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目的:评价二甲双胍对比胰岛素/格列本脲在治疗妊娠期糖尿病的安全性及疗效。方法:以“妊娠期/孕期糖尿病,二甲双胍”为检索词,检索Cochrane Library(2012年第3期)、MEDLINE(PubMed 1980~2011年)、EMBASE(1984~2011年)、中国生物医学文献光盘数据库(1978~2011年)、中文期刊全文数据库(1979~2011年)的文献,手工检索相关文献,要求为临床随机对照试验。评价文献质量。数据分析采用Stata 11.0,对于异质性小的研究合并效应量。结果:纳入6个随机对照试验,共1 144个受试对象。结果表明,二甲双胍与胰岛素或格列本脲对比早产的发生率增高,但是在胎儿畸形,新生儿体重、低血糖发生率、巨大儿发生率、产伤、新生儿呼吸系统疾病发生率等方面,两者均无明显差异,但亚组分析中格列本脲比二甲双胍有增加新生儿体重倾向,结果有统计学意义。结论:二甲双胍在控制血糖及新生儿并发症上和胰岛素无差异,同时对于控制新生儿体质量效果明显,使用安全,是一个适用于妊娠期糖尿病尤其是肥胖患者的口服降糖药。
Objective: To evaluate the safety and efficacy of metformin versus insulin / glyburide in the treatment of gestational diabetes mellitus. METHODS: The Cochrane Library (2012 issue 3), MEDLINE (PubMed 1980-2011), EMBASE (1984-2011), and Chinese biomedical literature were searched using the term “pregnancy / gestational diabetes mellitus and metformin” CD-ROM database (1978 ~ 2011), Chinese Journal Full-text Database (1979 ~ 2011) literature, manual retrieval of relevant literature, required for clinical randomized controlled trials. Evaluation of the quality of the literature. Data analysis using Stata 11.0, for heterogeneity of the study combined effect amount. Results: Six randomized controlled trials were included for a total of 1 144 subjects. The results showed that metformin and insulin or glyburide increased the incidence of preterm birth, but in fetal malformations, neonatal body weight, the incidence of hypoglycemia, the incidence of giant children, birth trauma, neonatal respiratory disease incidence and so on, There was no significant difference between the two groups, but the subgroup analysis of glyburide than metformin increased weight trends in newborns, the results were statistically significant. CONCLUSION: Metformin has no difference in the control of blood sugar and neonatal complications and insulin, and is effective in controlling neonatal body weight. It is an oral antidiabetic drug suitable for gestational diabetes, especially in obese patients.