目的 系統(tǒng)評(píng)價(jià)胰島素持續(xù)皮下輸注給藥與多次皮下注射給藥對(duì)妊娠期糖尿病患者血糖控制及妊娠結(jié)局的影響。方法 計(jì)算機(jī)檢索PubMed、Embase、Cochrane Library、中國學(xué)術(shù)期刊全文數(shù)據(jù)庫（CNKI）、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（CBM）、維普生物醫(yī)學(xué)數(shù)據(jù)庫（VIP）、萬方數(shù)據(jù)庫（Wanfang Deta），搜索胰島素持續(xù)皮下輸注給藥與多次皮下注射給藥治療妊娠合并糖尿病的回顧性病例對(duì)照研究，檢索時(shí)間為數(shù)據(jù)庫建立至2022年1月31日。采用Review Manager 5.3軟件進(jìn)行Meta分析。結(jié)果 共納入15項(xiàng)研究，1 301例患者。Meta分析結(jié)果顯示：相較于胰島素多次皮下注射，持續(xù)皮下輸注能顯著縮短產(chǎn)婦血糖達(dá)標(biāo)時(shí)間［SMD=-2.40，95% CI（-2.91，-1.89）］、減少胰島素用量［SMD=-1.45，95% CI（-1.61，-1.28）］，降低妊高癥發(fā)生率［OR=0.31，95% CI（0.22，0.43）］、低血糖發(fā)生率［OR=0.32，95% CI（0.22，0.47）］、羊水過多發(fā)生率［OR=0.36，95% CI（0.26，0.49）］、胎膜早破發(fā)生率［OR=0.28，95% CI（0.12，0.63）］、宮內(nèi)窘迫發(fā)生率［OR=0.32，95% CI（0.18，0.56）］和產(chǎn)后出血發(fā)生率［OR=0.21，95% CI（0.11，0.43）］，降低新生兒巨大兒發(fā)生率［OR=0.26，95% CI（0.18，0.39）］、早產(chǎn)發(fā)生率［OR=0.32，95% CI（0.22，0.47）］、窒息發(fā)生率［OR=0.29，95% CI（0.20，0.42）］、畸形發(fā)生率［OR=0.27，95% CI（0.09，0.79）］、低血糖發(fā)生率［OR=0.31，95% CI（0.21，0.44）］和高膽紅素血癥發(fā)生率［OR=0.30，95% CI（0.19，0.47）］，差異均有統(tǒng)計(jì)學(xué)意義（P＜0.01）。結(jié)論 胰島素持續(xù)皮下輸注給藥治療妊娠期合并糖尿病較多次皮下注射給藥在妊娠期糖尿病患者血糖控制和減少不良妊娠結(jié)局更有顯著優(yōu)勢。

Objective To systematically evaluate the difference of blood glucose control and pregnancy outcomes of continuous subcutaneous infusion and intermittent subcutaneous injection of insulin in the treatment of patients with gestational diabetes mellitus (GDM). Methods Literature search was conducted across PubMed, Embase, Cochrane Library, CNKI, CBM, Wanfang Deta, and VIP, to search for retrospective case-control study of continuous subcutaneous infusion and intermittent subcutaneous injection of insulin in the treatment of GDM. The retrieval time was set from the establishment of the database to January 31, 2022. and Meta-analysis was conducted by Review Manager 5.3 software. Results A total of 15 retrospective case-control studies involving 1 301 patients were included. Meta-analysis showed that compared with intermittent subcutaneous injection of insulin, continuous subcutaneous infusion could significantly shorten the time to reach the blood sugar target[SMD=-2.40, 95%CI (-2.91, -1.89)], reduce insulin dosage[SMD=-1.45, 95%CI (-1.61, -1.28)], reduce complication rates of maternity in pregnancy-induced hypertension[OR=0.31, 95%CI (0.22, 0.43)], hypoglycemia[OR=0.32, 95%CI (0.22, 0.47)], polyhydramnios[OR=0.36, 95%CI (0.26, 0.49)], premature rupture of membranes[OR=0.28, 95%CI (0.12, 0.63)], intrauterine distress[OR=0.32, 95%CI (0.18, 0.56)] and postpartum hemorrhage[OR=0.21, 95%CI (0.11, 0.43)], reduce complication rates of newborn in macrosomia[OR=0.26, 95%CI (0.18, 0.39)], preterm birth[OR=0.32, 95%CI (0.22, 0.47)], asphyxia[OR=0.29, 95%CI (0.20, 0.42)], deformity[OR=0.27, 95%CI (0.09, 0.79)], hypoglycemia[OR=0.31, 95%CI (0.21, 0.44)], and hyperbilirubinemia[OR=0.30, 95%CI (0.19, 0.47)], which were statistically significant (P < 0.01). Conclusion The continuous subcutaneous infusion of insulin in the treatment of GDM is more effective in the control of blood glucose and the reduction of adverse pregnancy outcomes than intermittent subcutaneous injection.

R969.3;R984

河北省衛(wèi)生健康委科研基金項(xiàng)目（20221505）