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目的:探讨大剂量维生素D联合胰岛素治疗对妊娠期糖尿病患者血清同型半胱氨酸（homocysteine，HCY）、血糖、血脂代谢及妊娠结局的影响。方法:选取2020年6月至2023年5月延安市人民医院收治的120例妊娠期糖尿病患者为研究对象，按照随机数字表法分为观察组、对照组各60例。对照组采用门冬胰岛素治疗，观察组采用门冬胰岛素+大剂量维生素D治疗，对比两组患者治疗前后的血清HCY、糖代谢指标、血清25羟基维生素D3［25-hydroxyvitamin D3，25-OH-D3］及血脂代谢水平，并通过随访对比分析两组患者的妊娠结局。符合正态分布的计量资料两组间比较采用独立样本 t检验，组内比较采用配对 t检验；计数资料组间比较采用 χ2检验。 结果:治疗后，观察组空腹血糖［（4.67±0.52）mmol/L与（5.46±0.68）mmol/L］、2 h餐后血糖［（6.67±0.56）mmol/L与（8.42±0.78）mmol/L］及稳态模型胰岛素抵抗指数（2.45±0.45与3.87±0.34）均低于对照组，稳态模型胰岛β细胞功能指数（homeostasis model assessment of islets in pre diabetes patients β cell function index，HOMA-β）高于对照组（87.15±10.45与75.92±10.06），差异均有统计学意义（ t值分别为7.15、14.12、19.50、6.00，均 P<0.001）。治疗后，观察组血清HCY水平低于对照组［（8.72±1.27）μmol/L与（10.18±1.65）μmol/L］，血清25-OH-D3水平高于对照组［（15.05±2.41）μg/L与（11.25±2.37）μg/L］，差异均有统计学意义（ t值分别为5.43、8.71，均 P<0.001）。治疗后，观察组血清甘油三酯、总胆固醇及低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL-C）水平均低于对照组［（2.15±0.15）mmol/L与（3.23±0.18）mmol/L、（5.23±0.14）mmol/L与（6.34±0.17）mmol/L、（1.53±0.21）mmol/L与（2.21±0.22）mmol/L］，血清高密度脂蛋白胆固醇（high density lipoprotein cholesterol，HDL-C）水平高于对照组［（1.18±0.11）mmol/L与（0.98±0.12）mmol/L］，差异均有统计学意义（ t值分别为35.70、39.04、17.32、9.52，均 P<0.001）。观察组不良妊娠结局发生率低于对照组［10%（6/60）与40%（24/60）］，差异有统计学意义（ χ2=14.28， P<0.001）。 结论:妊娠期糖尿病患者选择大剂量维生素D联合胰岛素治疗不仅可有效改善其糖脂代谢，还可降低HCY水平，改善其不良妊娠结局。

Objective:To investigate the effect of high-dose vitamin D combined with insulin on serum homocysteine (HCY), glucose and lipid metabolism and pregnancy outcome in patients with gestational diabetes mellitus.Methods:From June 2020 to May 2023, 120 patients with gestational diabetes mellitus in Yan'an People's Hospital were selected as the research object, and they were randomly divided into observation group and control group with 60 cases in each group. The control group was treated with insulin aspart, while the observation group was treated with insulin aspart and large dose of vitamin D. The levels of serum HCY, glucose metabolism, serum 25-hydroxyvitamin D3 and blood lipid metabolism were compared between the two groups before and after treatment. The pregnancy outcomes of the two groups were compared and analyzed through follow-up.Independent sample t-test is used for comparison between two groups of econometric data that conform to normal distribution, while paired t-test is used for comparison within groups. The comparison between the groups was performed by χ2 test. Results:After treatment, fasting blood glucose ((4.67±0.52) mmol/L vs (5.46±0.68) mmol/L), 2-hour postprandial blood glucose ((6.67±0.56) mmol/L vs (8.42±0.78) mmol/L) and homeostasis model insulin resistance index (2.45±0.45 vs 3.87±0.34) in the observation group were significantly lower than those in the control group, and homeostasis model assessment of islets in pre diabetes patients β cell function index (HOMA-β) in the observation group was significantly higher than that in the control group (87.15±10.45 vs 75.92±10.06). The differences were statistically significant (t values were 7.15, 14.12, 19.50, and 6.00; all P<0.001). After treatment, the serum HCY level ((8.72±1.27) μmol/L vs (10.18±1.65) μmol/L), in the observation group was lower than that in the control group and the serum 25-OH-D3 level ((15.05±2.41) μg/L vs (11.25±2.37) μg/L) in the observation group was higher than that in the control group. The differences were statistically significant ( t=5.43, 8.71, P<0.001). After treatment, the serum triglyceride, total cholesterol and low density lipoprotein cholesterol (LDL-C) in the observation group were compared with those in the control group. LDL-C levels were lower than those in the control group ((2.15±0.15) mmol/L vs (3.23±0.18) mmol/L, (5.23±0.14) mmol/L vs (6.34±0.17) mmol/L, (1.53±0.21) mmol/L and (2.21±0.22) mmol/L), serum high density lipoprotein cholesterol (HDL-C), HDL-C levels were significantly higher than those in the control group ((1.18±0.11) mmol/L vs (0.98±0.12) mmol/L), and the differences were statistically significant (t-values were 35.70, 39.04, 17.32, and 9.52, respectively, all P<0.001). The incidence of adverse pregnancy outcome in the observation group was lower than that in the control group (10% (6/60) vs 40% (24/60)), and the difference was statistically significant ( χ2=14.28, P<0.001). Conclusion:High-dose vitamin D combined with insulin therapy can not only effectively improve glucose and lipid metabolism, but also reduce the HCY level and improve the adverse pregnancy outcome in patients with gestational diabetes mellitus.