局、围生儿结局、用药安全性的差异。结果治疗后,两组患者空腹血糖、餐后2h血糖和Hb A1C水平均低于治疗前,差异均有统计学意义(均P<0. 05);而两组间比较,差异均无统计学意义(均P>0. 05)。治疗后,两组患者TBIL水平高于治疗前,UA、m A1b低于治疗前,差异均有统计学意义(均P<0. 05);且观察组患者TBIL水平高于对照组,UA、m A1b低于对照组,差异均有统计学意义(均P<0. 05)。观察组患者羊水过多、胎膜早破、剖宫产、巨大儿、早产、胎儿窘迫和新生儿窒息发生率与对照组比较,差异均无统计学意义(均P>0. 05)。观察组用药安全构成比与对照组比较,差异无统计学意义(P>0. 05)。结论二甲双胍能有效控制妊娠期糖尿病患者血糖水平、安全可靠,且能显著提升TBIL水平、降低UA和m A1b水平,改善母婴结局、利于优生优育,可视其为胰岛素的替代治疗药物。
Objective To explore the effect of metformin in the treatment of gestational diabetes mellitus and its impact on total bilirubin( TBIL),uric acid( UA),urine microprotein( m A1 b) and blood glucose. Methods 136 cases of gestational diabetes mellitus( GDM)admitted to Affiliated Hospital of Panzhihua College from July 2015 to June 2017 were randomly divided into observation group( 68 patients)and control group( 68 patients). The observation group was treated with metformin orally,and the control group adopted the subcutaneous injection of insulin aspart. The levels of fasting blood glucose,postprandial 2-hour blood glucose,glycosylated hemoglobin( Hb A1 c),TBIL,UA,m A1 b and post-treatment pregnancy outcomes,perinatal outcomes,medication safety after treatment were observed and compared between two groups. Results After treatment,the levels of fasting blood glucose,postprandial 2-hour blood glucose,glycosylated hemoglobin( Hb A1 c) in the two groups were significantly lower than those before treatment( P<0. 05); but there was no statistically significant difference between two groups( P>0. 05). After treatment,the level of TBIL in the two groups was higher than that before treatment,and the level of UA,m A1 b was lower than that before treatment( P<0. 05). The level of TBIL in the observation group was higher than that in the control group,and the levels of UA,m A1 b in the observation group were lower than those in the control group( P<0. 05). There was no significant difference in the rate of amniotic fluid over-pregnancy,premature rupture of membranes,cesarean section,macrosomia,premature delivery,fetal distress and neonatal asphyxia between the observation group and the control group( P>0. 05). There was no statistically significant difference in the safety composition ratio between the observation group and the control group( P >0. 05).Conclusion Metformin can effectively control blood glucose levels in patients with gestational diabetes,it is safe and reliable,and it can significantly improve the level of TBIL,reduce the levels of UA and m A1 b,improve maternal and infant outcomes and promote prenatal and postnatal care,so it can be regarded as an alternative medicine for insulin.
Objective To explore the effect of metformin in the treatment of gestational diabetes mellitus and its impact on total bilirubin( TBIL),uric acid( UA),urine microprotein( m A1 b) and blood glucose. Methods 136 cases of gestational diabetes mellitus( GDM)admitted to Affiliated Hospital of Panzhihua College from July 2015 to June 2017 were randomly divided into observation group( 68 patients)and control group( 68 patients). The observation group was treated with metformin orally,and the control group adopted the subcutaneous injection of insulin aspart. The levels of fasting blood glucose,postprandial 2-hour blood glucose,glycosylated hemoglobin( Hb A1 c),TBIL,UA,m A1 b and post-treatment pregnancy outcomes,perinatal outcomes,medication safety after treatment were observed and compared between two groups. Results After treatment,the levels of fasting blood glucose,postprandial 2-hour blood glucose,glycosylated hemoglobin( Hb A1 c) in the two groups were significantly lower than those before treatment( P<0. 05); but there was no statistically significant difference between two groups( P>0. 05). After treatment,the level of TBIL in the two groups was higher than that before treatment,and the level of UA,m A1 b was lower than that before treatment( P<0. 05). The level of TBIL in the observation group was higher than that in the control group,and the levels of UA,m A1 b in the observation group were lower than those in the control group( P<0. 05). There was no significant difference in the rate of amniotic fluid over-pregnancy,premature rupture of membranes,cesarean section,macrosomia,premature delivery,fetal distress and neonatal asphyxia between the observation group and the control group( P>0. 05). There was no statistically significant difference in the safety composition ratio between the observation group and the control group( P >0. 05).Conclusion Metformin can effectively control blood glucose levels in patients with gestational diabetes,it is safe and reliable,and it can significantly improve the level of TBIL,reduce the levels of UA and m A1 b,improve maternal and infant outcomes and promote prenatal and postnatal care,so it can be regarded as an alternative medicine for insulin.
引文
[1]Kgosidialwa O,Egan AM,Carmody L,et al.Treatment with diet and exercise for women with gestational diabetes mellitus diagnosed using IADPSG criteria[J].J Clin Endocrinol Metab,2015,100(12):4629-4636.
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[7]张书梅,王云飞,李学全,等.胰岛素联合二甲双胍对妊娠期糖尿病孕妇妊娠结局及新生儿的影响[J].中国妇幼保健,2017,32(12):2545-2547.
[8]Esteghamati A,Eskandari D,Mirmiranpour H,et al.Effects of metformin on markers of oxidative stress and antioxidant reserve in patients with newly diagnosed type 2 diabetes:a randomized clinical trial[J].Clin Nutr,2013,32(2):179-185.
