维生素D联合胰岛素对妊娠期糖尿病患者血糖、糖化血红蛋白及胰岛素抵抗的meta分析

江晓锋; 夏国祥; 金梦霞; 孙嘉情; 袁琳; 漏璐垚

doi:10.16766/j.cnki.issn.1674-4152.004471

维生素D联合胰岛素对妊娠期糖尿病患者血糖、糖化血红蛋白及胰岛素抵抗的meta分析

doi: 10.16766/j.cnki.issn.1674-4152.004471

1.
杭州市萧山区闻堰街道社区卫生服务中心, 浙江杭州 311258
2.
杭州市萧山区第一人民医院妇产科, 浙江杭州 311200

基金项目:

浙江省医药卫生科技计划项目 2025KY1209

详细信息

通讯作者:
孙嘉情，E-mail：sunjiaqing_celery@163.com

中图分类号: R587.1 R977.15 R977.24
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出版历程
- 收稿日期: 2025-03-31

Meta-analysis of vitamin D supplementation combined with insulin therapy on blood glucose, HbA1c and insulin resistance in gestational diabetes mellitus

1.
Wenyan Street Community Health Service Center, Xiaoshan District, Hangzhou, Zhejiang 311258, China

摘要

摘要: 目的评估维生素D联合胰岛素治疗妊娠期糖尿病的疗效，为临床应用提供循证依据。方法使用检索词：gestational diabetes mellitus、Vitamin D、insulin、妊娠期糖尿病、维生素D和胰岛素等，在The Cochrane Library、Embase、PubMed、Web of Science、万方、维普、知网和中国生物医学文献数据库中进行检索。由2名研究员独立筛选和评价后，采用RevMan 5.4进行数据分析和处理。结果共纳入26篇研究，2 392例样本。干预组(维生素D和胰岛素治疗)空腹血浆葡萄糖(MD=-0.96，95% CI：-1.26~-0.65)、空腹血糖(MD=-0.62，95% CI：-0.96~-0.29)、餐后2小时血糖(MD=-1.27，95% CI：-1.56~-0.98)、餐后2小时血浆葡萄糖(MD=-1.61，95% CI：-2.61~-0.61)、糖化血红蛋白(MD=-1.21，95% CI：-1.53~-0.72)、稳态模式胰岛素抵抗指数(MD=-0.59，95% CI：-0.87~-0.31)均低于对照组(仅胰岛素治疗)。敏感性分析发现，餐后2小时血浆葡萄糖的合并效应有显著改变，提示结果不稳健。糖化血红蛋白的漏斗图不对称，提示存在发表偏倚。结论维生素D联合胰岛素有助于维持妊娠期糖尿病患者血糖水平，提高胰岛素抵抗指数。
- 妊娠期糖尿病 /
- 维生素D /
- 胰岛素 /
- meta分析
Abstract: Objective To evaluate the efficacy of Vitamin D combined with insulin in the treatment of gestational diabetes mellitus, and to provide evidence-based support for clinical application. Methods A comprehensive search was conducted in the Cochrane Library, Embase, PubMed, Web of Science, Wanfang, VIP, CNKI and CBM Database using keywords including geostationary diabetes mellitus, GDM, Vitamin D, insulin, gestational diabetes, Vitamin D and insulin. Two researchers independently screened the studies and performed a quality assessment. The analysis of the data conducted were analyzed using RevMan 5.4. Results A total of 26 RCTs involving 2 392 participants were included in the analysis. A meta-analysis was conducted to ascertain the efficacy of the intervention group (Vitamin D + insulin) achieved significantly lower levels than control (insulin alone) in fasting plasma glucose (FPG, MD=-0.96, 95% CI: -1.26 to -0.65), fasting blood glucose (FBG, MD=-0.62, 95% CI: -0.96 to -0.29), 2-hour postprandial blood glucose (2hPG, MD=-1.27, 95% CI: -1.56 to -0.98), 2-hour postprandial plasma glucose (2hBG, MD=-1.61, 95% CI: -2.61 to -0.61), glycated hemoglobin (HbA1c, MD=-1.21, 95% CI: -1.53 to -0.72), homeostatic model assessment of insulin resistance (HOMA-IR, MD=-0.59, 95% CI: -0.87 to -0.31). A sensitivity analysis was conducted, which revealed a significant change in the combined effect of 2hBG, indicating unstable results. Funnel plot asymmetry was observed for HbA1c, suggesting potential publication bias. Conclusion The combination of vitamin D and insulin has been demonstrated to assist patients diagnosed with GDM in the maintenance of optimal blood glucose levels, in addition to the enhancement of HOMA-IR.
- Gestational diabetes mellitus /
- Vitamin D /
- Insulin /
- Meta-analysis
利益冲突 无

