慢性HBV感染与妊娠期糖尿病关系的Meta分析

Meta-analysis of association between chronic hepatitis B virus infection and gestational diabetes mellitus

目的探讨慢性乙型肝炎病毒(HBV)感染是否为妊娠期糖尿病(GDM)的危险因素。方法通过PubMed、Web of Science、中国知网、万方、维普数据库搜索2009年1月1日到2014年12月31日期间发表,筛选研究类型为回顾性队列研究或者病例对照研究的相关文献,共搜索出477篇,最终有10篇文献符合纳入标准,总样本量为413 150例。敏感性分析用一种循序算法降低异质性,之后的Me协分析采用随机效应模型。结果对10篇文献进行了Meta分析,经异质性检验,各研究间存在统计学异质性(x^2=30.07,df=9,P=0.0004,I^2=70%)。为降低异质性,删除2篇文献后,其余8篇具有较高的同质性(x^2=13.69,df=7,P=0.06,I^2=49%)。8篇文献Meta分析结果显示:慢性HBV感染组GDM发生率与非慢性HBV感染组比较,差异具有统计学意义(OR=1.31,95%CI:1.03~1.66,P=0.03),反映了慢性HBV感染是GDM的高危因素。按研究对象是否来自中国进行分组,结果显示:对中国人群还不能确定慢性HBV感染是否为GDM的危险因素(OR=1.10,95%CI:0.87~1.39,P=0.42),国外人群慢性HBV感染为GDM的危险因素(OR=1.60,95%CI:1.07~2.37,P=0.02)。结论慢性HBV感染是GDM的危险因素,但在中国尚不能确定慢性HBV感染是否为GDM的危险因素。

Objective To explore whether chronic hepatitis B virus （HBV） infection was the risk factor of gestational diabetes mellitus （ GDM） among pregnant women.Methods PubMed, Web of Science, CNKI database, Wanfang database and VIP database were searched from January 1, 2009 to December 31, 2014, and a total of 477 articles were identified with retrospective case-control study or a cohort study design.Finally 10 publications involving 413 150 subjects met the inclusion criteria.A sequential algorithm was used to reduce heterogeneity among studies, and further meta-analysis was conducted using a random-effects model.Results With meta-analysis, statistical heterogeneity was found among the 10 studies（χ^2 =30.07,df=9,P=0.0004,I^2 =70%）.Two articles were deleted to reduce heterogeneity, and the rest had high homogeneity（χ^2 =13.69,df=7,P=0.06,I^2 =49%）.Meta-analysis of 8 articles revealed significant difference in the incidence of GDM between chronic HBV infection group and non-chronic HBV infection group （OR=1.31,95%CI：1.03-1.66,P=0.03 ） , which indicated that HBV infection during pregnancy was the risk factor of GDM.Subjects in the study were categorized according to nationality, and the results showed that Chronic HBV infection was not confirmed as the risk factor of GDM among Chinese population（OR=1.10,95%CI：0.87 -1.39,P=0.42）but among foreign population（OR=1.60,95%CI：1.07 -2.37,P=0.02）.Conclusion Chronic HBV infection is a risk factor of GDM, but it cannot be determined among Chinese population.