地特胰岛素联合门冬胰岛素对妊娠期糖尿病患者糖脂代谢及血清神经调节蛋白4、肝细胞生长因子、血清淀粉样蛋白A水平的影响

The Effects of Insulin Detemir Combined with Insulin Aspart on Glycolipid Metabolism and Serum Levels of Neuregulin 4, Hepatocyte Growth Factor and Serum Amyloid A in Patients with Gestational Diabetes Mellitus

摘要

目的 探讨地特胰岛素联合门冬胰岛素对妊娠期糖尿病（gestational diabetes mellitus，GDM）患者糖脂代谢及血清神经调节蛋白4（neuregulin 4，NRG4）、肝细胞生长因子（hepatocyte growth factor，HGF）、血清淀粉样蛋白A（serum amyloid A，SAA）的影响。方法 选取中国人民解放军海军第九七一医院2022年8月至2024年10月收治的GDM患者200例作为研究对象，采用随机数字表法分为观察组与对照组，各100例。对照组予以门冬胰岛素联合精蛋白人胰岛素治疗，观察组予以地特胰岛素联合门冬胰岛素治疗，疗程均为8周。比较2组空腹血糖（fasting plasma glucose，FPG）、餐后2 h血糖（2-hour postprandial plasma glucose，2hPG）达标时间及血糖达标时胰岛素用量；比较治疗前和治疗4、8周后的FPG、2hPG、糖化血红蛋白（hemoglobin A1c，HbA1c）、血脂指标[总胆固醇（total cholesterol，TC）、甘油三酯（triglyceride，TG）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）]及血清NRG4、HGF、SAA变化，并记录不良母婴结局发生率。结果 观察组FPG、2hPG达标时间短于对照组，且血糖达标时胰岛素用量更少（P< 0.05）；观察组治疗4、8周后FPG、2hPG、HbA1c、TC、TG、LDL-C、SAA低于对照组，血清NRG4、HGF高于对照组（ P< 0.05）；观察组产妇早产、产后出血及新生儿低血糖发生率更低（ P< 0.05）。结论 地特胰岛素联合门冬胰岛素有助于改善GDM患者糖脂代谢，调节血清NRG4、HGF及SAA水平，并能降低早产、产后出血以及新生儿低血糖发生率。

Abstract

Objective To explore the effects of insulin detemir combined with insulin aspart on glycolipid metabolism and serum levels of neuregulin 4 (NRG4), hepatocyte growth factor (HGF) and serum amyloid A (SAA) in patients with gestational diabetes mellitus (GDM). Methods A total of 200 patients with GDM admitted to No. 971 Hospital of the People's Liberation Army Navy from August 2022 to October 2024 were selected as the research subjects. All patients were divided into an observation group and a control group by random number table method, with 100 patients in each group. The control group was treated with insulin aspart combined with protamine human insulin, while the observation group was treated with insulin detemir combined with insulin aspart. Both groups were treated continuously for 8 weeks. The time to target of fasting plasma glucose (FPG) and 2-hour postprandial plasma glucose (2hPG), as well as the insulin dosage at glycemic target, were compared between the two groups. Changes in FPG, 2hPG, hemoglobin A1c (HbA1c), blood lipid indicators [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C)], and serum NRG4, HGF, and SAA were compared before treatment, at 4 weeks and 8 weeks after treatment, and the incidence of adverse maternal and neonatal outcomes was recorded.Results The time to target of FPG and 2hPG in the observation group was shorter than that in the control group, and the insulin dosage at target was lower (P< 0.05); after 4 and 8 weeks of treatment, the levels of FPG, 2hPG, HbA1c, TC, TG, LDL-C and SAA in the observation group were lower than those in the control group, while the serum NRG4 and HGF in the observation group were higher ( P< 0.05). The incidences of preterm birth, postpartum hemorrhage and neonatal hypoglycemia in the observation group were lower ( P< 0.05). Conclusion Insulin detemir combined with insulin aspart helps to improve glycolipid metabolism, regulate serum levels of NRG4, HGF and SAA, and reduce the incidence of preterm birth, postpartum hemorrhage, and neonatal hypoglycemia in GDM patients.

关键词

地特胰岛素 / 门冬胰岛素 / 妊娠期糖尿病 / 糖脂代谢 / 母婴结局

Key words

insulin detemir / insulin aspart / gestational diabetes mellitus / glycolipid metabolism / maternal and neonatal outcomes

参考文献

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基金资助

山东省青岛市医药卫生科研指导项目(2023-WJZD246)