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Objective:To explore the efficacy of mecobalamin combined with insulin in the treatment of patients with gestational diabetes (GDM) and its effect on Toll-like receptor 4 (TLR4)/myeloid differentiation factor 88 (MyD88) signaling pathway and maternal and infant outcomes.Methods:A total of 132 patients with GDM in the Fourth Central Hospital of Baoding City were selected and they were randomly grouped according to the principles of stratified random design and controlled design trials, with 66 cases in each group. The control group was treated with insulin, and the observation group was treated with mecobalamin combined with insulin. The curative effect, fasting blood glucose (FBG) and 2 h postprandial blood glucose (2 h PBG), TLR4, MyD88, tumor necrosis factor-α (TNF-α), white blood cells interleukin 1β (IL-1β) before and after treatment and infant outcomes were compared between the two groups.Results:The total effective rate in the observation group was higher than that in the control group: 95.45%(63/66) vs. 84.85%(56/66), and the difference was statistically significant ( χ2 = 4.181, P<0.05). After 1, 2, 3 weeks of treatment, the levels of FBG and 2 h PBG in the observation group were lower than those in the control group: after 1week of treatment, the differences were statistically significant ( P<0.05). After 1, 2, 3 weeks of treatment, the levels of serum TLR4, MyD88, TNF-α, IL-1β in the observation group were lower than those in the control group: after 1 week of treatment, the differences were statistically significant ( P<0.05). The incidence of cesarean section, polyhydramnios, macrosomia and premature birth in the observation group were lower than those in the control group: 7.58%(5/66) vs. 21.21%(14/66), 4.55%(3/66) vs. 16.67%(11/66), 1.52%(1/66) vs. 13.64%(9/66), 3.03%(2/66) vs. 7.58%(5/66), the differences were statistically significant ( P<0.05). Conclusions:Mecobalamin combined with insulin can regulate the TLR4/MyD88 signaling pathway, which can help to control blood sugar and improve the maternal and infant outcomes.
Résumé
Objective:To analyze the correlation between serum ferritin (SF), perilipin, leptin and the outcome of patients with gestational diabetes mellitus (GDM).Methods:From October 2017 to December 2019, 126 patients with GDM who underwent maternity checkups in Baoding Fourth Central Hospital and gave birth were selected as the GDM group, and 82 normal pregnant women during the same period were selected as the control group for retrospective analysis. The levels of serum SF, perilipin, and leptin in the GDM group and the control group were measured and compared, and the expressions of serum indexes of patients with different blood glucose control and different pregnancy outcomes in the GDM group were measured. Pearson correlation analysis was used to explore the correlation between the expression of serum indexes in GDM patients and fasting blood glucose (FPG), 2 h postprandial blood glucose (2 h PG), and insulin resistance index (HOMA-IR). Logistic regression was used to analyze the relationship between the expression of serum indicators and adverse pregnancy outcomes in GDM patients. The receiver operating characteristic (ROC) curve was used to observe the value of single serum indexes and to predict the pregnancy outcome of GDM patients.Results:The levels of SF, perilipin and leptin in GDM group were higher than those in control group: (152.48 ± 37.64) μg/L vs. (109.27 ± 32.16) μg/L, (857.06 ± 192.35) ng/L vs. (262.83 ± 104.7) ng/L, (23.54 ± 2.28) μg/L vs.(14.62 ± 1.83) μg/L, the differences were statistically significant ( P<0.05). The levels of SF, perilipin and leptin in patients with good blood glucose control in GDM group were lower than those in patients with poor blood glucose control: (132.10 ± 36.52) μg/L vs. (176.37 ± 40.06) μg/L, (176.37 ± 40.06) ng/L vs. (946.42 ± 205.37) ng/L, (21.49 ± 2.16) μg/L vs. (25.94 ± 2.40) μg/L, the differences were statistically significant ( P<0.05). The levels of serum SF, perilipin and leptin in GDM patients were positively correlated with FPG, 2 h PG and HOMA-IR levels ( P<0.05). The levels of serum SF, perilipin and leptin in GDM patients with adverse pregnancy outcomes were higher than those in patients without occurrence: (182.86 ± 42.29) μg/L vs. (138.86 ± 35.47) μg/L, (1 013.35 ± 216.07) ng/L vs. (787.00 ± 183.49) ng/L, (27.04 ± 2.5) μg/L vs. (21.97 ± 2.07) μg/L, the differences were statistically significant ( P<0.05). Logistic regression analysis showed that serum SF, perilipin and leptin were closely related to the adverse pregnancy outcomes in GDM patients ( P<0.05). ROC curve analysis showed that the sensitivity and the specificity of SF, perilipin, leptin combined detection to predict GDM patients with adverse pregnancy outcomes was 76.92% and 83.91%. Conclusions:The serum SF, perilipin and leptin are abnormally high expression in GDM patients, and it is positively correlated with blood glucose level and HOMA-IR. Joint detection can improve the predictive value of adverse pregnancy outcomes and provide a basis for early intervention.
Résumé
Objective To explore the clinical effect of moist dressing combined with high energy narrow band phototherapy on chronic dermal ulcer.Methods Sixty cases with dermal chronic ulcer were randomly divided into two groups equally.The experimental group was treated by moist dressing combined with high energy narrow band phototherapy,while the control group was treated by moist dressing.The areas of wound surface were compared after treating for 14 and 21 days.Result Twenty-one days after treatment,the areas of wound surface were significantly reduced in the experimental group than that in the control group(P<0.05).Conclusion Moist dressing combined with high energy narrow band phototherapy can eradicate necrotic tissue,adjust micro-environment,and promote granulation and healing in chronic dermal ulcer.