[1]吕诗诗,徐勇,王吉英.胰岛素类似物对妊娠安全性的影响:系统评价和荟萃分析[J].国际内分泌代谢杂志,2015,(02):93-99.[doi:10.3760/cma.j.issn.1673-4157.2015.02.006]
　LV Shishi,Xu Yong,Wang Jiying.Safety of insulin analogues in pregnant women: a systematic review and meta-analysis[J].International Journal of Endocrinology and Metabolism,2015,(02):93-99.[doi:10.3760/cma.j.issn.1673-4157.2015.02.006]
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胰岛素类似物对妊娠安全性的影响:系统评价和荟萃分析()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
期数:
2015年02
页码:
93-99
栏目:
荟萃分析
出版日期:
2015-03-20

文章信息/Info

Title:
Safety of insulin analogues in pregnant women: a systematic review and meta-analysis
作者:
吕诗诗; 徐勇; 王吉英
646000　四川省泸州医学院附属医院内分泌科
Author(s):
LV Shishi; Xu Yong; Wang Jiying．
Department of Endocrinology，Affiliated Hospital of Luzhou Medical College，Luzhou 646000，China Corresponding author：Xu Yong，Email：xywyll@aliyun.com
关键词:
胰岛素类似物; 妊娠; 糖尿病; 不良结局
Keywords:
Insulin analogues; Pregnancy; Diabetes mellitus; Adverse outcome
DOI:
10.3760/cma.j.issn.1673-4157.2015.02.006
摘要:
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。
Abstract:
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 hypo-glycemia 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.

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备注/Memo

备注/Memo:
通信作者：徐勇，Email:xywyll@aliyun.com
更新日期/Last Update: 2015-03-20