妊娠期糖尿病相关因素的Meta分析

目的:探讨妊娠期糖尿病(GDM)与部分相关因素的关系。方法:通过中国期刊全文数据库、中国生物医学文献数据库、HighWire Press、Medline等数据库收集1995年至2011年国内外公开发表的关于GDM相关因素的文献,采用Meta分析综合定量分析最终纳入的文献。结果:糖尿病家族史(合并OR为2.84,95%CI为1.95～4.15),超重或肥胖(合并OR为2.23,95%CI为1.90～2.61),年龄(合并OR为2.97,95%CI为2.28～3.89),肿瘤坏死因子α基因启动子308位点(TNF-α-308)G/A基因多态性(GA+AA基因型合并OR为3.69,95%CI为2.52～5.36;携带A等位基因合并OR为3.40,95%CI为2.56～4.53),糖化血红蛋白(HbA1c)含量(合并OR为84.43,95%CI为17.01～418.96),不良孕产史(合并OR为1.90,95%CI为1.55～2.34),吸烟(合并OR为2.23,95%CI为1.16～4.28),体育锻炼(合并OR为0.69,95%CI为0.49～0.96),种族差异(白色人种合并OR为0.62,95%CI为0.53～0.74,黄色人种合并OR为2.58,95%CI为1.90～3.50),上述因素均为GDM相关因素。文化程度和非洲裔美国人的合并结果无统计学差异(P>0.05)。结论:糖尿病家族史、超重或肥胖、年龄(≥25岁)、TNF-α-308携带A等位基因、不良孕产史和吸烟均为GDM危险因素,体育锻炼为其保护因素;种族差异可能是造成对GDM敏感性不同的影响因素之一;作为判定血糖长期控制情况的良好指标,糖化血红蛋白为妊娠期糖尿病的筛查和诊断提供了新途径和新方法。

Meta-analysis of partial relevant factors of gestational diabetes mellitus

Objective:To evaluate the relationship between some of the relevant factors and gestational diabetes mellitus(GDM).Methods:The references between 1995 to 2011 concerning the effect factors of GDM were retrieved through CNKI,CBM,HighWire Press,Medline and other databases.Meta-analysis was used to systematically analyze the literatures that were included finally.Results:GDM was probably associated with family history of diabetes mellitus(pooled OR=2.84,95%CI:1.95～4.15),overweight or obesity(pooled OR=2.23,95% CI:1.90～2.61),age(pooled OR=2.97,95% CI:2.28～3.89),the polymorphism of tumor necrosis factor alpha 308 gene(TNF-α-308)promoter(pooled OR=3.69,95%CI 2.52～5.36),glycolated hemoglobin(pooled OR=84.43,95% CI:17.01～418.96),abnormal pregnancy history(pooled OR=1.90,95% CI:1.55～2.34),smoking(pooled OR=2.23,95% CI:1.16～4.28),physical exercise(pooled OR=0.69,95% CI:0.49～0.96)and ethnic difference(pooled OR of white race was 0.62,95% CI:0.53～0.74,pooled OR of yellow race was 2.58,95% CI:1.90～3.50).Conclusion:Family history of diabetes mellitus,overweight or obesity,age,the 308 G→A polymorphism of TNF-α promoter gene,abnormal pregnancy history,smoking are risk factors of GDM while physical exercise may be a protective factor.The ethnic difference may be one of the influence factors to cause the different sensitivity of GDM.HbA1c,as a criterion of long-term glycemic control,it provides a new approach for screening and diagnosing of GDM.