格列本脲和胰岛素在妊娠期糖尿病治疗效果比较的系统评价

Systematic evaluation of comparison of curative effects of glibenclamide and insulin for treatment of gestational diabetes mellitus

目的:评价格列本脲(优降糖)对比胰岛素在治疗妊娠期糖尿病的安全性及疗效。方法:以妊娠期/孕期糖尿病、口服降糖药、格列本脲、优降糖为检索词,检索conhrence图书馆(2010年第3期)、MEDLIN(pubmed 1980～2011年)、EMBASE(1984～2011年)、中国生物医学文献光盘数据库(1978～2011年)、中文期刊全文数据库(1979～2011年)的文献,手工检索相关文献,要求为临床随机对照试验,评价文献质量。数据分析采用Stata 11.0,对于异质性小的研究合并效应量。结果:纳入4个随机对照试验,共577个受试对象。结果表明格列本脲与胰岛素对比在控制血糖上同样有效,且对胎儿的生长发育无不良反应。但是在新生儿体重、巨大儿发生率及新生儿低血糖发生率等方面两者有差异。结论:格列本脲在控制血糖效果上和胰岛素无差异且使用安全,但是对新生儿、巨大儿及新生儿低血糖发生率的影响仍不能优于胰岛素。

Objective： To evaluate the safeties and curative effects of glibenclamide （glybenzcyclamide） and insulin for treatment of gestational diabetes mellitus （GDM） . Methods ： Taking GDM, oral hypoglycemic drugs, glibenclamide, glybenzcyclamide as key words to search literatures from Cochane Library （issue 3 in 2010）, MEDLINE （PubMed 1980 -2011 ）, EMBASE （1984 -2011 ）, Chinese bio- medical literature database （1978 -2011 ）, and full -text databases of Chinese periodicals, the related literatures were searched manually, meeting the criterion of clinical random case - control study, and the qualities of literatures were assessed. The data were analyzed by Stata 11.0 software, the influencing quantity was combined in studies with litter heterogeneity. Results： Four random case - control studies were included, including 577 participants. Glibenclamide and insulin were effective for controlling blood glucose, and they had no impact on fetal growth and development, but there was statistically significant difference in neonatal weight, the incidences of macrosomia and neonatal hypoglycemia between glibenclamide and insulin. Conclusion： There was no statistically significant difference in the effect of controlling blood glucose between glibenclamide and insulin, and both of them were safe, but the effect of glibenclamide on neonatal weight, the incidences of macrosomia and neonatal hypoglycemia is not superior to insulin.