动态血糖监测联合胰岛素泵治疗妊娠期糖尿病对分泌型卷曲相关蛋白5及新生儿预后的影响
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摘要
目的探讨动态血糖监测联合胰岛素泵治疗妊娠期糖尿病对分泌型卷曲相关蛋白5(Sfrp5)及新生儿预后的影响。方法回顾性分析2015年5月～2017年5月于衡水市第四人民医院产科行口服葡萄糖耐量试验(OGTT)确诊为妊娠期糖尿病的84例患者的临床资料。根据治疗方法分为研究组(n=42)和对照组(n=42)。研究组采用动态血糖监测联合胰岛素泵治疗,对照组采用动态血糖监测联合胰岛素注射治疗。比较两组患者血糖、胰岛素、Sfrp5水平、胰岛抵抗指数(HOMA-IR)及新生儿预后等。结果治疗后两组患者的空腹血糖及餐后2 h血糖、空腹胰岛素水平、HOMA-IR均低于治疗前(均P <0.05),且研究组低于对照组(均P <0.05);治疗后两组患者的Sfrp5水平均高于治疗前(均P <0.05),且研究组高于对照组(P <0.05);研究组新生儿不良结局发生率显著低于对照组(P <0.05)。结论动态血糖监测联合胰岛素泵治疗妊娠期糖尿病,可显著提高患者的Sfrp5水平,并改善患者的血糖及胰岛素水平,降低新生儿不良结局的发生率,值得临床推广应用。
Objective To investigate the dynamic blood glucose monitoring combined with insulin pump in the treatment of gestational diabetes mellitus on secreted frizzled related protein 5(Sfrp5) and neonatal prognosis. Methods The clinical data of 84 patients with gestational diabetes mellitus who were diagnosed with oral glucose tolerance test(OGTT) in the Department of Obstetrics, the No 4 People′ Hospital of Hengshui from May 2015 to May 2017 were retrospectively analyzed. They were divided into study group(n = 42) and control group(n = 42) according to the treatment method. The study group was treated with dynamic blood glucose monitoring combined with insulin pump,and the control group was treated with dynamic blood glucose monitoring combined with insulin injection. Blood glucose, insulin, Sfrp5 levels, islet resistance index(HOMA-IR) and neonatal prognosis were compared between the two groups. Results After treatment, the levels of fasting blood glucose and postprandial 2 h blood glucose, fasting insulin and HOMA-IR were lower than before treatment(all P < 0.05), and the study group was lower than the control group(all P < 0.05); the Sfrp5 levels in the latter two groups were higher than those before treatment(P < 0.05), and the study group was higher than the control group(P < 0.05). The incidence of adverse neonatal outcomes in the study group was significantly lower than that in the control group(P < 0.05). Conclusion Dynamic blood glucose monitoring combined with insulin pump in the treatment of gestational diabetes mellitus, can significantly improve the Sfrp5 level of pregnant women, and improve blood sugar and insulin levels of patients, reduce the incidence of neonatal adverse pregnancy outcomes, it is worthy of clinical promotion and application.
Objective To investigate the dynamic blood glucose monitoring combined with insulin pump in the treatment of gestational diabetes mellitus on secreted frizzled related protein 5(Sfrp5) and neonatal prognosis. Methods The clinical data of 84 patients with gestational diabetes mellitus who were diagnosed with oral glucose tolerance test(OGTT) in the Department of Obstetrics, the No 4 People′ Hospital of Hengshui from May 2015 to May 2017 were retrospectively analyzed. They were divided into study group(n = 42) and control group(n = 42) according to the treatment method. The study group was treated with dynamic blood glucose monitoring combined with insulin pump,and the control group was treated with dynamic blood glucose monitoring combined with insulin injection. Blood glucose, insulin, Sfrp5 levels, islet resistance index(HOMA-IR) and neonatal prognosis were compared between the two groups. Results After treatment, the levels of fasting blood glucose and postprandial 2 h blood glucose, fasting insulin and HOMA-IR were lower than before treatment(all P < 0.05), and the study group was lower than the control group(all P < 0.05); the Sfrp5 levels in the latter two groups were higher than those before treatment(P < 0.05), and the study group was higher than the control group(P < 0.05). The incidence of adverse neonatal outcomes in the study group was significantly lower than that in the control group(P < 0.05). Conclusion Dynamic blood glucose monitoring combined with insulin pump in the treatment of gestational diabetes mellitus, can significantly improve the Sfrp5 level of pregnant women, and improve blood sugar and insulin levels of patients, reduce the incidence of neonatal adverse pregnancy outcomes, it is worthy of clinical promotion and application.
