妊娠期糖尿病早期筛查指标建立的探索及系统评价  

Exploration of establishment of early screening indexes of gestational diabetes mellitus and systematical evaluation

作　　者：张展[1] 蒋陈东 冯杨[1] 张琳琳[1] 王金铭[1] 宋婉玉 徐娜[1] 

机构地区：[1]郑州大学第三附属医院检验科,河南郑州450052

出　　处：《中国妇幼保健》2015年第31期5501-5506,共6页Maternal and Child Health Care of China

基　　金：2014年度中国疾病预防控制中心妇幼保健中心合生元母婴营养与健康研究项目〔2014FYH011〕

摘　　要：目的通过系统评价的方法,探究相关孕早期血清学指标与妊娠期糖尿病(GDM)的相关性,为GDM早期筛查指标的建立提供参考。方法检索Pub Med、MEDLINE、Embase、CNKI及万方数据库中关于GDM孕早期血清学指标的相关研究,孕早期收集各指标的血标本并即时检测,检索时限为建库至2015年2月。分析软件为Rev Man 5.3,合并效应量为加权均数差(WMD)。结果共纳入23篇研究,主要血清学指标为脂联素、瘦素及肿瘤坏死因子-α(TNF-α)等。孕早期血清脂联素水平分析,纳入2 511例孕产妇,Meta分析显示,GDM组孕早期血清脂联素水平低于对照组(WMD=3.19μg/ml,95%CI为-3.91^-2.46,P<0.01)。中国人群亚组分析,纳入758例孕产妇,结果显示,GDM组孕早期血清脂联素水平低于对照组(WMD=-4.85μg/ml,95%CI为-5.65^-3.59,P<0.01)。瘦素水平分析,纳入557例孕产妇,Meta分析显示,GDM组孕早期血清瘦素水平高于对照组(WMD=10.35 ng/ml,95%CI为7.80~12.90,P<0.01)。中国人群亚组分析,纳入376例孕产妇,WMD=6.98 ng/ml,95%CI为5.60~8.36,P<0.01。TNF-α分析,纳入384例孕产妇,Meta分析显示,GDM组孕早期血清TNF-α水平高于对照组,WMD=2.29 pg/ml,95%CI为1.08~3.50,P<0.01。结论孕早期血清脂联素水平降低及瘦素与TNF-α水平增加可增加人群患GDM的风险,可纳入为GDM早期筛查的血清学指标。Objective To explore the correlation between serological indexes during the first trimester of pregnancy and gestational diabetes mellitus （GDM） by systematical evaluation, provide reference for establishing early screening indexes of GDM. Methods The relevant studies about serological indexes of GDM during the first trimester of pregnancy were retrieved in PubMed, Medline, Embase, CNKI, and Wanfang database; the blood specimens during the first trimester of pregnancy were collected and detected immediately, the retrieval time was from establishment of the database to February 2015, all the data was analyzed on RevMan 5.3 software, the effect size was weighted mean difference （WMD） . Results A total of 23 studies were included. The main serological indexes included adipouectin, leptin, tumor necrosis factor-α （TNF-α） , and so on. A total of 2 511 pregnant women were included into serum adiponectin levels analysis during the first trimester of pregnancy. Meta analysis showed that serum adiponectin level during the first trimester of pregnancy in GDM group was statistically significantly lower than that in control group （WMD= 3. 19 μg/ml, 95% CI： -3.91--2.46, P〈0. 01 ） . A total of 758 pregnant women were included into Chinese population subgroup analysis, the results showed that serum adiponectin level during the first trimester of pregnancy in GDM group was statistically significantly lower than that in control group （WMD =-4. 85 μg/ml, 95% CI： -5.65--3.59, P〈 0.01 ） . A total of 557 pregnant women were included into leptin levels analysis, Meta analysis showed that serum adiponectin level during the first trimester of pregnancy in GDM group was statistically significanily higher than that in control group （ WMD = 10. 35 ng/ml, 95% CI： 7. 80-12. 90, P〈0. 01 ） . A total of 376 pregnant women were included into Chinese population subgroup analysis, the results showed that WMD was 6. 98 ng/ml, 95% CI ranged from 5.60 to 8.36 （P〈0. 01 ） . A total of 384 pregnant women wer

关 键 词：妊娠期糖尿病 脂联素 瘦素 TNF-Α META分析 

分 类 号：R714.256[医药卫生—妇产科学]