Analysis of the Effect of High Dose of Vitamin D Injection Combined with Insulin Aspart Injection on Parathyroid Hormone Level, Insulin Sensitivity and Maternal and Infant Outcomes in Gestational Diabetes Mellitus
YANG Kun, WEI Jiaxi, et al
The Central Hospital of Suining, Sichuan Suining 629000, China
Abstract:Objective: To study the effect of high dose of vitamin D injection combined with injection of insulin aspart on the parathyroid hormone level, insulin sensitivity and maternal and infant outcomes in the treatment of gestational diabetes mellitus (GDM). Methods: 238 gestational diabetes patients selected as object were divided them into two groups, called control group (n=109 cases) and research group (n=129 cases) by digital table. The patients of control group were treated by insulin aspart combined with low dose of vitamin D, while the patients of research group were treated by insulin aspart combined with high dose of vitamin D. the parathyroid hormone related indexes , insulin sensitivity related indexes, vitamin D level, maternal and infant outcomes and incidence of hypoglycemia during pregnancy of two groups were compared. Results: The iPTH, product of calcium and phosphorus , phosphorus, calcium of two groups before treatment had no statistically difference (P>0.05),after treating four weeks the iPTH, product of calcium and phosphorus, phosphorus of research group were much less than control group (P<0.05),the calcium of two groups had no statistically difference (P>0.05). The iPTH, product of calcium and phosphorus, phosphorus of two groups after four weeks' treatment were all much less than pre-treatment respectively (P<0.05),while calcium of two groups after treatment had no statistically difference with pre-treatment respectively (P>0.05). The FPG, FINS, 2hPG of two groups before treatment had no statistically difference (P>0.05); the FPG, FINS, 2hPG of research group had no statistically difference with control group (P>0.05); The FPG, FINS, 2hPG of two groups after four weeks' treatment were all much less than pre-treatment respectively (P<0.05). The HOMA-βand HOMA-IR of two groups before treatment had no statistically difference (P>0.05), the HOMA-βof research group after treatment was much higher than control group. HOMA-IR much less than control group (P<0.05). The HOMA-βand HOMA-IR of two groups after four weeks' treatment were all much less than pre-treatment respectively (P<0.05). The vitamin D level of two groups before treatment had no statistically difference (P>0.05). The moderate lack rate of research group after treatment was less than control group (P<0.05). The normal rate of research group after treatment was more than control group(P<0.05); the slight lack rate of research group after treatment of two groups had no statistically difference (P>0.05). The moderate lack rate and slight lack rate of two groups after four weeks' treatment were all much less than pre-treatment respectively (P<0.05); normal rate was much higher than pre-treatment respectively (P<0.05). The rate of maternal and infant outcomes and hypoglycemia of research group was 20.93%, while control group was 31.19%; they had statistically difference (P<0.05). Conclusion: High dose of vitamin D injection combined with injection of insulin aspart in the treatment of GDM can prevent the occurrence of physiological hyperparathyroidism in late pregnant period ,increase the insulin sensitivity, effectively control blood sugar and improve the deficiency degree of vitamin D, and definite effect, decrease maternal and neonatal complications rate, which is worthy of being clinically promoted.
杨堃, 魏佳希, 邓卉. 门冬胰岛素联合高剂量维生素D对妊娠期糖尿病患者甲状旁腺激素胰岛素敏感性和母婴结局的影响分析[J]. 河北医学, 2017, 23(2): 250-254.
YANG Kun, WEI Jiaxi, et al. Analysis of the Effect of High Dose of Vitamin D Injection Combined with Insulin Aspart Injection on Parathyroid Hormone Level, Insulin Sensitivity and Maternal and Infant Outcomes in Gestational Diabetes Mellitus. HeBei Med, 2017, 23(2): 250-254.
[1] 张黎明,龙艳,苏珂,等.维生素D对妊娠期糖尿病患者胰岛素敏感性及视黄醇结合蛋白4的作用机制[J].广东医学,2014,35(4):561~564. [2] 朱超望,翟光华.国际糖尿病与妊娠研究组诊断新标准对妊娠糖尿病筛查的影响[J].国际检验医学杂志,2013,34(12):1533~1534. [3] 周建烈.补充较大剂量维生素D的营养风险与健康效果的研究进展[J].卫生研究,2013,41(1):155~161. [4] 吴迎爽,刘瑶,朱亦堃,等.门冬胰岛素在妊娠糖尿病患者应用的临床观察[J].中国药物与临床,2012,12(1):101~102. [5] Xiang F,Jiang J,Li H,et al.High prevalence of vitamin D insufficiency in pregnant women working indoors and residing in Guiyang,China[J].Endocrinol Invest,2013,36(7):503~507. [6] Holick MF,Binkley NC,Bischoff-Ferrari HA,et al.Evaluation,treatment,and prevention of vitamin D deficiency:an Endocrine Society clinical practice guideline[J].Clin Endocrinol Metab,2011,96(7):1~20. [7] 胡杰妤,陈朝彦,覃桦,等.危重患者维生素缺乏及其对预后的影响[J].中华内分泌代谢杂志,2013,29(10):827~831. [8] Cheng Q,Li YC,Boucher BJ,et al.A novel role for vitamin D:modulation of expression and function of the local renin-angiotensin system in mouse pancreatic islets[J].Diabetologia,2011,54(8):2077~2081. [9] 吴冕,陆俊茜,黄凯,等.维生素D与1型糖尿病患者β血细胞功能的相关性分析[J].中华内分泌代谢杂志,2013,29(10):832~835. [10] 周惠娜,魏梓雯,袁小松,等.妊娠期糖尿病患者血浆25-OH维生素D的水平变化及预测价值[J].重庆医学,2014,43(28):3775~3777. [11] 杨敏.妊娠期糖尿病患者血清25-羟维生素D水平及胰岛素抵抗的关系[J].中国妇幼保健,2013,28(28):4639~4641.