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目的探讨营养膳食联合经皮下注射胰岛素治疗妊娠期糖尿病(GDM)合并高脂血症患者临床疗效,并观察其对患者血糖、血脂指标及妊娠结局的影响,为患者高效、安全治疗提供保障。方法回顾性分析2014年10月-2016年9月收治的182例GDM合并高脂血症患者临床资料,其中采用经皮下注射胰岛素治疗,加强运动干预及健康教育,给予辛伐他汀片治疗者为对照组91例;在对照组治疗基础上实施营养膳食干预者为观察组91例。检测两组治疗前、后血糖[空腹血糖(FPG)、糖化血红蛋白(HbAlc)]水平、炎症状态、生活质量、胰岛β细胞功能指标[胰岛素抵抗指数(HOMA-IR)、空腹胰岛素(FINS)、胰岛素分泌指数(HOMA-β)、胰岛素敏感指数(ISI)]及脂质代谢指标情况。统计两组临床疗效、妊娠结局。结果治疗后,观察组患者HOMA-IR、ISI、FINS及HOMA-β分别为(1.32±0.52)、(3.41±0.51)×10~(-2)、(4.41±0.38)μU/ml、(67.14±3.17)与对照组(1.92±0.56)、(2.91±0.55)×10~(-2)、(6.42±0.61)μU/ml、(55.89±3.75)比较,差异有统计学意义(t=7.48、6.35、26.67、21.85,均P<0.05)。治疗后,两组FBG、HbA1c水平、炎症指标水平明显低于治疗前,且观察组明显低于对照组,差异有统计学意义(均P<0.05);两组患者治疗后TG及LDL-C水平明显低于治疗前,而HDL-C水平明显高于治疗前,观察组HDL-C、生活质量评分明显高于对照组,而TG及LDL-C水平明显低于对照组,差异有统计学意义(均P<0.05)。观察组患者临床治疗总有效率94.51%(86/91),明显高于对照组70.33%(64/91),差异有统计学意义(χ~2=18.37,P<0.05)。观察组妊娠结局不良率6.59%(6/91),明显低于对照组21.98%(20/91),差异有统计学意义(χ~2=8.79,P<0.05)。治疗期间均无不良反应发生。结论采用经皮下注射胰岛素联合营养膳食治疗GDM合并高脂血症患者临床效果显著且安全,同时还可有利于改善患者炎症状态、代谢指标,更好地改善其生活质量及妊娠结局。
Objective To investigate the clinical efficacy of nutritional diet combined with subcutaneous insulin in the treatment of gestational diabetes mellitus (GDM) combined with hyperlipidemia and to observe its effect on blood glucose, blood lipid and pregnancy outcome in patients with high and safe treatment. Methods The clinical data of 182 patients with GDM complicated with hyperlipidemia admitted to our hospital from October 2014 to September 2016 were retrospectively analyzed. The patients underwent subcutaneous injections of insulin, exercise intervention and health education. The patients treated with simvastatin tablets were The control group of 91 cases; in the control group based on the implementation of nutritional diet intervention for the observation group of 91 cases. The levels of blood glucose (FPG, HbAlc), inflammatory status, quality of life, pancreatic β-cell function index [HOMA-IR, FINS, Insulin secretion index (HOMA-β), insulin sensitivity index (ISI)] and lipid metabolism indicators. Statistics of two groups of clinical efficacy, pregnancy outcome. Results After treatment, the HOMA-IR, ISI, FINS and HOMA-β in the observation group were (1.32 ± 0.52), (3.41 ± 0.51) × 10 -2, (4.41 ± 0.38) μU / ml, ± 3.17) was significantly higher than that in control group (1.92 ± 0.56), (2.91 ± 0.55) × 10 -2, (6.42 ± 0.61) μU / ml and (55.89 ± 3.75), respectively , 6.35,26.67,21.85, all P <0.05). After treatment, the levels of FBG, HbA1c and inflammation in the two groups were significantly lower than before treatment, and the observation group was significantly lower than the control group, the difference was statistically significant (P <0.05); TG and LDL-C HDL-C levels were significantly higher than before treatment, HDL-C in the observation group, quality of life scores were significantly higher than the control group, and TG and LDL-C levels were significantly lower than the control group, the difference was statistically significant Significance (all P <0.05). The total effective rate of clinical observation in the observation group was 94.51% (86/91), which was significantly higher than that in the control group (70.33%, 64/91). The difference was statistically significant (χ ~ 2 = 18.37, P <0.05). The negative rate of pregnancy outcome in observation group was 6.59% (6/91), which was significantly lower than that in control group (21.98%, 20/91). The difference was statistically significant (χ ~ 2 = 8.79, P <0.05). No adverse reactions occurred during treatment. Conclusion The clinical effect of subcutaneous injection of insulin combined with dietary therapy in patients with GDM and hyperlipidemia is significant and safe. At the same time, it is also beneficial to improve patients’ inflammatory status and metabolic parameters, and to better improve their quality of life and pregnancy outcomes.