摘要
目的系统评价应用二甲双胍及胰岛素治疗GDM的效果。方法系统检索Cochrane Library、Embase、Pub Med、Web of Science、中国知网、万方数据库、中国生物医学文献数据库中有关二甲双胍、胰岛素治疗GDM的随机对照研究。采用Cochrane 5.1.0系统进行文献质量评价,Rev Man 5.3软件进行Meta分析。结果共纳入9项研究。Meta分析结果显示,与胰岛素治疗组比较,二甲双胍治疗组干预期间孕妇[加权均数差(WMD)=-1.48,95%CI(-2.22^-0.74),P<0.01]和新生儿体重[标准均数差(SMD)=-0.29,95%C(I-0.54^-0.05),P=0.02]体重增加量降低;新生儿低血糖[相对危险度(RR)=0.61,95%C(I0.43~0.88),P=0.009]和巨大儿[RR=0.38,95%C(I0.16~0.71),P=0.004]的发生率降低。孕妇FPG[SMD=-0.03,95%C(I-0.29~0.23),P=0.80]、餐后血糖[SMD=-0.16,95%C(I-0.56~0.24),P=0.44]、Hb A1c[WMD=0.01,95%CI(-0.14~0.16),P=0.91]、剖宫产率[RR=1.05,95%C(I0.94~1.17),P=0.39]、早产率[RR=1.27,95%CI(0.96~1.69),P=0.10]、新生儿高胆红素血症发生率[RR=0.98,95%CI(0.63~1.51),P=0.91]、呼吸窘迫综合征发生率[RR=0.94,95%C(I0.56~1.57),P=0.80]比较,差异无统计学意义(P>0.05)。结论二甲双胍可降低新生儿低血糖、巨大儿的发病率,有效控制孕妇和新生儿体重及调节GDM患者血糖水平,但仍需高质量、大样本研究进一步探讨。
Objective To systematic evaluate the therapeutic effects of metformin and insulin in patients with gestational diabetes(GDM).Methods Systematic searches were done in Cochrane Library,EMBASE,Pub Med,Web of Science,China Knowledge Network,Wanfang Database and China Biomedical Literature Database in metformin and insulin treatment in GDM related literature.The Cochrane 5.1.0 was used for literature quality evaluation and the Rev Man 5.3 software was used for meta-analysis.Results A total of nine studies were included.The meta-analysis showed that the weight gain of pregnant women during the intervention[WMD=-1.48,95%CI(-2.22^-0.74),P<0.01)and neonatal weight[SMD=-0.29,95%C(I-0.54^-0.05),P=0.02]were lower,neonatal hypoglycemia rates[RR=0.61,95%C(I0.43~0.88),P=0.009]and macrosomia rates[RR=0.38,95%CI(0.16~0.71),P=0.004]were also lower in metformin treatment group than in insulin treatment group.Fasting blood glucose[SMD=-0.03,95%CI(-0.29~0.23),P=0.80],postprandial blood glucose[SMD=-0.16,95%CI(-0.56~0.24),P=0.44],glycated hemoglobin A1 c level(HbA1c)[WMD=0.01,95%CI(-0.14~0.16),P=0.91],Cesarean section rate[RR=1.05,95%CI(0.94~1.17),P=0.39],preterm delivery rate[RR=1.27,95%CI(0.96~1.69),P=0.10],neonatal hyperbilirubinemia rate[RR=0.98,95%CI(0.63~1.51),P=0.91]and respiratory distress syndrome rate[RR=0.94,95%CI(0.56~1.57),P=0.80]were not statistically different between the two groups.Conclusion Metformin could reduce neonatal hypoglycemia and the incidence of macrosomia,while effectively control the weight of pregnant women and newborns,and regulate blood glucose levels in GDM patients.
作者
殷秀敏
历广招
聂立婷
王功朝
YIN Xiumin;LI Guangzhao;NIE Liting(Department of Thoracic Surgery,Shandong Provincial Hospital,College of Medicine,Shandong University,Ji'nan 250000,China)
出处
《中国糖尿病杂志》
CAS
CSCD
北大核心
2020年第6期415-422,共8页
Chinese Journal of Diabetes
基金
山东省自然科学基金(ZR2015HM066)。
