Abstract:

Objective　To explore the efficacy of insulin combined with low molecular weight heparin (LMWH) in patients with gestational diabetes mellitus. Methods　A prospective study was conducted on 86 patients with gestational diabetes mellitus treated in Yantai Mountain Hospital of Yantai City from February 2019 to January 2020, who were randomly divided into a single group and a combined group with 43 cases in each group. The age of the single group was (28.3±5.6) years old; there were 27 cases of primipara and 16 cases of multipara. The age of the combined group was (27.3±3.5) years old; there were 25 cases of primipara and 18 cases of multipara. The patients in the single group were treated with insulin, and the patients in the combined group were treated with insulin and LMWH. The C-reactive protein (CRP), lipoprotein-associated phospholipase A2 (LpLA2), serum cystatin (CysC), total bilirubin (TBil), total cholesterol (TC), urinary microalbumin (mAlb), fasting insulin (FINS), islet β cell function index (HOMA-β), insulin resistance index (HOMA-IR), glycosylated serum protein (GSP), fasting blood glucose (FBG), and glycosylated hemoglobin (HbA1c) were detected in the two groups and were compared by LSD-t test, and the pregnancy complications and neonatal conditions were recorded in the two groups and were compared by χ² test. Results　After treatment, the levels of serum CRP [(5.46±0.16) mg/L], LpLA2 [(96.25±4.17) U/L], and CysC [(0.73±0.18) mg/L] in the combined group were lower than those in the single group [CRP (8.49±0.38) mg/L, LpLA2 (112.63±9.54) U/L, and CysC (1.03±0.26) mg/L] (t=48.190, 10.320, and 6.221; all P<0.001). After treatment, the level of TBil in the combined group was higher than that in the single group [(11.76±3.87) μmol/L vs. (9.68±2.94) μmol/L], while the levels of TC [(2.64±0.83) mmol/L] and mAlb [(10.25±3.17) mg/L] were lower than those in the single group [TC (3.65±1.12) mmol/L and mAlb (14.66±4.28) mg/L] (t=2.806, 4.751, and 5.430; all P<0.05). After treatment, the levels of FINS [(1.26±0.14) mU/L] and HOMA-IR [(2.57±0.16)] in the combined group were lower than those in the single group [FINS (1.52±0.42) mU/L and HOMA-IR (3.98±0.21)], while the level of HOMA-β was higher than that in the single group [(65.20±5.86) vs. (51.14±4.35)] (t=3.851, 35.022, and 12.633; all P<0.05). After treatment, the levels of GSP [(191.69±10.14) μmol/L], FBG [(3.21±1.06) mmol/L], and HbA1c [(3.98±0.18)%] in the combined group were lower than those in the single group [GSP (252.86±12.25) μmol/L, FBG (5.36±1.56) mmol/L, and HbA1c (5.39±1.46)%] (t=25.224, 7.475, and 6.285; all P<0.05). After treatment, the incidence of pregnancy complications in the combined group [18.60% (8/43)] was lower than that in the single group [39.53% (17/43)] (χ²=4.568, P=0.033); the total incidence of adverse neonatal conditions in the combined group [13.95% (6/43)] was lower than that in the single group [34.88% (15/43)] (χ²=5.103, P=0.024). Conclusion　Insulin combined with LMWH can effectively control the blood glucose and inflammatory factors in patients with gestational diabetes mellitus, reduce the levels of GSP, FBG, and HbA1c, and improve the maternal insulin resistance, pregnancy outcomes, and neonatal conditions.

Key words:

Insulin, Low molecular weight heparin, Gestational diabetes mellitus, Maternal and infant outcomes

摘要：

目的　探究胰岛素联合低分子肝素对妊娠期糖尿病患者的疗效。方法　选取2019年2月至2020年1月于烟台市烟台山医院接受治疗的妊娠期糖尿病患者86例开展前瞻性研究，随机分为单独组、联合组各43例。单独组年龄（28.3±5.6）岁；初产妇27例，经产妇16例。联合组年龄（27.3±3.5）岁；初产妇25例，经产妇18例。单独组患者使用胰岛素进行治疗，联合组患者使用胰岛素联合低分子肝素进行治疗。对两组患者C反应蛋白（CRP）、脂蛋白相关磷脂酶A2（LpLA2）、血清胱抑素（CysC）、总胆红素（TBil）、总胆固醇（TC）、尿微量白蛋白（mAlb）、空腹胰岛素（FINS）、胰岛β细胞功能指数（HOMA-β）、胰岛素抵抗指数（HOMA-IR）、糖化血清蛋白（GSP）、空腹血糖（FBG）、糖化血红蛋白（HbA1c）进行检测并采用LSD-t检验比较，记录两组患者妊娠期并发症情况和新生儿情况并行χ²检验比较。结果　治疗后联合组患者血清CRP［（5.46±0.16）mg/L］、LpLA2［（96.25±4.17）U/L］、CysC［（0.73±0.18）mg/L］水平均低于单独组［CRP（8.49±0.38）mg/L、LpLA2（112.63±9.54）U/L、CysC（1.03±0.26）mg/L］（t=48.190、10.320、6.221，均P<0.001）。治疗后联合组患者TBil高于单独组［（11.76±3.87）μmol/L比（9.68±2.94）μmol/L］，TC［（2.64±0.83）mmol/L］、mAlb［（10.25±3.17）mg/L］水平均低于单独组［TC（3.65±1.12）mmol/L、mAlb（14.66±4.28）mg/L］（t=2.806、4.751、5.430，均P<0.05）。治疗后联合组患者FINS［（1.26±0.14）mU/L］、HOMA-IR［（2.57±0.16）］水平均低于单独组［FINS（1.52±0.42）mU/L、HOMA-IR（3.98±0.21）］，HOMA-β水平高于单独组［（65.20±5.86）比（51.14±4.35）］（t=3.851、35.022、12.633，均P<0.05）。治疗后联合组患者GSP［（191.69±10.14）μmol/L］、FBG［（3.21±1.06）mmol/L］、HbA1c［（3.98±0.18）%］水平均低于单独组［GSP（252.86±12.25）μmol/L、FBG（5.36±1.56）mmol/L、HbA1c（5.39±1.46）%］（t=25.224、7.475、6.285，均P<0.05）。治疗后联合组患者妊娠期并发症发生率［18.60%（8/43）］低于单独组［39.53%（17/43）］（χ²=4.568，P=0.033）。治疗后联合组患者新生儿不良情况总发生率［13.95%（6/43）］低于单独组［34.88%（15/43）］（χ²=5.103，P=0.024）。结论　使用胰岛素联合低分子肝素对妊娠期糖尿病患者进行治疗，可有效控制患者血糖和炎症因子，降低GSP、FBG、HbA1c水平，改善患者胰岛素抵抗和妊娠期结局和新生儿情况。

关键词:

胰岛素, 低分子肝素, 妊娠期糖尿病, 母婴结局