目的系統(tǒng)評(píng)價(jià)胰島素對(duì)不同孕周妊娠期糖尿病患者血糖控制及妊娠結(jié)局，為臨床治療提供循證醫(yī)學(xué)依據(jù)。方法檢索PubMed、Embase、Cochrane Library、中國(guó)學(xué)術(shù)期刊全文數(shù)據(jù)庫(kù)（CNKI）、維普中文期刊全文數(shù)據(jù)庫(kù)（VIP）、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)（CBM）和萬(wàn)方數(shù)據(jù)庫(kù)，收集觀察組（孕周≤ 32周）對(duì)比對(duì)照組（孕周>32周）的妊娠期糖尿病患者使用胰島素的病例對(duì)照研究，檢索時(shí)間均為建庫(kù)至2020年10月，篩選文獻(xiàn)、提取數(shù)據(jù)和質(zhì)量評(píng)價(jià)后，用RevMan5.3軟件進(jìn)行Meta分析。結(jié)果共納入15項(xiàng)研究，1 637例妊娠期糖尿病患者。Meta分析結(jié)果顯示，觀察組分娩時(shí)空腹血糖（SMD=-0.37，95% CI=-0.47~-0.27）、產(chǎn)后2 h血糖（SMD=-0.42，95% CI=-0.52~-0.32）均顯著小于對(duì)照組（P<0.01）；暴露組早產(chǎn)（OR=0.35，95% CI=0.25~0.48）、剖宮產(chǎn)（OR=0.57，95% CI=0.46~0.71）、妊娠期高血壓（OR=0.40，95% CI=0.30~0.54）、羊水過(guò)多（OR=0.35，95% CI=0.23~0.52）、產(chǎn)后出血（OR=0.41，95% CI=0.26~0.64）和產(chǎn)后感染（OR=0.22，95% CI=0.12~0.38）均顯著小于對(duì)照組（P<0.01）；觀察組巨大兒（OR=0.41，95% CI=0.31~0.55）、新生兒窒息（OR=0.23，95% CI=0.15~0.35）、新生兒低血糖（OR=0.24，95% CI=0.15~0.37）、高膽紅素血癥（OR=0.29，95% CI=0.18~0.47）和新生兒低體質(zhì)量（OR=0.31，95% CI=0.20~0.49）均顯著小于對(duì)照組（P<0.01）。結(jié)論對(duì)于GDM患者孕早期（孕周≤ 32周）開始使用胰島素更能有效控制產(chǎn)婦血糖水平，降低母兒圍產(chǎn)期不良結(jié)果發(fā)生率。

Objective To systematically evaluate the blood glucose control and pregnancy outcome of insulin in the treatment of gestational diabetes mellitus (GDM) in different gestational ages, and provide evidence for clinical treatment of GDM. Methods Case-control studies of the experimental group (gestational age ≤ 32 weeks) was compared with the control group (gestational age > 32 weeks) GDM patients started taking insulin in PubMed, Embase, Cochrane Library, CNKI, CBM, VIP and Wanfang database form database up to October of 2020. Meta-analysis was carried out with RevMan 5.3 software after selecting literature,extracting data, and evaluating quality. Results A total of 15 studies and 1 637 patients was included. Meta-analysis showed that fasting blood glucose (SMD = -0.37, 95%CI = -0.47 to -0.27) and postpartum 2 hours blood glucose (SMD = -0.42, 95%CI = -0.52 to -0.32) in the experimental group were significantly lower than those in the control group (P < 0.01); Preterm birth (OR=0.35, 95%CI = 0.25 to 0.48), cesarean section (OR = 0.57, 95%CI = 0.46 to 0.71), gestational hypertension (OR = 0.40, 95%CI = 0.30 to 0.54], polyhydramnios (OR = 0.35, 95%CI = 0.23 to 0.52), postpartum hemorrhage (OR = 0.41, 95%CI = 0.26 to 0.64) and postpartum infection (OR= 0.22, 95%CI = 0.12 to 0.38) in the experimental group were significantly lower than those in the control group (P < 0.01). Fetal macrosomia (OR = 0.41, 95%CI = 0.31 to 0.55), neonatal asphyxia (OR = 0.23, 95%CI = 0.15 to 0.35), neonatal hypoglycemia (OR = 0.24, 95%CI = 0.15 to 0.37], hyperbilirubinemia (OR = 0.29, 95%CI = 0.18 to 0.47) and low birth weight (OR = 0.31, 95%CI = 0.20 to 0.49) in the experimental group were significantly lower than those in the control group (P < 0.01). Conclusion For the GDM patients, early pregnancy (gestational ages ≤32 weeks) starting insulin is more effective to control maternal blood glucose level and reduce the incidence of perinatal adverse outcomes.

R977

湖北省衛(wèi)生計(jì)生委科研項(xiàng)目（WJ2019H485）