益生菌对妊娠期糖尿病影响的系统评价

Systematic evaluation of the effect of probiotics on gestational diabetes mellitus

目的:系统评价益生菌对妊娠期妇女糖尿病(GDM)的影响。方法:计算机检索PubMed、EMbase、Cochrane图书馆临床对照试验资料库、CBM、CNKI、维普和万方数据库,检索时间均从建库至2021年10月,手工检索相关文献。收集评价使用益生菌预防妊娠期妇女糖尿病和治疗妊娠期糖尿病的随机对照试验(RCT)。对符合纳入标准的临床研究进行质量评价和资料提取后,采取RevMan 5.1软件进行Meta分析。结果:共纳入8个RCT,包含1 149例患者,其中预防GDM的RCT 4项(802例患者);治疗GDM的RCT 4项(347例患者)。Meta分析结果表明,在预防GDM方面,与对照组(安慰剂)比较,使用益生菌能有效降低妊娠期糖尿病的发生率[RR=0.48,95%CI(0.31,0.74),P=0.001],而在妊娠期空腹血清胰岛素、空腹血糖和胰岛素抵抗指数均无统计学差异;在治疗GDM方面,与对照组(安慰剂)比较,使用益生菌能有效改善胰岛素抵抗指数[RR=-0.65,95%CI(-1.18,-0.11),P=0.02],降低空腹血清胰岛素[RR=-2.94,95%CI(-5.69,-0.20),P=0.04]水平,而在空腹血糖方面差异无统计学意义。结论:预防性使用益生菌能有效降低妊娠期糖尿病的发生率;使用益生菌治疗GDM能有效改善GDM患者胰岛素抵抗指数,降低空腹血清胰岛素。

Objective:To systematically evaluate the effect of probiotics on gestational diabetes mellitus(GDM).Methods:PubMed,EMbase,Cochrane Library clinical controlled trial database,CBM,CNKI,Weipu,and Wanfang databases were searched by computer.The retrieval time was from the establishment of the database to October 2021.Relevant documents were manually searched.Randomized controlled trials(RCTs)were collected and conducted to assess the prevalence of probiotics and their impact on gestational diabetes mellitus in pregnancy.After the quality evaluation and data extraction of clinical studies meeting the inclusion criteria,a meta-analysis was conducted using RevMan 5.1 software.Results:A total of 8 RCTs involving 1149 patients were included,including 4 RCTs for prevention of GDM involving 802 patients and 4 RCTs for treatment of GDM involving 347 patients.The results of the meta-analysis showed that:①In terms of prevention of GDM,compared with the control group(placebo),the use of probiotics could effectively reduce the incidence of diabetes in pregnancy[RR=0.48,95%CI(0.31,0.74),P=0.001],but there was no statistical difference in fasting serum insulin,fasting blood glucose,and insulin resistance index during pregnancy.②In the treatment of GDM,compared with the control group(placebo),probiotics can effectively improve the insulin resistance index[RR=-0.65,95%CI(-1.18,-0.11),P=0.02]and reduce the fasting serum insulin[RR=-2.94,95%CI(-5.69,-0.20),P=0.04]levels.However,there is no statistically significant difference in fasting blood glucose.Conclusion:Prophylactic use of probiotics can effectively reduce the incidence of diabetes in pregnancy.Using probiotics to treat GDM can effectively improve the insulin resistance index of GDM patients and reduce fasting serum insulin.