妊娠糖尿病孕妇接受低血糖生成指数食物干预效果的系统评价

System assessment of low glycemic index diets for patients with gestational diabetes mellitus

目的 为研究低血糖生成指数食物干预妊娠期糖尿病的效果,对国外已发表的相关临床随机对照研究进行系统评价。方法 检索MEDLINE等外文主要数据库,应用Rev.Man 5.2软件进行Meta分析,选用风险比（RR）作为效应量,绘制森林图。结果 共获得符合标准的研究5个,对于母体的疗效方面,LGI干预减少胰岛素使用的合并RR值为0.67,95%CI[0.44~1.00],其结果虽趋向于得出保护性结论,但由于缺乏统计学意义,因此尚无法确证LGI干预可以减少胰岛素的使用。对于新生儿,LGI干预可减少巨大儿分娩,合并RR值为0.27,95%CI[0.10~0.71]。排除具有膳食纤维差异的试验后,对于胰岛素使用情况,合并RR值为0.69,95%CI[0.52~0.92],即“单纯”LGI干预也可以减少胰岛素的使用。进一步分析LGI伴随高纤维的研究显示,对于分娩巨大儿情况,各合并RR值为0.17,95%CI[0.04~0.71]。结论 LGI对GDM作用更直接地体现在减少高血糖的不良影响。有效的LGI干预主要发挥了直接的降血糖效果。

Objective To explore the system assessment of low glycemic index （LGI） diets for patients with gestational diabetes mellitus （ GDM ）. Methods Authors searched the MEDLINE, EMBASE, EBSCO, Springer, Ovid, and Cochrane Library databases for studies of the effects of LGI diets in GDM patients. Authors performed a recta-analysis of the effects of the LGI diets with and with- out added dietary fiber （DF） on GDM outcomes. Risk ratios （RR） and 95% confidence intervals （CIs） were calculated by using random- and fixed-effects models. Results Totally 5 studies met standard were obtained. For the effect of maternal, combined RR of LGI intervention reduced the use of insulin was 0.67, 95% CI was [ 0.44 - 1.001. Although the results showed a trend to draw the conclusion of the protection, but due to the lack of statistical significance, it was still unable to confirm that the LGI intervention can reduce insulin use. For newborns, the combined RR of LGI intervention reduced the huge baby delivery was 0.27, 95% CI value was [0.10 N 0.71 ]. After the exclusion of dietary fiber differences in the test, for the use of insulin, the combined RR was 0.69, 95% CI was [0.52 -0.92 ] , that indicated ＂simple＂ LGI intervention can also reduce the use of insulin. Further analysis of LGI with high fiber research showed that for the great cases of delivery, the combined RR value was 0.17, 95 % CI was [ 0.04 - 0.71 ]. Conclusion Effect of LGI on GDM can directly reflect in the reduction of adverse effects of high blood sugar. Effective LGI intervention mainly exerts a direct effect on reducing blood sugar.