1例妊娠期糖尿病患者的循证治疗

Evidence-Based Treatment for a Patient with Gestational Diabetes Mellitus

目的查找循证医学证据,为1例妊娠期糖尿病患者制定合理的治疗方案。方法针对患者的临床问题,以妊娠期糖尿病、二甲双胍等为检索词,电子检索ACP Journal Club(1991～2006.12)、Cochrane图书馆(2006年第4期)、MEDLINE(1966～2006.12)和中国生物医学文献数据库(1980～2006.12),查找相关的系统评价、随机对照试验等,并对所获证据进行质量评价。结果从MEDLINE检索到Meta分析1篇(2006年),从Cochrane临床试验中心登记库查到临床对照试验2篇,其结果提示二甲双胍可降低妊娠期糖尿病围产期并发症的发生率,但尚无证据证明其是否会导致胎儿畸性。由于所纳入试验的样本量较小,还需要高质量、大规模临床随机对照试验来证实。据此,我们结合医生经验及患者意愿,对该患者不采用口服二甲双胍治疗,而是通过严格饮食控制及血糖检测,结合适量运动。妊娠期间,患者体重增长平稳,胎儿监护反应良好,于孕39+4周自然分娩一足月健康女婴。结论我们运用循证医学证据为该例妊娠期糖尿病患者选择了安全、合理的治疗方案。口服降糖药二甲双胍对妊娠期糖尿病患者的有效性和安全性尚需高质量、大样本的随机对照试验证实。

Objective To formulate an evidence-based treatment plan for a patient with gestational diabetes mellitus. Methods Based on the clinical questions raised from a reallife patient of gestational diabetes mellitus, we searched ACP Journal Club （1991 to Dec. 2006）, The Cochrane Library （Issue 4, 2006）, MEDLINE （1966 to Dec. 2006） and Chinese Biological Medical Database （1980 to Dec. 2006） for systematic reviews, randomized controlled trials, cohort and case-control studies. We used the following keywords： gestational diabetes, metformin, and pregnancy complication. The quality of the included studies was assessed. Results One meta-analysis （from MEDLINE） and two randomized controlled trials （from the Cochrane Central Register of Controlled Trials）were included. These studies concluded that there was no clear evidence on the benefits of metformin for gestational diabetes. Based on the current evidence, integrated with cl inical expertise and the patient＇s values, metformin was not used for this patient. Instead, intensive dietary control, blood glucose control, and appropriate exercise were administered. After this individual treatment, the patient gave birth to a healthy baby in 39^＋4 Weeks. Conclusion The appropriate management for gestational diabetes mellitus has been formulated with the approach of evidence-based medicine. Large-scale, methodologically-sound trials are required.