CAJ | 학술논문

目的：探讨高剂量维生素 D 注射联合门冬胰岛素对妊娠期糖尿病患者胰岛素敏感性及甲状旁腺激素水平的影响。方法选择2013年妊娠期糖尿病住院患者142例，按照随机数字表法分为对照组和治疗组，各71例。对照组给予普通剂量维生素 D 肌肉注射和门冬胰岛素皮下注射，治疗组给予高剂量维生素 D 肌肉注射和门冬胰岛素皮下注射，疗程均为4周。比较两组患者治疗前后不同维生素 D 水平的改善情况，记录两组患者治疗过程中胰岛素敏感性各相关指标、甲状旁腺激素功能相关生化指标的变化，以及孕期血糖及母婴并发症的发生情况。结果治疗4周后，两组患者维生素 D 缺乏程度明显较治疗前改善（ P ＜0.05），治疗组改善程度高于对照组（ P ＜0.05）；两组治疗方案均能良好控制血糖，治疗前后比较差异有统计学意义（ P ＜0.05），治疗组胰岛素抵抗指数、胰岛素分泌指数改善程度优于对照组（ P ＜0.05），治疗前、后血钙无明显变化（ P ＞0.05），血磷、钙磷乘积、血清全段甲状旁腺激素（iPTH）治疗后明显下降（ P ＜0.05）；治疗组孕期低血糖及母婴并发症情况（低血糖、剖宫产、羊水过多）发生率较对照组低，两组比较差异有统计学意义（ P ＜0.05）。结论高剂量维生素 D 注射联合门冬胰岛素在妊娠期糖尿病患者的治疗中，能改善维生素 D 缺乏程度，有效控制血糖，提高胰岛素敏感性，预防妊娠晚期“生理性甲状旁腺功能亢进”的发生，孕期低血糖及母婴并发症的发生率小，疗效确切，值得临床推广。
목적：탐토고제량유생소 D 주사연합문동이도소대임신기당뇨병환자이도소민감성급갑상방선격소수평적영향。방법선택2013년임신기당뇨병주원환자142례，안조수궤수자표법분위대조조화치료조，각71례。대조조급여보통제량유생소 D 기육주사화문동이도소피하주사，치료조급여고제량유생소 D 기육주사화문동이도소피하주사，료정균위4주。비교량조환자치료전후불동유생소 D 수평적개선정황，기록량조환자치료과정중이도소민감성각상관지표、갑상방선격소공능상관생화지표적변화，이급잉기혈당급모영병발증적발생정황。결과치료4주후，량조환자유생소 D 결핍정도명현교치료전개선（ P ＜0.05），치료조개선정도고우대조조（ P ＜0.05）；량조치료방안균능량호공제혈당，치료전후비교차이유통계학의의（ P ＜0.05），치료조이도소저항지수、이도소분비지수개선정도우우대조조（ P ＜0.05），치료전、후혈개무명현변화（ P ＞0.05），혈린、개린승적、혈청전단갑상방선격소（iPTH）치료후명현하강（ P ＜0.05）；치료조잉기저혈당급모영병발증정황（저혈당、부궁산、양수과다）발생솔교대조조저，량조비교차이유통계학의의（ P ＜0.05）。결론고제량유생소 D 주사연합문동이도소재임신기당뇨병환자적치료중，능개선유생소 D 결핍정도，유효공제혈당，제고이도소민감성，예방임신만기“생이성갑상방선공능항진”적발생，잉기저혈당급모영병발증적발생솔소，료효학절，치득림상추엄。
Objective To study the effects of high dose of vitamin D injection combined with injection of insulin aspart on the insulin sensitivity and the parathyroid hormone level in the treatment of gestational diabetes mellitus(GDM). Methods 142 cases of GDM from january to December 2013 were selected and divided into the control group and the treatment group according to the random number table,71 cases in each group. The control group received the ordinary dose of vitamin D by intramuscular injection and insulin aspart by subcutaneous injection and the treated group was given the high dose of vitamin D by intramuscular injection and subcutaneous in-jection of insulin aspart. The course of treatment in the two groups was 4 weeks. The improvement situations of different concentrations of vitamin D before and after treatment were compared between the two groups. The related indexes of the insulin sensitivity and the changes of related biochemical indexes of the parathyroid function during the treatment course were recorded. The blood glucose and the occurrence of maternal and neonatal complications were also recorded. Results After 4 weeks of treatment,the vitamin D deficiency de-grees in the two groups were significantly improved compared with before treatment( P < 0. 05),but the improvement degree in the treatment group was higher than that in the control group( P < 0. 05);the improvement degrees of the insulin resistance index and the insulin secretion index in the treatment group were superior to those in the control group( P < 0. 05). The blood calcium level had no significant change between the before and after treatment( P > 0. 05). But the blood phosphorus,calcium - phosphorus product and serum intact parathyroid hormone(iPTH) after treatment were significantly decreased( P < 0. 05);the occurrence rates of gestational hypo-glycemia and the maternal and neonatal complications(hypoglycemia,cesarean section,polyhydrammnios,etc. )in the treatment group were lower than those in the control group,the differences between the two groups had statistical significance( P < 0. 05). Conclusion High dose of vitamin D injection combined with injection of insulin aspart in the treatment of GDM can improve the deficiency degree of vi-tamin D,effectively control blood sugar,increase the insulin sensitivity and prevent the occurrence of physiological hyperparathyroidism in late pregnant period with the lower occurrence rate of gestational hypoglycemia and maternal and neonatal complications and definite effect,which is worthy of being clinically promoted.