【摘要】 目的 探讨二甲双胍治疗轻中度妊娠期高血压（gestational hypertension, GH）的效果。方法 选取2018年6月至2020年6月北京市垂杨柳医院收治的112例轻中度GH患者，按照随机数字表法分为观察组（n=56）及对照组（n=56）。对照组予以拉贝洛尔口服治疗，观察组在此基础上予以二甲双胍口服治疗。比较两组患者的疗效，血压，血液流变学，凝血功能[活化部分凝血活酶时间（activated partial thromboplastin time, APTT）、凝血酶原时间（prothrombin time, PT）、凝血酶时间（thrombin time, TT）]，炎性因子[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素（interleukins, IL）-1β、IL-6]，氧化应激指标[脂质过氧化物（lipid peroxidation, LPO）、丙二醛（malondialdehyde, MDA）、超氧化物歧化酶（superoxide dismutase,SOD）]及不良妊娠结局。结果 观察组患者的总有效率高于对照组，差异有统计学意义（91.07%vs. 75.00%,P=0.023）。治疗后，观察组患者的收缩压、舒张压低于对照组，差异有统计学意义[收缩压：（128.95±6.21）mmHg vs.(135.27±7.46)mmHg,P<0.05；舒张压：（84.51±6.02）mmHg vs.(94.67±7.18)mmHg,P<0.05,1 mmHg=0.133 kPa]。治疗后，观察组患者的红细胞压积、血浆黏度、全血还原黏度低于对照组，差异有统计学意义[红细胞压积：38.95%±3.83%vs. 43.16%±4.71%,P<0.05；血浆黏度：（1.22±0.24）mPa·s vs.(1.46±0.28)mPa·s,P<0.05；全血还原黏度：（4.32±0.39）mPa·s vs.(5.18±0.53)mPa·s,P<0.05]。治疗后，观察组患者的APTT、PT、TT高于对照组，差异有统计学意义[APTT:(30.45±2.27)s vs.(27.09±1.96)s,P<0.05;PT:(14.83±1.65)s vs.(12.76±1.49)s,P<0.05;TT:(15.68±1.49)s vs.(13.92±1.20)s,P<0.05]。治疗后，观察组的血清TNF-α、IL-6、IL-1β浓度低于对照组，差异有统计学意义[TNF-α:(16.14±2.76)ng/L vs.(20.92±3.11)ng/L,P<0.05;IL-1β:(21.59±2.37)pg/mL vs.(35.41±3.20)pg/mL,P<0.05;IL-6:(12.65±2.73)pg/mL vs.(16.24±3.16)pg/mL,P<0.05]。治疗后，观察组患者的血清SOD浓度、LPO、MDA浓度均高于对照组，差异有统计学意义[SOD:(122.49±10.67)U/mL vs.(95.23±8.85)U/mL,P<0.05;LPO:(6.83±1.03)mmol/L vs.(11.24±1.46)mmol/L,P<0.05;MDA:(5.54±0.71)mmol/L vs.(8.26±1.03)mmol/L,P<0.05]。观察组患者的不良妊娠结局发生率低于对照组，差异有统计学意义（7.15%vs. 21.44%,P=0.031）。结论 二甲双胍能有效控制轻中度GH患者的血压变化，降低血液黏度，改善凝血功能，调节炎性因子水平，缓解氧化应激反应，减少不良妊娠结局，疗效确切。更多还原

【Abstract】 Objectives To explore the curative effect of metformin on mild to moderate gestational hypertension(GH). Methods Totally 112 patients with mild to moderate GH admitted to Beijing Chuiyangliu Hospital from June 2018 to June 2020 were randomly divided into observation group(n=56) and control group(n=56) by random number table method. Control group was given labetalol orally, while observation group was given metformin orally on this basis. The efficacy, blood pressure, hemorheology, coagulation function[activated partial thromboplastin time(APTT), prothrombin time(PT), thrombin time(TT)], inflammatory factors [tumor necrosis factor alpha(TNF-α), interleukin(IL)-1 β, IL-6], oxidative stress indicators [lipid peroxidation(LPO), malondialdehyde(MDA), superoxide dismutase(SOD)] and adverse pregnancy outcomes were compared between the two groups. Results The total effectiveness rate of observation group was higher than that of control group(91.07% vs. 75.00%, P=0.023). After treatment, the systolic and diastolic blood pressure of observation group were lower than those of control group [systolic blood pressure:(128.95±6.21) mmHg vs.(135.27±7.46) mmHg, P<0.05; diastolic blood pressure:(84.51±6.02) mmHg vs.(94.67±7.18) mmHg, P<0.05; 1 mmHg = 0.133 kPa]. After treatment, the red blood cell volume, plasma viscosity and whole blood reducing viscosity of observation group were lower than those of control group[red blood cell volume: 38.95%±3.83% vs. 43.16%±4.71%, P<0.05; plasma viscosity:(1.22±0.24) mPa·s vs.(1.46±0.28) mPa·s, P<0.05; whole blood reducing viscosity(4.32±0.39) mPa·s vs.(5.18±0.53) mPa·s, P<0.05]. After treatment, APTT, PT and TT in observation group were higher than those in control group [APTT:(30.45±2.27)s vs.(27.09±1.96)s, P<0.05; PT:(14.83±1.65)s vs.(12.76±1.49)s, P<0.05; TT:(15.68±1.49)s vs.(13.92±1.20)s, P<0.05]. After treatment, the serum concentrations of TNF-α, IL-6, and IL-1β in observation group were lower than those in control group[TNF-α:(16.14±2.76)ng/L vs.(20.92±3.11)ng/L, P<0.05; IL-1β:(21.59±2.37)pg/mL vs.(35.41±3.20)pg/mL, P<0.05; IL-6:(12.65±2.73)pg/mL vs.(16.24±3.16)pg/mL,P<0.05]. After treatment, the serum concentrations of SOD, LPO and MDA in observation group were higher than those in control group[SOD:(122.49±10.67) U/mL vs.(95.23±8.85)U/mL, P<0.05; LPO:(6.83±1.03)mmol/L vs.(11.24±1.46)mmol/L, P<0.05; MDA:(5.54±0.71)mmol/L vs.(8.26±1.03)mmol/L, P<0.05]. The incidence of adverse pregnancy outcomes in observation group was lower than that in control group, and the difference was statistically significant(7.15% vs. 21.44%, P=0.031). Conclusions Metformin can effectively control blood pressure changes, reduce blood viscosity, improve coagulation function, regulate levels of inflammatory factors, relieve oxidative stress response and reduce adverse pregnancy outcomes in patients with mild to moderate GH, which has significant curative effect.更多还原