维生素D补充对妊娠期糖尿病患者血糖及血脂控制的影响:随机对照研究的Meta分析

Effects of vitamin D supplementation on glycaemic control and lipid profiles in gestational diabetes mellitus: a Meta-analysis of randomized controlled trials

目的系统评价妊娠期糖尿病患者补充维生素D与糖稳态参数及血脂指标的关系。方法计算机检索PubMed、Web of Science、中国知网和万方数据库,搜索补充维生素D相关的随机对照试验,检索时间为建库开始至2018年2月1日。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3和Stata 15.0软件进行Meta分析。结果最终纳入6个RCT,共409例患者(试验组204例,对照组205例)。Meta分析结果显示,试验组与对照组相比,空腹血糖[MD=-11.43,95% CI=(-15.24-7.61),P=0.000 01]、空腹胰岛素[MD=-4.8,95% CI=(-5.99,3.62),P<0.000 01]、稳态模型评估的胰岛素抵抗指数(HOMA-IR)[MD=-1.48,95% CI=(-1.81,1.16),P<0.000 01]、总胆固醇(TC)[MD=-14.09,95% CI=(-22.09,5.2),P=0.002]、低密度脂蛋白胆固醇(LDL)水平显著下降[MD=-10.54,95% CI=(-18.18,2.89),P=0.007],高密度脂蛋白胆固醇(HDL)水平较对照组升高[MD=2.11,95% CI=(0.36,3.86),P=0.02],但对于甘油三酯(TG),两组比较差异无统计学意义。结论妊娠期糖尿患者补充维生素D可降低空腹血糖、胰岛素、TC、LDL,改善胰岛素抵抗,升高HDL,但对TG无明显影响。

Objective To systematically evaluate the effects of vitamin D supplementation on glucose homeostasis parameters and lipid profiles in gestational diabetes patients. Methods Four main databases including PubMed, Web of Science, CNKI and Wanfang were searched to collect randomized controlled trials (RCTs) about vitamin D supplementation for gestational diabetes mellitus from inception to February 1, 2018.Two investigators were chosen to search, extract and evaluate the data independently. Software RevMan 5.3 and Stata 15.0 were used for meta-analysis. Results Results A total of 6 randomized RCTs were included including 409 patients totally which were divided into two groups as study group(n=204) and control group(n=205). The results showed that compared with the control group, patients in study group had lower fasting plasma glucose(FPG)[MD=-11.43, 95% CI=(-15.24-7.61), P=0.000 01], fasting insulin(FIns)[MD=-4.8, 95% CI=(-5.99, 3.62), P<0.000 01], insulin homeostasis model assessment of insulin resistance(HOMA-IR)[MD=-1.48, 95% CI=(-1.81, 1.16), P<0.000 01], total-cholesterol(TC)[MD=-14.09, 95% CI=(-22.09, 5.2), P=0.002], low-density lipoprotein(LDL)[MD=-10.54, 95% CI=(-18.18, 2.89), P=0.007] and high-density lipoprotein(HDL)[MD=2.11, 95% CI=(0.36, 3.86), P=0.02]. No significant difference was found in triglycerides level(TG) between the two groups. Conclusion Vitamin D supplementation in patients with gestational diabetes can improve FPG, insulin, TC, LDL, insulin resistance and HDL, but has no effect on TG.