摘要
目的对口服降糖药二甲双胍和格列苯脲治疗妊娠期糖尿病(gestational diabetes mellitus,GDM)的有效性及安全性的系统评价进行再评价。方法计算机检索The Cochrane Library、The Joanna Briggs Institute Library、EMBASE、PubMed、中国生物医学数据库,中国知网,万方,维普数据库,搜集口服降糖药二甲双胍或格列苯脲治疗GDM安全性和有效性的系统评价,检索时间限定为从建库至2018年11月。由2位评价员独立筛选文献,采用AMSTAR评价纳入研究的方法学质量,提取资料并采用RevMan5软件定量合并分析其效应值,结局指标采用GRADE评价系统进行证据质量分级。结果最终纳入13篇系统评价(包括31项RCT研究)。AMSTAR评价结果显示:纳入的系统评价总体质量有待提高。主要结局指标的meta分析结果表明:口服降糖药二甲双胍餐后血糖控制效果优于胰岛素,且二甲双胍组妊娠诱发性高血压发生倾向更低,孕妇入组后体重增加及妊娠时限均低于胰岛素组;同时,二甲双胍组新生儿出生体重更低,大于胎龄儿,新生儿低血糖发生率、新生儿入住ICU率均显著低于胰岛素组。格列苯脲血糖控制效果与胰岛素相当,但可能增加新生儿出生体重,巨大儿及新生儿低血糖发生率也升高。GRADE评价结果显示:38个结局指标中,2项为高质量,13项为中等质量,14项为低质量,9项为极低质量,主要降级因素是研究的局限性和不精确性。结论口服降糖药二甲双胍和格列苯脲具有较好的血糖控制效果,二甲双胍的餐后血糖控制效果甚至优于胰岛素治疗效果。尚无数据说明口服降糖药格列苯脲或二甲双胍对孕妇及胎儿的远期影响。
Objective To overview the systematic review(SR) of efficacy and safety of oral hypoglycemic agents(OH A) for gestational diabetes mellitus(GDM).Methods The Cochrane Library,The Joanna Briggs Institute Library,EMBASE,PubMed,CBM,CNKI,WANFANG,VIP database were electronically searched to collect SR and meta-analysis on OHA of GDM from inception to Nov 2018.Two reviewers independently screened literature,then AMSTAR tool was used to assess the methodological quality of included studies.Data extracted were used to perform meta-analysis through RevMan 5 software.The GRADE tool was used to grade the evidence quality of outcome measures included in the SRs.Results A total of 13 relevant SRs were included,involving 31 RCTs.The assessment results of AMSTAR toolsuggested that:the quality of systematic reviews included need to be improved.Main outcome of meta-analysis:Metformin is better than insulin in postprandial blood glucose control and the incidence of Pregnancy-induced hypertension(PIH),weight gain after randomization,gestational age was lower in the metformin group.At the same time,the neonatal birth weight in the metformin group was lower.It can also significantly reduce several adverse neonatal outcomes including incidence of large for gestational age(LGA),hypoglycemia and neonatal intensive care admission.Glyburide is comparable with insulin in glycemic control and maternal outcomes.However,it may increase birth weight,and increase incidence of macrosomia and hypoglycemia.GRADE results showed:among 38 outcomes,2 outcomes were of high quality,13 outcomes were of moderate quality,14 outcomes were of low quality and 9 outcomes were of very low quality.And the main downgrading factors were the limitations and imprecision of the study.Conclusion The current overview shows that OHAs(metformin or glyburide) is comparable with insulin in general glycemic control,furthermore,metformin is even more effective than insulin in postprandial glucose control.There is barely data on the long-term effects of OHAs(metformin or glyburide) on maternal outcomes and neonatal outcomes.
作者
章孟星
周英凤
钟婕
李丽
丁焱
ZHANG Meng-xing;ZHOU Ying-feng;ZHONG Jie;LI Li;DING Yan(School of Nursing,Hehai University,Shanghai 200032,China;Department of Nursing,Obstetrics and Gynecology Hospital,Hehai University,Shanghai 200011,China)
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2020年第3期339-351,共13页
Hehai University Journal of Medical Sciences
基金
国家自然科学基金面上项目(71874035)。
