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目的探讨不同来源胰岛素治疗对妊娠期糖尿病(GDM)孕妇Toll样受体4(TLR4)乙酰化及核因子κB(NF-κB)p65表达的影响。方法选取2014年2月-2016年1月在陕西中医药大学第二附属医院收治的70例GDM患者,按照简单随机法将患者分成对照组及观察组,各35例。对照组患者采取生物合成人胰岛素注射液治疗,观察组患者以门冬胰岛素注射液治疗,观察两组患者的疗效、并发症、NF-κB p65及TLR4乙酰化水平。结果与治疗前相比,两组患者的空腹血糖、夜间血糖、餐后2 h血糖及三餐前血糖明显更低(P<0.05)。治疗后与对照组相比,观察组的空腹血糖、夜间血糖、餐后2 h血糖及三餐前血糖明显更低(P<0.05)。与治疗前相比,对照组及观察组患者的TLR4乙酰化水平均出现了降低,差异有统计学意义(t=3.776、11.652,P<0.05)。与对照组患者相比,观察组患者治疗后的TLR4乙酰化水平更低,差异有统计学意义(t=4.266,P<0.05)。与治疗前相比,对照组及观察组患者的NF-κB-p65水平均出现了降低,差异有统计学意义(t=5.095、7.278,P<0.05)。与对照组患者相比,观察组患者治疗后的NF-κB-p65水平更低,差异有统计学意义(t=4.683,P<0.05)。对照组患者不良反应发生率为57.1%(20/35),观察组为34.3%(12/35),两组比较差异有统计学意义(χ~2=7.322,P<0.05)。结论门冬胰岛素相对于生物合成胰岛素能够更加有效地控制GDM患者血糖水平,降低TLR4乙酰化及NF-κB p65的表达水平,临床应用价值较高。
Objective To investigate the effects of different sources of insulin therapy on the expression of TLR4 acetylation and NF-κB p65 in pregnant women with gestational diabetes mellitus (GDM). Methods Seventy patients with GDM who were admitted to the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from February 2014 to January 2016 were randomly divided into control group and observation group with 35 cases in each group. Patients in the control group were treated with biosynthetic human insulin injection. Patients in the observation group were treated with insulin aspart as injection. The curative effect, complication, NF-κB p65 and TLR4 acetylation were observed in both groups. Results Compared with those before treatment, fasting blood glucose, nocturnal blood glucose, postprandial blood glucose at 2 h and premeal blood glucose were significantly lower in both groups (P <0.05). Compared with the control group, the fasting blood glucose, nocturnal blood glucose, postprandial 2-h blood glucose and pre-n-glycemia in the observation group were significantly lower after treatment (P <0.05). The levels of TLR4 acetylation in control group and observation group decreased compared with that before treatment, the difference was statistically significant (t = 3.776, 11.652, P <0.05). Compared with control group, TLR4 acetylation was lower in observation group after treatment, the difference was statistically significant (t = 4.266, P <0.05). Compared with those before treatment, the levels of NF-κB-p65 in control group and observation group decreased significantly (t = 5.095,7.278, P <0.05). Compared with control group, the level of NF-κB-p65 in observation group was lower after treatment, the difference was statistically significant (t = 4.683, P <0.05). In the control group, the incidence of adverse reactions was 57.1% (20/35) in the observation group and 34.3% (12/35) in the observation group. The difference between the two groups was statistically significant (χ ~ 2 = 7.322, P <0.05). Conclusion Aspart insulin relative to biosynthesis of insulin can be more effective in controlling blood glucose levels in patients with GDM, reducing the expression of TLR4 acetylation and NF-κB p65, with high clinical value.