动态血糖和自我血糖监测对妊娠期糖尿病患者母婴结局影响的Meta分析-东南大学学报医学版

动态血糖和自我血糖监测对妊娠期糖尿病患者母婴结局影响的Meta分析

单位：1. 东南大学医学院南京鼓楼医院江苏南京 210009;
2. 南京大学医学院附属鼓楼医院内分泌科, 江苏南京 210009

分类号：R714.256

出版年·卷·期（页码）：2021·40·第五期（675-683）

摘要：

目的：系统评价动态血糖监测（continuous glucose monitoring，CGM）和自我血糖监测（self-monitoring blood glucose，SMBG）对妊娠期糖尿病（gestational diabetes mellitus，GDM）患者母婴结局的影响。方法：计算机检索PubMed、Web of Science、BMJ、万方数据库、中国知网（包括中国学术期刊网）和维普（VIP）数据库自建库至2020年12月；根据循证医学PICO原则，筛选出有关CGM和SMBG对GDM患者母婴结局影响的中英文随机对照试验（RCT），提取相关文献的研究数据，并运用Jadad量表对其进行质量评价。运用RevMan5.3软件对所提取的数据进行Meta分析。对比CGM和SMBG两组不良妊娠结局的发生率。结果：共纳入4篇文献。与SMBG相比，根据CGM调整治疗方案可降低巨大儿、剖宫产的发生率。巨大儿的OR=0.37，95% CI为0.19~0.72，P=0.003；剖宫产的OR=0.56，95% CI为0.39~0.80，P=0.001。与SMBG相比，根据CGM调整治疗方案可降低早产、羊水过多、新生儿低血糖、新生儿高胆红素血症的发生率，并且降低新生儿住院率，但差异均无统计学意义。早产的RR=0.54，95% CI为0.14~2.04，P=0.36；羊水过多的RR=-0.07，95% CI为-0.37~0.22，P=0.62；新生儿低血糖的RR=0.67，95% CI为0.32~1.43，P=0.31；高胆红素血症的RR=0.67，95% CI为0.13~3.61，P=0.65；新生儿住院率的RR=1.29，95% CI为0.73~2.27，P=0.38。孕期使用CGM会增加孕期胰岛素使用率和增加低出生体重儿的发生率。孕期胰岛素使用率的RR=1.79，95% CI为1.05~3.05，P=0.03；低出生体重儿的OR=2.25，95% CI为1.11~4.56，P=0.02。结论：GDM患者在孕期使用CGM调整治疗方案可降低巨大儿等不良妊娠结局的发生率，但同时会增加低出生体重儿发生率，仍须严格进行前瞻性对照研究以进一步验证。

Objective: To compare continuous glucose monitoring(CGM) and self-monitoring blood glucose(SMBG) on maternal and neonatal outcomes in patients with gestational diabetes mellitus(GDM). Methods: The PubMed, Web of Science, BMJ, Wanfang databases, CNKI(including Chinese academic periodical net), and VIP databases were searched up to December 2020 to collect the English and Chinese literature about randomized controlled trials(RCTs) of CGM (experimental group) versus SMBG (control group) in patients with GDM. The results of relevant literature were extracted and the Jadad scale was used to evaluate the quality. RevMan5.3 software was used to carry on Meta analysis about results of extraction to compare the maternal and neonatal outcomes. Results: A total of 4 papers were included. (1) Meta analysis showed that the experimental group had a lower incidence of adverse pregnancy outcomes such as macrosomia (OR=0.37, 95%CI:0.19-0.72, P=0.003), cesarean section than the control group, the differences being statistically significant (OR=0.56,95%CI:0.39-0.80, P=0.001). (2) Compared with SMBG, the CGM group could reduce the incidence of premature delivery(RR=0.54,95%CI:0.14-2.04, P=0.36), polyhydramnios(RR=-0.07,95%CI:-0.37-0.22, P=0.62), neonatal hypoglycemia(RR=0.67,95%CI:0.32-1.43, P=0.31), neonatal hyperbilirubinemia(RR=0.67,95%CI:0.13-3.61, P=0.65), and the rate of neonatal hospitalization(RR=1.29,95%CI:0.73-2.27,P=0.38), but not significantly; (3) The use of CGM during pregnancy increased the use of insulin during pregnancy(RR=1.79,95%CI:1.05-3.05, P=0.03) and the incidence of low birth weight infants(OR=2.25,95%CI:1.11-4.56, P=0.02), and the differences were statistically significant. Conclusion: The CGM group has a lower incidence of adverse pregnancy outcomes such as macrosomia in patients with GDM. However, it can increase the incidence of low birth weight infants, which still needs to be verified by further rigorous prospective randomized controlled studies.

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