国际内分泌代谢杂志
國際內分泌代謝雜誌
국제내분비대사잡지
INTERNATIONAL JOURNAL OF ENDOCRINOLOGY AND METABOLISM
2015年
2期
93-99
,共7页
胰岛素类似物%妊娠%糖尿病%不良结局
胰島素類似物%妊娠%糖尿病%不良結跼
이도소유사물%임신%당뇨병%불량결국
Insulin analogues%Pregnancy%Diabetes mellitus%Adverse outcome
目的 探讨胰岛素类似物门冬胰岛素(aspart)、赖脯胰岛素(lispro)、甘精胰岛素(glargine)、地特胰岛素(detemir)对妊娠糖尿病结局的影响.方法 分别在Embase、Pubmed、Cochrane数据库中检索不同胰岛素类似物治疗妊娠糖尿病的回顾性研究、前瞻性研究及随机对照研究的文献,所有数据库均检索至2014年3月31日.相关数据使用Revman5.2软件进行分析.结果 共检索文献3 519篇,其中24篇符合纳入标准,共纳入研究对象3 734例.Lispro与常规胰岛素相比,可以减少新生儿黄疸[风险比(RR=0.63,95％ CI:0.44～0.90,P=0.01)]、孕妇严重低血糖(RR=0.33,95％ CI:0.12～0.89,P =0.03)的发生,但可增加新生儿体重(WMD=116.44,95％ CI:28.78 ～ 204.11,P=0.009)和大于胎龄儿(RR=1.42,95％ CI:1.20～ 1.69,P＜0.000 1)的发生.Aspart与常规胰岛素相比,剖宫产及巨大儿的发生率无显著差别.Glargine与NPH相比,不增加新生儿体重、严重低血糖等不良结局的发生.Detemir 与NPH相比,不增加大于胎龄儿、巨大儿及新生儿低血糖的发生.结论 在妊娠糖尿病患者中使用aspart、glargine、detemir不会增加母亲和胎儿不良后果,有较好的安全性,但lispro的安全性需要进一步研究.
目的 探討胰島素類似物門鼕胰島素(aspart)、賴脯胰島素(lispro)、甘精胰島素(glargine)、地特胰島素(detemir)對妊娠糖尿病結跼的影響.方法 分彆在Embase、Pubmed、Cochrane數據庫中檢索不同胰島素類似物治療妊娠糖尿病的迴顧性研究、前瞻性研究及隨機對照研究的文獻,所有數據庫均檢索至2014年3月31日.相關數據使用Revman5.2軟件進行分析.結果 共檢索文獻3 519篇,其中24篇符閤納入標準,共納入研究對象3 734例.Lispro與常規胰島素相比,可以減少新生兒黃疸[風險比(RR=0.63,95％ CI:0.44～0.90,P=0.01)]、孕婦嚴重低血糖(RR=0.33,95％ CI:0.12～0.89,P =0.03)的髮生,但可增加新生兒體重(WMD=116.44,95％ CI:28.78 ～ 204.11,P=0.009)和大于胎齡兒(RR=1.42,95％ CI:1.20～ 1.69,P＜0.000 1)的髮生.Aspart與常規胰島素相比,剖宮產及巨大兒的髮生率無顯著差彆.Glargine與NPH相比,不增加新生兒體重、嚴重低血糖等不良結跼的髮生.Detemir 與NPH相比,不增加大于胎齡兒、巨大兒及新生兒低血糖的髮生.結論 在妊娠糖尿病患者中使用aspart、glargine、detemir不會增加母親和胎兒不良後果,有較好的安全性,但lispro的安全性需要進一步研究.
목적 탐토이도소유사물문동이도소(aspart)、뢰포이도소(lispro)、감정이도소(glargine)、지특이도소(detemir)대임신당뇨병결국적영향.방법 분별재Embase、Pubmed、Cochrane수거고중검색불동이도소유사물치료임신당뇨병적회고성연구、전첨성연구급수궤대조연구적문헌,소유수거고균검색지2014년3월31일.상관수거사용Revman5.2연건진행분석.결과 공검색문헌3 519편,기중24편부합납입표준,공납입연구대상3 734례.Lispro여상규이도소상비,가이감소신생인황달[풍험비(RR=0.63,95％ CI:0.44～0.90,P=0.01)]、잉부엄중저혈당(RR=0.33,95％ CI:0.12～0.89,P =0.03)적발생,단가증가신생인체중(WMD=116.44,95％ CI:28.78 ～ 204.11,P=0.009)화대우태령인(RR=1.42,95％ CI:1.20～ 1.69,P＜0.000 1)적발생.Aspart여상규이도소상비,부궁산급거대인적발생솔무현저차별.Glargine여NPH상비,불증가신생인체중、엄중저혈당등불량결국적발생.Detemir 여NPH상비,불증가대우태령인、거대인급신생인저혈당적발생.결론 재임신당뇨병환자중사용aspart、glargine、detemir불회증가모친화태인불량후과,유교호적안전성,단lispro적안전성수요진일보연구.
Objective To assess the effects of insulin analogues(aspart,lispro,glargine,and detemir) on the pregnant outcome in diabetic patients.Methods Embase,Pubmed,and Cochrane database were searched for respective study,prospective study and randomized study on different insulin analogues therapy through May 31,2014.Statistical analysis was done by RevMan 5.2 software.Results 3 519 articles were searched,24 studies met the eligible criteria and a total of 3 734 cases were included.Compared with regular insulin,lispro decreased the rates of neonatal jaundice [risk ratio(RR =0.63,95％ CI:0.44-0.90,P=0.01)] and severe maternalhypoglycemia (RR =0.33,95％ CI:0.12-0.89,P =0.03),and increased birth weight (WMD=116.44,95％ CI:28.78-204.11,P=0.009)and the incidence of large for gestational age (LGA) births (RR =1.42,95％ CI:1.20-1.69,P ＜0.000 1).Rates of cesarean section and macrosomia were similar in pregnant women treated with aspart and regular insulin.Birth weights and rates of severe maternal hypoglycemia were similar in pregnant women treated with glargine and NPH insulin.Rates of LGA,macrosomia,and neonatal hypoglycemia were similar in pregnant women treated with detemir and NPH insulin.Conclusions Aspart,glargine,detemir are safe for the treatment of diabetes during pregnancy,and do not increase the adverse outcome of mothers or fetuses,but the safety of lispro need further research.
