标题：格列美脲联合门冬胰岛素对妊娠期糖尿病患者胰岛素抵抗及胰岛细胞分泌功能的影响

      作者：张晓娜，王煜，苏青    西安市第四医院妇产科，陕西 西安 710021

      卷次： 2021年32卷23期

      【摘要】 目的 探究格列美脲联合门冬胰岛素对妊娠期糖尿病(GDM)患者胰岛素抵抗及胰岛细胞分泌功能的影响。方法 回顾性分析西安市第四医院2016年12月至2019年12月收治的110例GDM患者的临床资料，根据患者治疗方案的不同分组，其中62例选择门冬胰岛素治疗者纳入对照组，48例选择格列美脲联合门冬胰岛素治疗者纳入研究组，均持续治疗至分娩前，比较两组患者治疗前和分娩前的血糖水平、血糖达标时间、胰岛素用量、胰岛素抵抗、胰岛细胞分泌功能和母婴不良结局情况。结果 分娩前，研究组患者空腹血糖、餐后2 h血糖及糖化血红蛋白水平分别为(4.69±0.92) mmol/L、(6.29±1.26) mmol/L和(5.47±0.86)%，明显低于对照组分娩前的(5.48±1.68) mmol/L、(7.14±1.37) mmol/L和(6.38±0.93)%，差异均有统计学意义(P<0.05)；经治疗，研究组患者血糖达标时间为(7.52±2.43) d，明显短于对照组的(10.93±3.09) d，胰岛素用量为(12.32±2.23) U/d，明显少于对照组的(28.62±3.42) U/d，差异均有统计学意义(P<0.05)；分娩前，研究组患者的胰岛素抵抗指数(HOMA-IR)水平为2.16±0.61，明显低于对照组的2.68±0.73，胰岛素敏感指数(ISI)和胰岛素分泌指数(HOMA-β)水平分别为3.37±0.54和69.19±5.74，明显高于对照组的2.96±0.51和58.42±5.58，差异均有统计学意义(P<0.05)；两组患者的产科并发症及新生儿不良结局发生率比较差异均无统计学意义(P>0.05)。结论 格列美脲联合门冬胰岛素治疗GDM可有效控制患者血糖水平，改善胰岛素抵抗及胰岛细胞分泌功能，且未增加母婴不良结局风险。
      【关键词】 妊娠期糖尿病；格列美脲；门冬胰岛素；胰岛素抵抗；胰岛细胞分泌功能
      【中图分类号】 R714.256 【文献标识码】 A 【文章编号】 1003—6350（2021）23—3054—04

Effects of glimepiride combined with insulin aspart on insulin resistance and islet cell secretion function inpatients with gestational diabetes mellitus.
ZHANG Xiao-na, WANG Yu, SU Qing. Department of Obstetrics andGynecology, Xi’an Fourth Hospital, Xi’an 710021, Shaanxi, CHINA
【Abstract】 Objective To explore the effects of glimepiride combined with insulin aspart on insulin resistanceand islet cell secretion function in patients with gestational diabetes mellitus (GDM). Methods The data of 110 pa-tients with GDM admitted to Xi'an Fourth Hospital from December 2016 and December 2019 were retrospectively ana-lyzed, and the patients were grouped according to different treatment regimens. Among them, 62 patients who chose insu-lin aspart treatment were selected as control group, and 48 patients who chose glimepiride combined with insulin asparttreatment were selected as study group. All the patients were continuously treated until delivery. The blood glucose level,time of blood glucose compliance, insulin dosage, insulin resistance and islet cell secretion function, and adverse mater-nal-infant outcomes were compared between the two groups before treatment and before delivery. Results Before de-livery, the levels of fasting blood glucose, postprandial 2 h blood glucose, and glycosylated hemoglobin were (4.69 ±0.92) mmol/L, (6.29±1.26) mmol/L, and (5.47±0.86)% in the study group, which were significantly lower than (5.48±1.68) mmol/L, (7.14±1.37) mmol/L and (6.38±0.93)% in the control group (P<0.05). After treatment, the time of bloodglucose compliance in the study group was (7.52±2.43) d, which was significantly shorter than (10.93±3.09) d in the con-trol group; and the insulin dosage was (12.32±2.23) U/d, which was significantly less than (28.62±3.42) U/d in the con-trol group (P<0.05). Before delivery, the insulin resistance index (HOMA-IR) level in the study group was 2.16±0.61,which was significantly lower than 2.68±0.73 in the control group, while the levels of insulin sensitivity index (ISI) andinsulin secretion index (HOMA-β) were 3.37±0.54, 69.19±5.74, which were significantly higher than 2.96±0.51, 58.42±5.58 in the control group (P<0.05). There were no significant differences in the incidence rates of obstetric complicationsand adverse neonatal outcomes between the two groups (P>0.05). Conclusion Glimepiride combined with insulin as-part in the treatment of GDM can effectively control the blood glucose level, and improve insulin resistance and islet cellsecretion function, but it does not increase the risk of adverse maternal-infant outcomes.
      【Key words】 Gestational diabetes mellitus (GDM); Glimepiride; Insulin aspart; Insulin resistance; Islet cell secre-tion function