内科

目的探讨维生素D结合门冬胰岛素治疗对妊娠期糖尿病患者胰岛素抵抗、血脂水平及妊娠结局的影响。方法选取2016年1月至2018年12月我院收治的妊娠期糖尿病患者200例为研究对象，采用信封法分为观察组与对照组，每组100例。对照组患者给予门冬胰岛素治疗，观察组患者给予门冬胰岛素联合维生素D治疗，治疗至分娩结束。比较两组患者治疗前后的空腹血糖（FBG）、餐后2h血糖（2hPG）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）以及低密度脂蛋白（LDL）水平；比较两组患者的空腹胰岛素（FINS）水平、胰岛素抵抗指数（HOMA-IR）以及不良妊娠结局发生率。结果治疗后，两组患者的FBG、2hPG水平均显著下降，观察组患者的水平显著低于对照组，差异有统计学意义（P＜0.05）。治疗后，两组患者的TC、TG、LDL水平均显著下降，HDL水平均显著上升；观察组患者的TC、TG、LDL水平均显著低于对照组，HDL水平显著高于对照组，差异有统计学意义（P＜0.05）。治疗前后两组患者的FINS水平比较差异无统计学意义（P＞0.05）；治疗后，两组患者的HOMA-IR均显著下降，观察组的HOMA-IR显著低于对照组，差异有统计学意义（P＜0.05）。观察组患者的不良妊娠结局发生率（9.0%）显著低于对照组（21.0%），差异有统计学意义（P＜0.05）。结论维生素D结合门冬胰岛素治疗妊娠期糖尿病患者，可显著降低血糖、血脂水平，改善胰岛素抵抗状态，降低不良妊娠结局的发生率。

ObjectiveTo investigate the effect of vitamin D combined with insulin aspart on insulin resistance, blood lipid level and pregnancy outcome in patients with gestational diabetes mellitus. MethodsA total of 200 gestational diabetes mellitus patients admitted to our hospital from January 2016 to December 2018 were selected as the research subjects, and were divided into observation group and control group by the envelope method, with 100 cases in each group. Patients in the control group were administered insulin aspart, whereas patients in the observation group were administered insulin aspart combined with vitamin D. The treatment was continued until the end of delivery. Fasting blood glucose (FBG), 2 hours postprandial blood glucose (2hPG), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) levels before and after treatment were compared between the two groups. Fasting insulin (FINS) level, insulin resistance index (HOMA-IR), and incidence of adverse pregnancy outcomes were compared between the two groups. ResultsAfter treatment, the levels of FBG and 2hPG in the two groups significantly decreased, and the levels in the observation group were significantly lower than those in the control group, with the statistically significant differences (P＜0.05). After treatment, the levels of TC, TG, and LDL in the two groups significantly decreased, whereas the level of HDL increased significantly. Compared to the control group, the observation group yielded lower levels of TC, TG and LDL, while a higher HDL level, with the statistically significant differences (P＜0.05). There was no significant difference in FINS level between the two groups before and after treatment (P＞0.05). After treatment, HOMA-IR in both groups decreased significantly, and HOMA-IR in the observation group was significantly lower than that in the control group, with the statistically significant difference (P＜0.05). The incidence of adverse pregnancy outcomes in the observation group was significantly lower than that in the control group (9.0% vs. 21.0%), with the statistically significant difference (P＜0.05). ConclusionVitamin D combined with insulin aspart can significantly decrease blood glucose and lipid levels, improve the status of insulin resistance, and decrease the incidence of adverse pregnancy outcomes in patients with gestational diabetes mellitus.