维生素D联合胰岛素对妊娠期糖尿病患者血糖及TLR4、VCAM-1水平的影响

目的:研究维生素D联合胰岛素对妊娠期糖尿病患者血糖及Toll样受体4(TLR4)、血管细胞黏附分子1(VCAM-1)水平的影响。方法:选择我院收治的妊娠期糖尿病患者150例为研究对象。随机均分成常规治疗组(胰岛素降糖治疗,同时制定饮食和锻炼方案)和联合治疗组(在常规治疗组基础上给予维生素D治疗)。30d后,分别比较治疗前后两组血糖指标,血清TLR4、VCAM-1水平,脂肪细胞因子水平以及新生儿并发症发生情况。结果:治疗30d后,与常规治疗组比较,联合治疗组空腹血糖(FPG)(4.93±1.05)mmol/L比(4.03±0.95)mmol/L]、餐后2h血糖(2hPG)(7.38±1.28)mmol/L比(5.78±1.12)mmol/L]、糖化血红蛋白(HbAlc)(6.47±1.33)%比(5.31±1.01)%]、TLR4(8.23±1.27)mU/L比(5.59±1.02)mU/L]、VCAM-1(52.14±4.17)ng/ml比(40.17±4.02)ng/ml]、瘦素(4.77±0.62)mg/L比(3.8±0.48)mg/L]水平均显著降低,脂联素(6.84±0.91)mg/L比(11.26±1.50)mg/L]水平显著升高,P均=0.001;巨大儿(21.33%比9.33%)、黄疸(26.67%比12.00%)发生率显著降低(χ^2=4.160,5.172;P=0.041,0.023)。结论:维生素D联合胰岛素降糖疗法可显著降低妊娠期糖尿病患者的血糖、TLR4、VCAM-1水平,调节脂肪细胞因子水平,降低新生儿并发症发生风险。

Influence of vitamin D combined insulin on levels of blood glucose,TLR4 and VCAM-1 in patients with gestational diabetes

Objective:To study influence of vitamin D combined insulin on levels of blood glucose,Toll-like receptor 4(TLR4)and vascular cell adhesion molecule 1(VCAM-1)in patients with gestational diabetes(GD).Methods:A total of 150 GD patients treated in our hospital were randomly and equally divided into routine treatment group(received insulin,diet and exercise program)and combined treatment group(received vitamin D based on routine treatment group),both groups were treated for 30d.Levels of blood glucose indexes,serum TLR4,VCAM-1,adipocytokines before and after treatment,and incidence of newborn complications were compared between two groups.Results:Compared with routine treatment group after 30d treatment,there were significant reductions in levels of fasting plasma glucose(FPG)(4.93±1.05)mmol/L vs.(4.03±0.95)mmol/L],2h postprandial blood glucose(2hPG)(7.38±1.28)mmol/L vs.(5.78±1.12)mmol/L],glycosylated hemoglobin A1c(HbAlc)(6.47±1.33)%vs.(5.31±1.01)%],TLR4(8.23±1.27)mU/L vs.(5.59±1.02)mU/L],VCAM-1(52.14±4.17)ng/ml vs.(40.17±4.02)ng/ml]and leptin(4.77±0.62)mg/L vs.(3.8±0.48)mg/L],and significant rise in adiponectin level(6.84±0.91)mg/L vs.(11.26±1.50)mg/L]in combined treatment group,P=0.001 all;there were significant reductions in incidence rates of giant fetus(21.33%vs.9.33%)and jaundice(26.67%vs.12.00%)in combined treatment group(χ^2=4.160,5.172;P=0.041,0.023).Conclusion:Vitamin D combined insulin can significantly reduce levels of blood glucose,TLR4 and VCAM-1,regulate adipocytokine levels and reduce risk of newborn complications in patients with gestational diabetes.