摘要
目的通过评价二甲双胍治疗妊娠期糖尿病的安全性及有效性,以探讨二甲双胍用于治疗妊娠期糖尿病的可行性。方法通过在PubMed、Cochrane、Medline、Embase等数据库中检索二甲双胍与胰岛素治疗妊娠期糖尿病的随机对照试验,运用STATA12.0分析软件进行统计学分析。结果共10篇随机对照试验(共计2 128例妊娠期糖尿病患者)被纳入研究。其中1 029例患者接受二甲双胍治疗,1 099例患者接受胰岛素治疗。在二甲双胍组共计226例(22%)患者需要加入胰岛素控制血糖。Meta分析结果显示,二甲双胍并不增加早产风险[比值比(RR)=1.140,95%置信区间(95%CI)0.817~1.591,P=0.440],且二甲双胍能降低母亲妊娠期高血压发病率(RR=0.594,95%CI 0.387~0.913,P=0.018)。二甲双胍组孕36周以后母亲糖化血红蛋白较胰岛素组低[均数差(WMD)=-0.066,95%CI-0.117^-0.015,P=0.012]。二甲双胍能降低新生儿低血糖发生率(RR=0.654,95%CI 0.479~0.894,P=0.008)。二甲双胍能降低孕期体重增长(WMD=-1.551,95%CI-2.851^-0.252,P=0.019)。结论二甲双胍对治疗妊娠期糖尿病是可行的,但需要更多研究进一步确定其远期可行性。
Objective To determine the metformin feasibility on gestational diabetes mellitus by evaluating the safety and efficacy of metformin on gestational diabetes mellitus.Methods Randomized controlled trials of metformin and insulin on gestational diabetes mellitus were performed in PubMed,Cochrane,Medline,and Embase databases.Statistical analysis was performed by using STATA12.0 analysis software.Results Ten randomized controlled trials(2128 patients with gestational diabetes mellitus)were included in the study.Of these,1029 patients received metformin,and 1099 patients received insulin.A total of 226 patients(22%)in the metformin group needed insulin to control blood glucose.The meta analysis results showed those metformin did not increase the risk of preterm birth[odds ratio(RR)=1.140,95%confidence interval(95%CI)0.817-1.591,P=0.440],and metformin could reduce the incidence of maternal hypertension during pregnancy(RR=0.594,95%CI 0.387-0.913,P=0.018).After 36 weeks of pregnancy in the metformin group,the mother′s glycated hemoglobin was lower than that in the insulin group[weight mean difference(WMD)=-0.066,95%CI-0.117--0.015,P=0.012].Metformin could also reduce the incidence of hypoglycemia in newborns(RR=0.654,95%CI 0.479-0.894,P=0.008).In addition,metformin also could reduce weight gain during pregnancy(WMD=-1.551,95%CI-2.851--0.252,P=0.019).Conclusion Metformin is feasible for the treatment of gestational diabetes mellitus,but more research is needed to further determine its the long-term feasibility.
作者
蒋丹
毛佳蕾
唐秦
徐红兵
JIANG Dan;MAO Jialei;TANG Qin;XU Hongbing(Department of Obstetrics and Gynecology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《现代医药卫生》
2020年第20期3238-3243,3247,共7页
Journal of Modern Medicine & Health
