二甲双胍治疗妊娠糖尿病的系统评价  

Metformin for Gestational Diabetes:A Systemic Review

作　　者：张文慧[1] 米娜瓦尔.霍加 董旭南[2] 

机构地区：[1]新疆医科大学第一附属医院普通内科,新疆乌鲁木齐市830054 [2]新疆医科大学第一附属医院医务部

出　　处：《中国全科医学》2011年第6期592-595,共4页Chinese General Practice

摘　　要：目的评价二甲双胍治疗妊娠糖尿病的疗效及安全性。方法以"妊娠/孕期糖尿病、妊娠/孕期高血糖、降糖药物、二甲双胍、妊娠结局"为检索词,通过计算机检索Cocharane图书馆(CENTRAL 2009年第3期)、MEDLINE(Pubmed,1966—2009年)、EMBASE(1984—2008年)、中国生物医学文献光盘数据库(1978—2006年)、中文期刊全文数据库(1979—2009年)的文献,要求为临床随机对照试验。并尽量联系纳入研究的实施者。评价文献质量并提取数据,同时手工检索相关文献(包括杂志增刊及会议摘要文献)。对纳入文献进行质量评价。数据分析采用RevMan 5.0,对于异质性小的研究合并效应量。结果纳入4个随机对照试验,共872个受试对象,但有一个研究的具体数据缺乏,收集整理其余3个研究的数据。经分析,所纳入的研究不存在显著临床异质性,故采用合并分析。发现二甲双胍(单药或合用胰岛素)与单用胰岛素治疗在不良围生期结局(如新生儿低血糖、胎儿死亡、巨大儿、新生儿呼吸窘迫综合征、新生儿黄疸、新生儿入住监护病房)发生率以及宫内发育情况(出生体质量、身长)方面,差异无统计学意义(P>0.05);但与单用胰岛素相比,二甲双胍(单药或合用胰岛素)可减少孕妇体质量增加,改善治疗依从性,同时其存在较高的早产发生率及严重消化道不良反应发生率。结论二甲双胍不增加不良围生期结局发生率,对胎儿的生长发育无不良影响,但会引起消化道不良反应。Objective To assess the effect and safety of metformin for gestational diabetes.Methods Taking ＂gestational diabetes,gestational hyperglycemia,hypoglycemic agents,metformin and pregnancy outcome＂ as Key words：,search documents of clinical randomized controlled trial（RCT） in Cocharane Library,MEDLINE,EMBASE,etc,and try to contact the implementer involved in the study.Meanwhile,related documents from magazine and meeting abstract were also searched manually.The qualities of all the documents were assessed.RevMan 5.0 was used to analyze the data,with the influencing quantity of study of little heterogeneity being combined.Results Four randomized clinical trials involving 872 participants were included,of which one of the trials lacked concrete data,so data were collected from the other three trials.Analysis showed no significant clinical heterogeneity in the participants,for which combined analysis was used.The current limited data suggest that metformin（alone or complemented with insulin） was not accompanied with significantly increasing adverse perinatal outcomes（such as neonatal hypoglycemia,foetal death,giant baby,neonatal respiratory distress syndrome,newborn jaundice,newborn being in the care unit）,but with less weight gain and more treatment acceptability compared with insulin,but a higher incidence of preterm delivery and gastrointestinal side effects were shown from metformin.Conclusion Metformin will not increase the incidence of adverse perinatal outcomes and will not have adverse effect on the growth and development of the fetus,but can cause adverse reaction in alimentary tract.

关 键 词：二甲双胍 糖尿病 妊娠 围产期结局 META分析 

分 类 号：R714.25[医药卫生—妇产科学]