引文
[1]贺星星,马晓静,周健.动态血糖监测在妊娠合并糖尿病患者中的临床应用[J].中国糖尿病杂志,2015,7(10):649-651.
[2]Hirst JE,Loerup L,Mackillop L,et al.Digital blood glucose monitoring could provide new objective assessments of blood glucose control in women with gestational diabetes[J].Diabet Med,2016,33(11):1598-1599.
[3]邓惠宜,周丽华,谢志岳,等.24 h动态血糖监测系统在妊娠期糖尿病患者胰岛素治疗中的应用[J].海南医学,2016,27(16):2689-2690.
[4]刘晓宏,杜海涛,刘晓宁,等.动态血糖监测联合胰岛素泵对妊娠期糖尿病患者疗效及妊娠结局的影响[J].解放军预防医学杂志,2017,35(S2):93-95.
[5]Soffer MD,Factor SH,Rosenman A,et al.Improving Postpartum Glucose Monitoring in Women with Gestational Diabetes[J].J Matern Fetal Neonatal Med,2017,30(24):3014-3019.
[6]Kizirian NV,Goletzke J,Brodie S,et al.Lower glycemic load meals reduce diurnal glycemic oscillations in women with risk factors for gestational diabetes[J].Bmj Open Diabetes Res Care,2017,5(1):e000 351.
[7]Ouchi NA,Higuchi K,Ohashi,et al.Sfrp5 is an anti-inflammatory adipokine that modulates metabolic dysfunction in obesity[J].Science,2010,329(5990):454-457.
[8]贾晓炜,栾进.胰岛素两种给药方式对妊娠糖尿病疗效的比较[J].武警医学,2017,28(5):483-486.
[9]Carreiro MP,Lauria MW,Naves GN,et al.Seventy twohour glucose monitoring profiles in mild gestational diabetes mellitus:differences from healthy pregnancies and influence of diet counseling[J].Eur J Endocrinol,2016,175(3):201-209.
[10]杨蕾,李艳,杨玲竹.胰岛素泵双波疗法对妊娠期糖尿病患者妊娠结局的影响[J].中国计划生育学杂志,2017,25(7):455-458.
[11]Mendezfigueroa H,Schuster M,Maggio L,et al.Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring:A Randomized Controlled Trial[J].Ultrasound Obstet Gynecol,2017,130(1):163-170.
[12]沈赟,孙睿,丁波.动态血糖在妊娠期糖尿病患者胰岛素强化治疗期间的临床应用价值[J].重庆医学,2015(36):5152-5154.
[13]Bernstein JA,Lois MC,Gebel CM,et al.Lost opportunities to prevent early onset type 2 diabetes mellitus after a pregnancy complicated by gestational diabetes[J].BMJOpen Diabetes Res Care,2016,4(1):e000 250.
[14]Mendezfigueroa H,Schuster M,Maggio L,et al.Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring:A Randomized Controlled Trial[J].Curr Opin Obstet Gynecol,2017,130(1):163-170.
[15]宁改君,任卫东,董运成,等.胰岛素泵强化降糖治疗对合并冠心病的2型糖尿病患者血糖波动及胰岛素抵抗指数的影响[J].宁夏医科大学学报,2017,39(8):659-660.
[16]Cosson E,Baz B,Gary F,et al.Poor Reliability and Poor Adherence to Self-Monitoring of Blood Glucose are Common in Women with Gestational Diabetes Mellitus and May Be Associated with Poor Pregnancy Outcomes[J].Diabetes Care,2017,40(9):1181-1186.
[17]韩一栩.两种血糖监测方法在妊娠期糖尿病和2型糖尿病合并妊娠患者中的应用效果观察[J].海南医学,2015(14):2122-2124.
[18]Schinner S.Wnt-signalling and the metabolic syndrome[J].Horm Metab Res,2009,41(2):159-163.
[19]Miranda TS,Napimoga MH,Feres M,et al.Antagonists of Wnt/β-catenin signaling in the periodontitis associated with type 2 diabetes and smoking[J].J Clin Periodontol,2017,45(3):293-302.
[20]Kintiraki E,Goulis DG,Mameletzi S,et al.Large-and Small-for-Gestational-Age neonates born by women with gestational diabetes mellitus diagnosed by the new I-ADPSG criteria:a case control study of 289 patients and1 108 controls[J].Exp Clin Endocrinol Diabetes,2013,121(5):262-265.
