n-3多不饱和脂肪酸对妊娠糖尿病患者胰岛素抵抗与妊娠结局影响的Meta分析

Effect of n-3 ployunsaturated fatty acid on insulin resistance and the pregnancy outcome of gestational diabetes-a Meta analysis

目的系统评价n-3多不饱和脂肪酸对妊娠糖尿病患者胰岛功能、血脂代谢和妊娠结局的影响。方法检索英文数据库Medline、EMbase、Cochrane对照试验中心注册数据库(Cochrance Central register of controlled trials,CENTRAL),检索语言为英语,检索起止时间为2000年1月—2017年3月。检索词为gestational diabetes,n-3 polyunsaturated fatty acid,clinical trial。中文数据库为中国知网,检索起止时间为2000年1月—2017年3月,检索词为妊娠糖尿病、n-3多不饱和脂肪酸、临床研究。纳入对妊娠糖尿病患者添加n-3多不饱和脂肪酸的随机对照试验,采用Jadad量表进行研究质量评价,使用Rev Man5.2软件进行Meta分析。结果最终纳入5篇英文文献,来源于2个不同国家的高质量研究。n-3组的胰岛素释放(I^2=92%,95%CI=-4.95^-1.03,Z=2.99,P=0.003),新生儿高胆红素血症的发病率(I^2=0%,95%CI=0.07~0.58,Z=2.94,P=0.003),n-3组新生儿住院率低于对照组(I^2=0%,95%CI=0.07~0.64,Z=2.78,P=0.005),n-3组的血清总胆固醇高于对照组(I^2=82%,95%CI=2.39~10.61,Z=3.1,P=0.002),差异均有统计学意义。空腹血糖(FPG)(I^2=100%,95%CI=-9.87~16.98,Z=0.52,P=0.6)、血清甘油三酯(I^2=99%,95%CI=-40.69~20.85,Z=0.63,P=0.53)、需要接受胰岛素治疗的比例(I^2=0%,95%CI=0.05~2.16,Z=1.16,P=0.25)和巨大儿比例(I^2=9%,95%CI=0.11~1.45,Z=1.38,P=0.17)组间差异均无统计学意义。结论现有临床证据不足以证明n-3脂肪酸对改善妊娠糖尿病患者胰岛素抵抗和母代妊娠结局有益,但对新生儿健康状况有益作用。

Objective To systematically evaluate the effect of n-3 ployunsaturated fatty acid on insulin resistance, blood fat and the pregnancy outcome of gestational diabetes. Methods Databases ofMedlme, EMBase, Cochrane Central register of controlled trials （CENTRAL） were retrieved, and the language was English. Database of CNKI was retrieved, and the language was Chinese. Time was from January 2000 to March 2017, the search words were gestational diabetes, n-3 polyunsaturated fatty acid, clinical trial. All the randomized controlled trials were included after assessed by Jadad scale. RevMan 5.2 was used for statistical analysis. Results There were 5 English literatures that came from 2 different countries at last. The level of insulin （12=92%, 95% CI=-4.95--1.03, Z=2.99, P=0.003）, newborns＇ hyperbilirubinemia rate （/2=0%, 95% CI=0.07-0.58, Z=2.94, P=0.003）, newborns＇ hospitalization rate （I2=0%, 95% CI=0.07-0.64, Z=2.78, P=0.005） in n-3 group were lower than those in control group, total cholesterol （F=82%, 95% CI=2.39-10.61, Z=3.1, P=0.002） in n-3 group was higher than that in control group, the difference was statistically significant. There were no statistical difference m FPG （I2=100%, 95% CI=-9.87-16.98, Z=0.52, P=0.6）, triglycerides （F=99%, 95% CI=-40.69-20.85, Z=0.63, P=0.53）, need to insulin therapy after intervention rote （/2=0%, 95% CI= 0.05-2.16, Z=1.16, P=0.25） and the ratio ofmacrosomia 〉4 000 g （P=9%, 95% CI=O.11- 1.45, Z--1.38, P=0.17）. Conclusion The available clinical evidence is insufficient to prove that n-3 fatty acid is beneficial to improve the insulin resistance and the pregnancy outcome of pregnant, but it is beneficial to neonatal health.