硒补充对血糖及胰岛素稳态影响的Meta分析

Effect of Selenium Supplementation on Glucose Control and Insulin Sensitivity:A Meta-Analysis of Randomized Controlled Trials

目的:评价硒补充对血糖控制及胰岛素稳态的影响。方法:检索PubMed、Medline、Cochrane Library、CNKI、万方、维普数据库中关于硒补充对人群血糖控制及胰岛素稳态影响的随机对照试验(RCTs),时限为建库至2020年12月,由2名研究者进行文献筛选,使用Jadad量表评估文献质量,采用RevMan 5.3软件对纳入文献进行Meta分析。结果:共纳入16篇文献(n=21 419)。Meta分析结果显示,硒补充可降低胰岛素浓度[WMD=-2.78,95%CI(-4.56,-1.00)]和胰岛素抵抗指数[WMD=-0.78,95%CI(-1.52,-0.04)],增加胰岛素敏感性指数[WMD=0.01,95%CI(0.00,0.02)],但对于空腹血糖[WMD=-1.76,95%CI(-5.95,2.44)]无显著影响;可能增加糖尿病的发病风险[OR=1.12,95%CI(1.01,1.24)]。亚组分析结果显示,硒补充增加糖尿病患者和50岁以上人群的胰岛素敏感性指数,降低50岁及以下人群的胰岛素抵抗指数,其他指标无显著性差异。结论:硒补充能够降低胰岛素浓度和胰岛素抵抗指数,增加胰岛素敏感性指数,但对血糖浓度没有显著影响。另外,在特定人群中硒补充可能增加糖尿病的发病风险。

【Objective】To investigate the effect of selenium supplementation on glucose control and insulin homeostasis.【Method】We searched PubMed,Medline,Cochrane Library,CNKI and others databases(up to December 2020)for randomized controlled trials(RCTs)that assessed the effect of selenium supplementation on glucose control and insulin homeostasis.The literature was chosen according to including and excluding standards.RevMan 5.3 software was used for Meta-analysis.【Result】A total of 16 RCTs(n=21419)were included in the meta-analysis.The results showed that selenium supplementation significantly reduced insulin levels[WMD=-2.78,95%CI(-4.56,-1.00)]and homeostasis model assessment of insulin resistance(HOMA-IR)[WMD=-0.78,95%CI(-1.52,-0.04)]and increased quantitative insulin sensitivity check index(QUICKI)[WMD=0.01,95%CI(0.00,0.02)],Selenium supplementation had no beneficial effects on other glucose homeostasis parameters,such as fasting plasma glucose(FPG)[WMD=-1.76,95%CI(-5.95,2.44)],but increased the risk of diabetes prevalence[OR=1.12,95%CI(1.01,1.24)].The results of subgroup analysis showed that selenium supplementation increased the QUICK of diabetic patients and people over the age of 50,and decreased the HOMA-IR of people 50 and under.There was no significant difference in other indicators.【Conclusion】Selenium supplementation may lead to an improvement in insulin levels,HOMA-IR and QUICK,but did not affect FPG.In addition,selenium supplementation may increase the incidence of diabetes in certain populations.