妊娠糖尿病胎盘差异表达蛋白与胰岛素抵抗相关性的meta分析和系统评价  

The relationship between differential placental protein expressions and insulin resistance:a systematic review and meta-analysis

作　　者：黄萍萍 葛莉[1] 缪海燕[2] 王冠东 赖玉婷 江心泳 陈凡 庞书勤[1] 于红虹[1] HUANG Pingping;GE Li;MIAO Haiyan;WANG Guandong;LAI Yuting;JIANG Xinyong;CHEN Fan;PANG Shuqin;YU Honghong(School of Nursing,Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian 350122,P.R.China;Department of Obstetrics and Gynecology,the Second Peopled Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou,Fujian 350003,P.R.China)

机构地区：[1]福建中医药大学护理学院,福州350122 [2]福建中医药大学附属第二人民医院妇产科,福州350003

出　　处：《华西医学》2021年第12期1705-1715,共11页West China Medical Journal

基　　金：福建省自然科学基金(2018J01868);福建中医药大学校管课题重点专项资助(X2017011-重点)。

摘　　要：目的系统评价妊娠糖尿病(gestational diabetes mellitus,GDM)胎盘蛋白表达水平改变及其与母体胰岛素抵抗(insulin resistance,IR)的相关性。方法计算机检索PubMed、Cochrane Library、Scoups、Web of Science、Embase、中国知网数据库、维普数据库、万方数据库和中国生物医学文献数据库中有关GDM胎盘蛋白表达改变及与IR相关性的病例对照研究。检索时限均为2009年1月—2021年11月。由2名评价者独立筛选文献、提取资料及评价文献质量。采用RevMan 5.4软件进行meta分析,对不能合并分析的数据进行描述性分析。结果共纳入19篇文献,包括2 012例患者。Meta分析结果示:GDM胎盘上视黄醇结合蛋白4表达水平升高[标准化均数差=2.11,95%置信区间(confidence interval,CI)(1.64,2.58),P<0.000 01],蛋白酪氨酸磷酸酶1B表达阳性率升高[相对危险度(relative risk,RR)=1.56,95%CI(1.29,1.88),P<0.000 01],胰岛素受体底物1表达阳性率降低[RR=0.69,95%CI(0.60,0.78),P<0.000 01];且视黄醇结合蛋白4(P<0.000 01)、蛋白酪氨酸磷酸酶1B(P<0.000 01)蛋白表达与胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)呈正相关,胰岛素受体底物1(P<0.000 01)和脂联素(P=0.002)蛋白表达均与HOMA-IR呈负相关,葡萄糖转运蛋白4与HOMA-IR不相关(P=0.79)。描述性分析发现,脂肪细胞因子(瘦素、抵抗素)、氧化应激标志物(黄嘌呤氧化酶、丙二醛、8-异前列腺素)、炎症因子(肿瘤坏死因子-α、Toll样受体4、半乳糖凝集素3、半乳糖凝集素2、巨噬细胞移动抑制因子)、胎球蛋白A、叉形头转录因子O亚型1、叉形头转录因子O亚型3a、雌激素受体α在GDM胎盘中的表达水平或阳性率上调,且均与HOMA-IR呈正相关。胰岛素抵抗信号通路蛋白(磷脂酰肌醇3-激酶、蛋白激酶B、磷酸化蛋白激酶B、葡萄糖转运蛋白4)表达水平或阳性率下调,且磷脂酰肌醇3-激酶、蛋白激酶B与HOMA-IR呈负相关,磷酸�Objective To systematically evaluate the changes in placental protein expressions in gestational diabetes mellitus(GDM) and their correlations with maternal insulin resistance(IR). Methods PubMed, Cochrane Library, Scopus, Web of Science, Embase, China National Knowledge Infrastructure, VIP database, Wanfang Database and CBMdisc were searched for case-control studies published from January 2009 to November 2021, which reported the placental protein expressions in GDM and their correlations with IR. Two researchers independently reviewed the literature, extracted data and evaluated the literature quality. RevMan 5.4 software was used for meta-analysis, and descriptive analysis was performed on data that cannot be combined. Results A total of 19 studies were included,comprising 2 012 patients. The results of meta-analysis showed that: the expression level of retinol binding protein4(RBP4) [standard mean difference=2.11, 95% confidence interval(CI)(1.64, 2.58), P<0.000 01] and the positive rate of protein tyrosine phosphatase-1 B(PTP1 B) [relative risk(RR)=1.56, 95%CI(1.29, 1.88), P<0.000 01] were up-regulated, and the positive rate of insulin receptor substrate 1(IRS-1) [RR=0.69, 95%CI(0.60, 0.78), P<0.000 01] was down-regulated.The protein expression levels of RBP4(P<0.000 01) and PTP1 B(P<0.000 01) were positively correlated with homeostasis model assessment of insulin resistance(HOMA-IR), while the protein expression levels of IRS-1(P<0.000 01) and APN(P=0.002) were negatively correlated with HOMA-IR, and glucose transporter 4(GLUT 4) was not correlated with HOMA-IR(P=0.79). Descriptive analysis found that the expression levels or positive rates of adipocytokines(leptin,resistin), oxidative stress markers(xanthione oxidase, malondialdehyde, 8-isoprostaglandin), inflammatory factors(tumor necrosis factor α, Toll-like receptor 4, Galectin-3, Galectin-2, migration inhibitory factor), fetuin-A, forkhead box transcription factor 1, forkhead box transcription factor 3 a and estrogen receptor α in GDM placenta were u

关 键 词：妊娠糖尿病 胎盘 胎盘蛋白 胰岛素抵抗 系统评价 

分 类 号：R714.256[医药卫生—妇产科学]