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目的分析孕中期预防性应用维生素D降低妊娠期糖尿病发病率的临床效果。方法选取佛山市勒流医院自2014年8月到2015年3月期间收治的妊娠12周以前的妇女120例,采用连续随机数字表法随机分为干预组和对照组,每组60例,从妊娠12周开始,干预组给予维生素D,20万IU,肌肉注射,每月一次,连续三个月,对照组则给予安慰剂,治疗至妊娠足24周,复测空腹血糖、空腹胰岛素浓度、血清25羟维生素D3水平并通过糖耐量试验(OGTT)实验,明确两组的妊娠期糖尿病(GDM)发病人数。观察与对比两组孕妇干预前后血清25羟维生素D3水平及血糖、GDM发生情况。结果两组患者怀孕12周时,血清25羟维生素D3水平的妇女120例,采用连续随机数字法随机分为干预组和对照组,每组60例,从妊娠12周开比较无显著性差异(t=1.32,P>0.05),干预组行维生素D补充治疗后,其24周时血清25羟维生素D3水平显著高于对照组(t=5.31,P<0.05),干预组24周血清25羟维生素D3水平高于12周,而对照组24周血清25羟维生素D3水平低于12周,但两组组内比较均无显著性差异(t值分别为-1.79、1.83,均P>0.05)。12周时,两组患者空腹血糖水平、空腹胰岛素水平、胰岛素抵抗指数均无显著性差异(t值分别为0.93、0.77、0.46,均P>0.05),干预组24周空腹血糖水平、空腹胰岛素水平、胰岛素抵抗指数均显著低于对照组(t值分别为-4.54、-5.31、-5.57,均P<0.05),且糖尿病发病率显著低于对照组(χ~2=17.42,P<0.05)。结论孕中期预防性应用维生素D降低妊娠期糖尿病发病率具有显著的临床效果显著,值得推广与应用。
Objective To analyze the clinical effect of prophylactic vitamin D in pregnancy during the second trimester to reduce the incidence of gestational diabetes mellitus. Methods A total of 120 women before 12 weeks’ gestation who were admitted to Foshan Leliu Hospital from August 2014 to March 2015 were randomly divided into intervention group and control group with continuous random number table Pregnancy 12 weeks, the intervention group was given vitamin D, 200000 IU, intramuscular injection, once a month for three consecutive months, the control group was given placebo, treatment until pregnancy 24 weeks, retest fasting blood glucose, fasting insulin concentration, Serum 25-hydroxyvitamin D3 levels and through the glucose tolerance test (OGTT) test to determine the incidence of gestational diabetes mellitus (GDM) in both groups. The levels of serum 25-hydroxyvitamin D3 and the incidence of GDM were observed and compared before and after treatment. Results Twelve weeks of pregnancy, 120 women with serum 25-hydroxyvitamin D3 serum were randomly divided into intervention group and control group by continuous random number method, with 60 cases in each group. There was no significant difference between the two groups t = 1.32, P> 0.05). Serum 25-hydroxyvitamin D3 in intervention group was significantly higher than that in control group (t = 5.31, P <0.05) Vitamin D3 level was higher than 12 weeks, while 24 weeks serum 25 hydroxyvitamin D3 level in the control group was lower than 12 weeks, but there was no significant difference between the two groups (t = -1.79, 1.83, P> 0.05) . At 12 weeks, there was no significant difference in fasting blood glucose, fasting insulin and insulin resistance between the two groups (t = 0.93,0.77,0.46, all P> 0.05). The fasting blood glucose, fasting insulin (T = -4.54, -5.31, -5.57, respectively, P <0.05), and the incidence of diabetes mellitus was significantly lower than that of the control group (χ ~ 2 = 17.42, P <0.05) ). Conclusion Preventive application of vitamin D in the second trimester has a significant clinical effect of reducing the incidence of gestational diabetes mellitus, which is worthy of promotion and application.