胰岛素持续皮下输注与多次皮下注射对妊娠合并糖尿病患者影响的Meta分析

Meta-analysis of continuous subcutaneous infusion and intermittent subcutaneous injection of insulin in treatment of patients with gestational diabetes mellitus

目的系统评价胰岛素持续皮下输注给药与多次皮下注射给药对妊娠期糖尿病患者血糖控制及妊娠结局的影响。方法计算机检索PubMed、Embase、Cochrane Library、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普生物医学数据库(VIP)、万方数据库(Wanfang Deta),搜索胰岛素持续皮下输注给药与多次皮下注射给药治疗妊娠合并糖尿病的回顾性病例对照研究,检索时间为数据库建立至2022年1月31日。采用Review Manager 5.3软件进行Meta分析。结果共纳入15项研究,1301例患者。Meta分析结果显示:相较于胰岛素多次皮下注射,持续皮下输注能显著缩短产妇血糖达标时间[SMD=−2.40,95%CI(−2.91,−1.89)]、减少胰岛素用量[SMD=−1.45,95%CI(−1.61,−1.28)],降低妊高症发生率[OR=0.31,95%CI(0.22,0.43)]、低血糖发生率[OR=0.32,95%CI(0.22,0.47)]、羊水过多发生率[OR=0.36,95%CI(0.26,0.49)]、胎膜早破发生率[OR=0.28,95%CI(0.12,0.63)]、宫内窘迫发生率[OR=0.32,95%CI(0.18,0.56)]和产后出血发生率[OR=0.21,95%CI(0.11,0.43)],降低新生儿巨大儿发生率[OR=0.26,95%CI(0.18,0.39)]、早产发生率[OR=0.32,95%CI(0.22,0.47)]、窒息发生率[OR=0.29,95%CI(0.20,0.42)]、畸形发生率[OR=0.27,95%CI(0.09,0.79)]、低血糖发生率[OR=0.31,95%CI(0.21,0.44)]和高胆红素血症发生率[OR=0.30,95%CI(0.19,0.47)],差异均有统计学意义(P<0.01)。结论胰岛素持续皮下输注给药治疗妊娠期合并糖尿病较多次皮下注射给药在妊娠期糖尿病患者血糖控制和减少不良妊娠结局更有显著优势。

Objective To systematically evaluate the difference of blood glucose control and pregnancy outcomes of continuous subcutaneous infusion and intermittent subcutaneous injection of insulin in the treatment of patients with gestational diabetes mellitus(GDM).Methods Literature search was conducted across PubMed,Embase,Cochrane Library,CNKI,CBM,Wanfang Deta,and VIP,to search for retrospective case-control study of continuous subcutaneous infusion and intermittent subcutaneous injection of insulin in the treatment of GDM.The retrieval time was set from the establishment of the database to January 31,2022.and Meta-analysis was conducted by Review Manager 5.3 software.Results A total of 15 retrospective case-control studies involving 1301 patients were included.Meta-analysis showed that compared with intermittent subcutaneous injection of insulin,continuous subcutaneous infusion could significantly shorten the time to reach the blood sugar target[SMD=−2.40,95%CI(−2.91,−1.89)],reduce insulin dosage[SMD=−1.45,95%CI(−1.61,−1.28)],reduce complication rates of maternity in pregnancy-induced hypertension[OR=0.31,95%CI(0.22,0.43)],hypoglycemia[OR=0.32,95%CI(0.22,0.47)],polyhydramnios[OR=0.36,95%CI(0.26,0.49)],premature rupture of membranes[OR=0.28,95%CI(0.12,0.63)],intrauterine distress[OR=0.32,95%CI(0.18,0.56)]and postpartum hemorrhage[OR=0.21,95%CI(0.11,0.43)],reduce complication rates of newborn in macrosomia[OR=0.26,95%CI(0.18,0.39)],preterm birth[OR=0.32,95%CI(0.22,0.47)],asphyxia[OR=0.29,95%CI(0.20,0.42)],deformity[OR=0.27,95%CI(0.09,0.79)],hypoglycemia[OR=0.31,95%CI(0.21,0.44)],and hyperbilirubinemia[OR=0.30,95%CI(0.19,0.47)],which were statistically significant(P<0.01).Conclusion The continuous subcutaneous infusion of insulin in the treatment of GDM is more effective in the control of blood glucose and the reduction of adverse pregnancy outcomes than intermittent subcutaneous injection.