二甲双胍和格列苯脲在妊娠期糖尿病中的安全性和有效性评价：网络Meta分析

Safety and efficiency of metformin and glyburide in gestational diabetes mellitus：network Meta analysis

摘要:

目的：通过与胰岛素比较，分析二甲双胍和格列苯脲在妊娠期糖尿病（gestational diabetes mellitus，GDM）中的安全性和有效性；方法：系统性检索 PubMed，EMBASE，Cochrane中心注册的对照试验（cochrane central register of controlled trials，CEN－TRAL），和中国生物医学生物文献数据库，截至2013年12月有16篇随机对照试验包含二甲双胍及格列苯脲与胰岛素的比较。二甲双胍和格列苯脲的安全性和有效性评价的直接和间接结果通过R 2.15.2实验。结果：本研究有2 665例病例纳入。在巨大儿方面，格列苯脲组多于胰岛素组（OR=3.299，95%CI=1.649~6.600，P=0.001），而二甲双胍组低于格列苯脲组（OR=0.234，95%CI=0.061~0.893，P=0.033），二甲双胍组与胰岛素组无统计学差异（P=0.198）。在孕妇体质量增加方面，二甲双胍组明显低于胰岛素组（SMD=-0.539，95%CI=-0.716~-0.362，P=0.000）。妊娠时限方面，二甲双胍明显短于胰岛素组（SMD=-0.142，95%CI=-0.246~-0.039，P=0.007）。结论：二甲双胍控制血糖的疗效好，母亲体质量增加少，有更低的糖化血红蛋白水平且不增加母亲低血糖风险，但可能增加早产风险。格列苯脲组有更高的巨大儿发生率。

Abstract:

Objective：To assess the safety and efficiency of metformin and glyburide in gestational diabetes mellitus by comparing with insulin. Methods：Relevant 16 randomized controlled trials published before December，2013 were searched from PubMed，EMBASE，the Cochrane Central Register of Controlled Trials（CENTRAL），and Chinese biomedicine（CBM） literature database. The safety and efficiency between metformin and glyburide was assessed using direct and indirect results through R 2.15.2. Results：A total of 2 665 participants were identified in this Meta analysis. There were more macrosomia in glyburide group and in insulin group（OR=3.299，95%CI=1.649 to 6.600，P=0.001），more macrosomia in glyburide group than in metformin group（OR=0.234，95%CI=0.061 to 0.893，P=0.033），however there was no difference in macrosomia between metformin group than insulin group（P=0.198）. Maternal weight gain was lower in metformin group than in insulin group（SMD=-0.539，95%CI=-0.716 to -0.362，P=0.000）. Gestational age was smaller in metformin group than insulin group（SMD=-0.142，95%CI=-0.246 to -0.039，P=0.007）. Conclusion：Metformin can better control blood glucose and maternal weight gain and lower glycosylated hemoglobin level without increasing maternal hypoglycaemia，but it may significantly shorten gestational age. Incidence of macrosomia is higher in glyburide group.