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目的探讨中药汤剂联合胰岛素治疗妊娠期糖尿病(GDM)的临床疗效,并观察其对患者血清指标、内脂素及妊娠结局的影响。方法回顾性分析2012年6月-2016年6月黄岩区妇幼保健院确诊的100例GDM患者资料,根据治疗方法分为对照组和治疗组,每组各50例。对照组皮下注射门冬胰岛素;治疗组在对照组治疗基础上采用医院自拟中药汤剂治疗。两组患者均加强饮食控制及运动锻炼、健康宣教等。评价两组患者治疗前后中医证候积分变化,检测两组患者治疗前后血清脂肪因子水平(脂联素、内脂素、瘦素、抵抗素)变化;检测两组患者治疗前后血糖(FPG)、糖化血红蛋白(Hb A1c)及炎症指标水平、胰岛β细胞功能指标;记录两组妊娠结局及不良反应。结果治疗组治疗后中医证候积分明显低于对照组(P<0.05);治疗组治疗后脂联素、内脂素、瘦素、抵抗素水平与对照组比较,差异有统计学意义(P<0.05);两组患者治疗后脂联素水平明显高于治疗前,而内脂素、抵抗素及瘦素水平明显低于治疗前(P<0.05)。治疗后两组FPG、Hb A1c水平、炎症指标水平明显低于治疗前(P<0.05),且治疗组明显低于对照组(P<0.05);两组患者治疗后HOMA-IR、ISI、FINS及HOMA-β分别为与对照组比较,差异有统计学意义(均P<0.05)。治疗组妊娠结局不良率明显低于对照组(P<0.05);治疗组低血糖发生率明显低于对照组(P<0.05)。结论采用自拟中药汤剂联合胰岛素治疗GDM可有效改善其各项生化指标及胰岛β细胞功能,降低不良妊娠结局及低血糖发生率。
Objective To investigate the curative effect of decoction of Chinese medicine combined with insulin on gestational diabetes mellitus (GDM) and to observe its effect on serum indexes, visfatin and pregnancy outcome. Methods The data of 100 cases of GDM diagnosed in Huangyan District Maternity and Child Health Hospital from June 2012 to June 2016 were retrospectively analyzed. According to the treatment methods, they were divided into control group and treatment group, with 50 cases in each group. Control group subcutaneous injection of insulin aspart; treatment group in the control group based on the use of hospital self-made Chinese medicine decoction treatment. Two groups of patients are to strengthen diet control and exercise, health education and so on. The changes of TCM syndrome scores before and after treatment were evaluated. The changes of serum adipokines (adiponectin, visfatin, leptin and resistin) before and after treatment were measured before and after treatment. The levels of blood glucose (FPG) HbA1c and inflammation index, pancreatic β-cell function index; pregnancy outcomes and adverse reactions were recorded in both groups. Results After treatment, the scores of TCM syndromes in the treatment group were significantly lower than those in the control group (P <0.05). The levels of adiponectin, visfatin, leptin and resistin in the treatment group were significantly different from those in the control group (P <0.05). The levels of adiponectin in both groups were significantly higher than those before treatment, while the levels of visfatin, resistin and leptin were significantly lower than those before treatment (P <0.05). The levels of FPG, Hb A1c and inflammation in the two groups after treatment were significantly lower than those before treatment (P <0.05), and were significantly lower in the treatment group than those in the control group (P <0.05). HOMA-IR, ISI, FINS And HOMA-β respectively compared with the control group, the difference was statistically significant (P <0.05). The incidence of pregnancy failure in the treatment group was significantly lower than that in the control group (P <0.05). The incidence of hypoglycemia in the treatment group was significantly lower than that in the control group (P <0.05). Conclusion The treatment of GDM with self-made Chinese medicine decoction combined with insulin can effectively improve its biochemical and pancreatic β-cell function, reduce the incidence of adverse pregnancy and the incidence of hypoglycemia.