循环vaspin水平与妊娠糖尿病的关联:系统综述与Meta分析

Association between circulating vaspin levels and the risk of gestational diabetes mellitus:A systematic review and Meta-analysis

目的评价循环vaspin水平与妊娠糖尿病(gestational diabetes mellitus,GDM)的关联。方法系统检索PubMed、EMBASE、Web of Science、中国知网和万方数据库。检索时间截至2019年6月。使用随机效应模型或固定效应模型,计算合并标准化均数差(standardized mean differences,SMD)及其95%置信区间(confidence interval,CI)。通过亚组分析、Meta回归分析、敏感性分析和发表偏倚分析评价结果的异质性与稳定性。所有统计分析均使用STATA 12.0软件。结果共纳入2013年至2019年期间发表的9篇文献(11个研究),涵盖738例GDM患者和661例健康孕妇。GDM患者和健康孕妇之间总体循环vaspin水平差异有统计学意义(SMD=0.613,95%CI:0.044~1.182,P=0.035)。根据vaspin水平所处的孕期和体重指数(body mass index,BMI)是否匹配进行亚组分析,其相关方向与总结果相似;按照种族进行亚组分析,发现在"欧洲人"亚组中vaspin水平与GDM可能无关;通过敏感性分析,在排除了质量中等的研究和BMI没有匹配的研究后,循环vaspin水平与GDM的关系依然存在。结论在亚洲人群中,孕产妇循环vaspin水平可能与GDM的风险呈正相关。

Objective To review the existing literature and quantitatively evaluate the association of circulating vaspin levels and the risk of gestational diabetes mellitus(GDM).Methods We systematically searched the PubMed,EMBASE,Web of Science,China National Knowledge Infrastructure,and WanfangData databases up to June 2019.Pooled standardized mean differences(SMDs)with 95%confidence intervals(CIs)were calculated using random-or fixed-effects models based on the heterogeneity of studies.Subgroup analyses,Meta-regression,sensitivity and publication bias were assessed to analyze the heterogeneity and the robustness of the results.All statistical analyses were performed using STATA 12.0.Results Nine articles(11 comparisons)published from 2013 to 2019 were included in our final Meta-analysis,covering a total of 738 patients with GDM and 661 normal pregnant women.There was significant difference in the overall maternal circulating vaspin levels between GDM patients and healthy pregnant women(SMD=0.613,95%CI:0.044-1.182,P=0.035).Subgroup analyses stratified by trimester in which vaspin was measured and whether BMI was matched suggested the similar trend to the overall result.Subgroup analysis according to ethnicity found that circulating vaspin level might not be related to GDM in"European"subgroup;sensitivity analysis by excluding moderate-quality studies and BMI-unmatched studies found that circulating vaspin levels were still related to GDM risk.Conclusions Our Meta-analysis indicated that maternal circulating vaspin levels might be positively correlated with the risk of GDM in Asians.