[9]中华医学会妇产科学分会产科学组,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].中华围产医学杂志,2014,17(8):537-545.
[10]Boriboonhirunsarn D,Waiyanikron R.Emergency cesarean section rate between women with gestational diabetes and normal pregnant women[J].Taiwan J Obstet Gynecol,2016,55(1):64-47.
[11]陆菊明.沙格列汀和二甲双胍缓释片治疗2型糖尿病的研究进展[J].中国糖尿病杂志,2017,25(1):91-94.
[12]Hickman MA,Mc Bride R,Boggess KA,et al.Metformin compared with insulin in the treatment of pregnant women with overt diabetes:a randomized controlled trial[J].Am J Perinatol,2013,30(6):483-490.
[13]Liang X,Kong P,Wang J,et al.Effects of metformin on proliferation and apoptosis of human megakaryoblastic Dami and MEG-01cells[J].J Pharmacol Sci,2017,8(3):10-16.
[14]Nilsson C,Ursing D,Strevens H,et al.Towards normalized birthweight in gestational diabetes mellitus[J].Acta Obstet Gynecol Scand,2015,94(10):1090-1094.
[15]余丹.二甲双胍对糖尿病肾病的保护作用及其抗氧化应激机制[J].临床与病理杂志,2017,37(4):862-867.
[16]张艺颖,匡洪宇.二甲双胍治疗2型糖尿病合并慢性肾病的研究进展[J].国际药学研究杂志,2017,44(4):306-310.
[17]Yao XM,Ye SD,Xiao CC,et al.Metformin alleviates high glucosemediated ox idative stress in rat glomer ular mesangial cells by modulation of p38 mitogen-activated protein kinase expression in vitro[J].Mol Med Rep,2015,12(1):520-526.
[18]Bakris GL,Molitch ME.Should restrictions be relaxed for metformin use in chronic kidney disease?Yes,they should be relaxed!What’s the fuss?[J].Diabetes Care,2016,39(7):1287-1291.
[2]Scifres C,Feghali M,Althouse AD,et al.Adverse outcomes and potential targets for intervention in gestational diabetes and obesity[J].Obstet Gynecol,2015,126(2):316-325.
[3]Feghali MN,Caritis SN,Catov JM,et al.Timing of delivery and pregnancy outcomes in women with gestational diabetes[J].Am JObstet Gynecol,2016,215(2):1-7.
[4]赵秋连.妊娠结局探讨葡萄糖耐量试验(OGTT)不同时间点血糖异常的妊娠期糖尿病(GDM)孕妇临床特点及妊娠结局探讨[J].中国妇幼健康研究,2017,28(2):78-83.
[5]Khosrowbeygi A,Shiamizadeh N,Taghizadeh N.Maternal circulating levels of some metabolic syndrome biomarkers in gestational diabetes mellitus[J].Endocrine,2016,51(2):245-255.
[6]Tseng SC,Huang YC,Chen HJ,et al.Metformin-mediated downregulation of p38 mitogen-activated protein kinase-dependent excision repair cross-complementing 1 decreases DNA repair capacity and sensitizes human lung cancer cells to paclitaxel[J].Biochem Pharmacol,2013,85(4):583-594.
[7]张书梅,王云飞,李学全,等.胰岛素联合二甲双胍对妊娠期糖尿病孕妇妊娠结局及新生儿的影响[J].中国妇幼保健,2017,32(12):2545-2547.
[8]Esteghamati A,Eskandari D,Mirmiranpour H,et al.Effects of metformin on markers of oxidative stress and antioxidant reserve in patients with newly diagnosed type 2 diabetes:a randomized clinical trial[J].Clin Nutr,2013,32(2):179-185.
[9]中华医学会妇产科学分会产科学组,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].中华围产医学杂志,2014,17(8):537-545.
[10]Boriboonhirunsarn D,Waiyanikron R.Emergency cesarean section rate between women with gestational diabetes and normal pregnant women[J].Taiwan J Obstet Gynecol,2016,55(1):64-47.
[11]陆菊明.沙格列汀和二甲双胍缓释片治疗2型糖尿病的研究进展[J].中国糖尿病杂志,2017,25(1):91-94.
[12]Hickman MA,Mc Bride R,Boggess KA,et al.Metformin compared with insulin in the treatment of pregnant women with overt diabetes:a randomized controlled trial[J].Am J Perinatol,2013,30(6):483-490.
[13]Liang X,Kong P,Wang J,et al.Effects of metformin on proliferation and apoptosis of human megakaryoblastic Dami and MEG-01cells[J].J Pharmacol Sci,2017,8(3):10-16.
[14]Nilsson C,Ursing D,Strevens H,et al.Towards normalized birthweight in gestational diabetes mellitus[J].Acta Obstet Gynecol Scand,2015,94(10):1090-1094.
[15]余丹.二甲双胍对糖尿病肾病的保护作用及其抗氧化应激机制[J].临床与病理杂志,2017,37(4):862-867.
[16]张艺颖,匡洪宇.二甲双胍治疗2型糖尿病合并慢性肾病的研究进展[J].国际药学研究杂志,2017,44(4):306-310.
[17]Yao XM,Ye SD,Xiao CC,et al.Metformin alleviates high glucosemediated ox idative stress in rat glomer ular mesangial cells by modulation of p38 mitogen-activated protein kinase expression in vitro[J].Mol Med Rep,2015,12(1):520-526.
[18]Bakris GL,Molitch ME.Should restrictions be relaxed for metformin use in chronic kidney disease?Yes,they should be relaxed!What’s the fuss?[J].Diabetes Care,2016,39(7):1287-1291.