[21]Barnes RA,Edghill N,Mackenzie J,et al.Predictors of large and small for gestational age birthweight in offspring of women with gestational diabetes mellitus[J].Diabet Med,2013,30(9):1040-1046.
[2]Hirst JE,Loerup L,Mackillop L,et al.Digital blood glucose monitoring could provide new objective assessments of blood glucose control in women with gestational diabetes[J].Diabet Med,2016,33(11):1598-1599.
[3]邓惠宜,周丽华,谢志岳,等.24 h动态血糖监测系统在妊娠期糖尿病患者胰岛素治疗中的应用[J].海南医学,2016,27(16):2689-2690.
[4]刘晓宏,杜海涛,刘晓宁,等.动态血糖监测联合胰岛素泵对妊娠期糖尿病患者疗效及妊娠结局的影响[J].解放军预防医学杂志,2017,35(S2):93-95.
[5]Soffer MD,Factor SH,Rosenman A,et al.Improving Postpartum Glucose Monitoring in Women with Gestational Diabetes[J].J Matern Fetal Neonatal Med,2017,30(24):3014-3019.
[6]Kizirian NV,Goletzke J,Brodie S,et al.Lower glycemic load meals reduce diurnal glycemic oscillations in women with risk factors for gestational diabetes[J].Bmj Open Diabetes Res Care,2017,5(1):e000 351.
[7]Ouchi NA,Higuchi K,Ohashi,et al.Sfrp5 is an anti-inflammatory adipokine that modulates metabolic dysfunction in obesity[J].Science,2010,329(5990):454-457.
[8]贾晓炜,栾进.胰岛素两种给药方式对妊娠糖尿病疗效的比较[J].武警医学,2017,28(5):483-486.
[9]Carreiro MP,Lauria MW,Naves GN,et al.Seventy twohour glucose monitoring profiles in mild gestational diabetes mellitus:differences from healthy pregnancies and influence of diet counseling[J].Eur J Endocrinol,2016,175(3):201-209.
[10]杨蕾,李艳,杨玲竹.胰岛素泵双波疗法对妊娠期糖尿病患者妊娠结局的影响[J].中国计划生育学杂志,2017,25(7):455-458.
[11]Mendezfigueroa H,Schuster M,Maggio L,et al.Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring:A Randomized Controlled Trial[J].Ultrasound Obstet Gynecol,2017,130(1):163-170.
[12]沈赟,孙睿,丁波.动态血糖在妊娠期糖尿病患者胰岛素强化治疗期间的临床应用价值[J].重庆医学,2015(36):5152-5154.
[13]Bernstein JA,Lois MC,Gebel CM,et al.Lost opportunities to prevent early onset type 2 diabetes mellitus after a pregnancy complicated by gestational diabetes[J].BMJOpen Diabetes Res Care,2016,4(1):e000 250.
[14]Mendezfigueroa H,Schuster M,Maggio L,et al.Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring:A Randomized Controlled Trial[J].Curr Opin Obstet Gynecol,2017,130(1):163-170.
[15]宁改君,任卫东,董运成,等.胰岛素泵强化降糖治疗对合并冠心病的2型糖尿病患者血糖波动及胰岛素抵抗指数的影响[J].宁夏医科大学学报,2017,39(8):659-660.
[16]Cosson E,Baz B,Gary F,et al.Poor Reliability and Poor Adherence to Self-Monitoring of Blood Glucose are Common in Women with Gestational Diabetes Mellitus and May Be Associated with Poor Pregnancy Outcomes[J].Diabetes Care,2017,40(9):1181-1186.
[17]韩一栩.两种血糖监测方法在妊娠期糖尿病和2型糖尿病合并妊娠患者中的应用效果观察[J].海南医学,2015(14):2122-2124.
[18]Schinner S.Wnt-signalling and the metabolic syndrome[J].Horm Metab Res,2009,41(2):159-163.
[19]Miranda TS,Napimoga MH,Feres M,et al.Antagonists of Wnt/β-catenin signaling in the periodontitis associated with type 2 diabetes and smoking[J].J Clin Periodontol,2017,45(3):293-302.
[20]Kintiraki E,Goulis DG,Mameletzi S,et al.Large-and Small-for-Gestational-Age neonates born by women with gestational diabetes mellitus diagnosed by the new I-ADPSG criteria:a case control study of 289 patients and1 108 controls[J].Exp Clin Endocrinol Diabetes,2013,121(5):262-265.
[21]Barnes RA,Edghill N,Mackenzie J,et al.Predictors of large and small for gestational age birthweight in offspring of women with gestational diabetes mellitus[J].Diabet Med,2013,30(9):1040-1046.