門冬胰島素聯合地特胰島素治療妊娠糖尿病的療效分析

[摘要] 目的 探討門冬胰島素聯合地特胰島素治療妊娠糖尿病的臨床療效。方法 方便選擇該院自2014年1月—2016年6月收治的74例妊娠糖尿病患者為研究對象，并按照隨機數字表法分為對照組和觀察組，每組各37例。對照組患者使用生物合成人胰島素注射液治療（三餐前30 min皮下注射），觀察組患者接受門冬胰島素（三餐前進食前皮下注射）+地特胰島素（睡前皮下注射）治療。比較兩組患治療前后空腹血糖（FBG）、餐后2 h血糖（2 hPG）、糖化血紅蛋白（HbA1c）、血糖達標時間及低血糖發生率差異。結果 治療前兩組間FBG[對照組和觀察組分別為（9.57±3.24） mmol/L vs（9.54±2.68）mmol/L，t=0.526]、2 hPG[對照組和觀察組分別為（15.43±3.58）mmol/L vs（15.54±2.52）mmol/L，t=-0.632]和HbA1c[對照組和觀察組分別為（10.54±1.25）% vs（10.48±1.32）%，t=0.695]差異無統計學意義（P>0.05），治療后兩組FBG[對照組和觀察組分別為（6.78±2.15）mmol/L vs（5.43±1.64）mmol/L，t=0.3.423]、2 hPG[對照組和觀察組分別為（11.36±2.46）mmol/L vs（9.23±1.54）mmol/L，t=3.695]和HbA1c[對照組和觀察組分別為（7.65±1.54）% vs（6.23±1.63）%，t=3.452]較治療前均明顯降低，與治療前相比差異無統計學意義（P<0.05），且觀察組患者較對照組下降更為明顯（與對照組治療后相比，P<0.05）。治療期間觀察組患者血糖達標時間（6.24±1.43）d和低血糖發生率（5.41%）均明顯低于對照組[分別為（8.56±2.14）d、（18.9%）]患者，差異有統計學意義（t=3.562，χ2=3.446，P<0.05）。結論 門冬胰島素聯合地特胰島素治療妊娠糖尿病臨床效果顯著，低血糖發生率低，值得在臨床中推廣應用。

[關鍵詞] 妊娠糖尿病；門冬胰島素；地特胰島素；臨床效果

[中圖分類號] R5 [文獻標識碼] A [文章編號] 1674-0742（2016）12（b）-0029-04

Analysis of Insulin Aspart Insulin Detemir Treatment of Gestational Diabetes Mellitus

LIN Chuang-hui， XIAO Hong-gang

Guangdong City of Dongguan Province Houjie Renkang Hospital Department of Endocrinology， Dongguan， Guangdong Province， 523952 China

[Abstract] Objective To investigate the clinical efficacy of insulin aspart insulin detemir treatment of gestational diabetes mellitus. Methods Convenient selection 74 cases of gestational diabetes in our hospital from January 2014 to June 2016 were selected and divided into control group and observation group according to the random number table， 37 cases in each group. The control and treatment of adult patients using Neutrul Insulin Injection protamine （three before subcutaneous injection of 30min）， the patients in the observation group received insulin aspart （meals intake before subcutaneous injection of insulin detemir before subcutaneous injection treatment. Compared the two groups before and after the treatment of fasting blood glucose （FBG）， postprandial 2 h blood glucose （2 hPG）， glycosylated hemoglobin （HbA1c）， blood sugar compliance time and the incidence of hypoglycemia. Results Before treatment between the two groups of [（9.57±3.24）mmol/L vs （9.54±2.68）mmol/L，t=0.526]、2 hPG[（15.43±3.58） mmol/L vs（15.54±2.52）mmol/L，t=-0.632] and HbA1c[（10.54±1.25）% vs（10.48±1.32）%，t=0.695] showed no significant difference （P > 0.05）， the two groups after treatment of FBG[（6.78±2.15）mmol/L vs（5.43±1.64） mmol/L，t=0.3.423]、2 hPG[（11.36±2.46）mmol/L vs（9.23±1.54）mmol/L，t=3.695] and HbA1c[（7.65±1.54）% vs（6.23±1.63）%，t=3.452]were significantly lower than before treatment， compared with before treatment， the difference was not statistically significant （P < 0.05）， and the patients in the observation group than the control group decreased more significantly （compared with the control group after treatment were P < 0.05）. During the treatment period， the time of reaching the standard（6.24±1.43）d and the incidence（5.41%）of hypoglycemia in the observation group were significantly lower than those in the control group[（8.56±2.14）d、（18.9%）]， and the difference was statistically significant （t=3.562 and χ2=3.446，P < 0.05）. Conclusion Insulin aspart insulin detemir combined with significant clinical effect for the treatment of gestational diabetes， hypoglycemia， is worth popularizing in clinical application.

[Key words] Gestational diabetes mellitus； Insulin aspart； Insulin detemir； Clinical effect

妊娠糖尿病指的是孕婦在妊娠期間出現糖耐量異常或診斷為糖尿病，流行病學統計表明全球妊娠期糖尿病的發病率約為1%～5%，并且有逐年上升的趨勢[1]。大量研究表明妊娠期糖尿病會對母嬰造成巨大損害，嚴重時可出現羊水過多、胎兒窘迫甚至死胎等后果[2]?！?br>