目的 探討門冬胰島素治療妊娠糖尿病(GDM)的臨床效果.方法 將復旦大學附屬中山醫(yī)院分院2010年4月—2013年8月確診的GDM初診患者136例隨機分為對照組和治療組,每組68例.對照組餐前30 min皮下注射精蛋白生物合成人胰島素注射液;治療組每日3餐進食前皮下注射門冬胰島素30注射液.對兩組患者進行隨訪,比較其血糖控制情況、炎性因子及母嬰結局.結果 治療后兩組患者空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血紅蛋白(HbA1C)和尿C肽均明顯好轉(zhuǎn),與治療前差異具有統(tǒng)計學意義(P<0.01).治療后,治療組FPG、2 h PG、HbA1C低于對照組,餐后0.5、2 h尿C肽高于對照組,兩組比較差異有統(tǒng)計學意義(P<0.05、0.01).治療組血糖達標時間、每日胰島素用量、低血糖發(fā)生率均低于對照組,兩組比較差異具有統(tǒng)計學意義(P<0.05).治療后,兩組患者C-反應蛋白(CRP)、白細胞介素6(IL-6)、和正五聚蛋白(PTX-3)均較治療前顯著降低,同組治療前后差異具有統(tǒng)計學意義(P<0.01);治療后,治療組這些指標低于對照組,兩組比較差異有統(tǒng)計學意義(P<0.01).兩組患者母嬰結局差異均無統(tǒng)計學意義,未出現(xiàn)嚴重不良反應.結論 門冬胰島素治療妊娠糖尿病具有較好的臨床療效,可減少藥物用量,縮短血糖達標時間,對GDM炎性癥狀改善良好,值得臨床推廣應用.

Objective To explore the clinical effect of insulin aspart in the treatment of gestational diabetes mellitus (GDM). Methods Newly diagnosed patients with GDM (136 cases) in Zhongshan Hospital, Fudan Universityfrom April 2010 to August 2013 were randomly divided into control and treatment groups, and each group had 68 cases. The patients in the control group were sc administered with Isophane Protamine Biosynthetic Human Insulin Injection, while the patients in the treatment group were sc administered with Insulin Aspart 30 Injection before eating. Two groups of patients were followed up, and their blood sugar, inflammatory factors, and outcomes of maternal and neonatal in two groups were compared. Results After treatment, FPG, 2 h PG, HbA1C, and C peptide of two groups were significantly improved, and the difference was statistically significant in the same group before and after treatment (P < 0.01). After treatment, FPG, 2 h PG, and HbA1C in treatment group were lower than those in the control group, while C peptide at 0.5 h and 2 h after meal in treatment group were higher than those in the control group, and there were differences between the two groups (P < 0.05, 0.01). Blood glucose standard time, daily dosage of insulin, and hypoglycemia incidence in the treatment group were lower than those in the control group, and there were differences between the two groups (P < 0.05). After treatment, CRP, IL-6, and PTX-3 in two groups were significantly reduced, and the difference was statistically significant in the same group before and after treatment (P < 0.01). After treatment, the indicators in the treatment group were lower than those in the control group, and there were differences between the two groups (P < 0.01). And outcomes of maternal and neonatal in two groups had no statistical significance, and patients in two groups did not appear serious adverse reactions. Conclusion Insulin aspart has the good clinical effect in the treatment of GDM, and can reduce drug and blood glucose standard time, while can improve inflammatory symptoms of GDM, which is worth clinical promotion.