参芪降糖颗粒联合西药对妊娠期糖尿病患者不良妊娠结局影响的Meta分析  

Meta-analysis of Shenqi Jiangtang Granules combined with western medicine on adverse pregnancy outcomes in women with gestational diabetes mellitus

作　　者：张丽君 胡晓强 于晶晶 王颖 张嘉蔚 徐贤荣 杨军[1,2] ZHANG Li-jun;HU Xiao-qiang;YU Jing-jing;WANG Ying;ZHANG Jia-wei;XU Xian-rong;YANG Jun(Department of Nutrition and Toxicology,School of Public Health,Hangzhou Normal University,Hangzhou 311121,China;Center for Uterine Cancer Diagnosis and Therapy Research,the Affiliated Women′s Hospital,Zhejiang University,Hangzhou 310006,China)

机构地区：[1]杭州师范大学公共卫生学院营养与毒理学系,浙江杭州311121 [2]浙江大学附属妇产科医院子宫恶性肿瘤诊治中心,浙江杭州310006

出　　处：《中国中药杂志》2022年第10期2811-2818,共8页China Journal of Chinese Materia Medica

基　　金：国家自然科学基金项目(31971138);浙江省自然科学基金项目(LZ19H260001)。

摘　　要：为评估参芪降糖颗粒(SJG)联合西药治疗对妊娠期糖尿病(GDM)患者不良妊娠结局的影响,该文检索了PubMed、Web of Science、中国知网(CNKI)、万方(Wanfang)、维普(VIP),收集SJG联合西药治疗GDM的临床随机对照试验(RCT),采用Cochrane系统评价指导手册推荐的评价标准对纳入文献进行风险评估,用Stata 12.0、RevMan 5.3软件进行Meta分析。共纳入19项RCTs,1647例患者,其中单纯西药治疗824例,SJG联合西药治疗823例,治疗时间最长12周,最短2周。Meta分析结果显示,与单纯西药治疗相比,SJG联合西药可以降低产后出血(OR=0.23,95%CI[0.10,0.53],P=0.0006)、妊娠期高血压(OR=0.24,95%CI[0.13,0.45],P<0.00001)、羊水过多(OR=0.25,95%CI[0.14,0.46],P<0.00001)、胎膜早破(OR=0.20,95%CI[0.09,0.45],P<0.0001)、剖宫产(OR=0.40,95%CI[0.29,0.55],P<0.00001)、巨大儿(OR=0.19,95%CI[0.08,0.47],P<0.0003)、新生儿窒息(OR=0.22,95%CI[0.12,0.40],P<0.00001)、早产(OR=0.19,95%CI[0.12,0.30],P<0.00001)、蛋白尿(OR=0.19,95%CI[0.06,0.58],P=0.004)及低血糖(OR=0.28,95%CI[0.16,0.50],P<0.0001)的发生,且差异均具有统计学意义。各指标的漏斗图及Egger′s检验结果显示,除巨大儿存在发表偏倚外,其他指标的结果均不存在显著的发表偏倚。因此,SJG联合西药治疗能够有效降低GDM患者多种不良妊娠结局发生率,但因纳入研究质量参差不齐,临床应用该结论尚需谨慎。The present study evaluated the effect of Shenqi Jiangtang Granules(SJG)combined with western medicine on the adverse pregnancy outcomes in women with gestational diabetes mellitus(GDM).PubMed,Web of Science,CNKI,Wanfang,and VIP were searched for clinical randomized controlled trials(RCTs)of SJG combined with western medicine against GDM.The included RCTs were assessed for risks using the assessment criteria recommended by the Cochrane handbook for systematic reviews of interventions.Meta-analysis was performed using Stata 12.0 and RevMan 5.3.Nineteen RCTs were included,with 1647 patients involved,including 824 cases treated with western medicine alone,and 823 cases treated with SJG combined with western medicine.The course of treatment ranged from 2 to 12 weeks.As revealed by Meta-analysis results,compared with western medicine treatment alone,SJG combined with western medicine could reduce the incidence of postpartum hemorrhage(OR=0.23,95%CI[0.10,0.53],P=0.0006),gestational hypertension(OR=0.24,95%CI[0.13,0.45],P<0.00001),polyhydramnios(OR=0.24,95%CI[0.12,0.45],P<0.0001),premature rupture of membranes(OR=0.20,95%CI[0.09,0.45],P<0.0001),cesarean section(OR=0.40,95%CI[0.29,0.55],P<0.00001),macrosomia(OR=0.19,95%CI[0.08,0.47],P<0.0003),neonatal asphyxia(OR=0.22,95%CI[0.12,0.40],P<0.00001),premature delivery(OR=0.19,95%CI[0.12,0.30],P<0.00001),proteinuria(OR=0.19,95%CI[0.06,0.58],P=0.004)and hypoglycemia(OR=0.28,95%CI[0.16,0.50],P<0.0001).The funnel plots and Egger′s test showed that except macrosomia,there was no significant publication bias in the results of other indicators.Therefore,as indicated by the findings,SJG combined with western medicine can reduce the incidence of adverse pregnancy outcomes in GDM patients.However,due to the uneven quality of the included trials,the clinical application of this protocol requires caution.

关 键 词：参芪降糖颗粒 妊娠期糖尿病 不良妊娠结局 疗效 META分析 

分 类 号：R714.256[医药卫生—妇产科学]