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图 1 文献偏倚风险比例

Figure 1. Proportion of risk of bias in the literature

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图 2 文献偏倚风险

Figure 2. Risk of bias in the literature

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图 3 餐后2小时血浆葡萄糖森林图

Figure 3. Forest plot of 2-hour postprandial plasma glucose

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图 4 糖化血红蛋白发表偏倚分析

Figure 4. Publication bias analysis of glycated hemoglobin

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表 1 纳入研究的基本特征

Table 1. Basic characteristics of included studies

文献	样本量(T/C，例)	干预措施		疗程	结局指标
文献	样本量(T/C，例)	治疗组	对照组	疗程	结局指标
YAZDCHI R 2016^[5]	36/36	降糖药/胰岛素+VD3, 50 000 U/次，1次/2周	降糖药/胰岛素+安慰剂	2个月	②⑤⑥
李芬霞2016^[6]	52/52	门冬胰岛素+骨化三醇胶丸0.25 μg，1次/d	门冬胰岛素	1个月	⑥
李红2016^[7]	35/35	生物合成人胰岛素+VD，400 U/次，2次/d	生物合成人胰岛素	2个月	①③⑤⑥
刘烨2018^[8]	45/43	生物合成人胰岛素+VD，400 U/次，2次/d	生物合成人胰岛素	2个月	②③⑤
潘小燕2019^[9]	31/31	门冬胰岛素+VD，800 U/d	门冬胰岛素	3个月	①⑤⑥
邓丽2020^[10]	30/30	胰岛素+VD₃，400 U/d	胰岛素	2周	①
胡秋2020^[11]	75/75	胰岛素+1, 25(OH)₂D₃，0.25 μg/d	胰岛素	1个月	②③⑤
孟静2020^[12]	100/100	门冬胰岛素+VD，0.25 μg/d	门冬胰岛素	1个月	①⑥
刘克娜2020^[13]	32/32	门冬胰岛素+VD，400 U/次，2次/d	门冬胰岛素	2周	①⑤
刘小红2020^[14]	52/52	门冬胰岛素+VD，400 U/次，2次/d	门冬胰岛素	2个月	①④
赵敏2020^[15]	50/50	门冬胰岛素+VD，400 U/次，2次/d	门冬胰岛素	2个月	②③⑤
朱广美2020^[16]	45/55	门冬胰岛素+VD，400 U/次，2次/d	门冬胰岛素	2个月	①③
高莉2021^[17]	30/30	门冬胰岛素+VD，400 U/次，2次/d	门冬胰岛素	2个月	①④
李真2021^[18]	43/43	门冬胰岛素+VD，800 U/次，1次/d	门冬胰岛素	1个月	②③⑤
龙小云2021^[19]	35/35	门冬胰岛素+VD，800 U/d	门冬胰岛素	至分娩	③④⑥
王慧2022^[20]	45/45	门冬胰岛素+VD，400 U/d，1次/d	门冬胰岛素	至分娩	①③⑤
董仕华2022^[21]	52/52	门冬胰岛素+VD，400 U/次, 2次/d	门冬胰岛素	1个月	①③⑥
王建红2022^[22]	65/65	门冬胰岛素+VD，400 U/次, 2次/d	门冬胰岛素	1个月	②③⑥
高香荣2023^[23]	45/45	门冬胰岛素+VD，400 U/次, 2次/d	门冬胰岛素	1个月	①③
李迎2023^[24]	24/24	门冬胰岛素+VD₃，400 U/d，针对VD缺乏者，可口服1 200 U/d	门冬胰岛素	1个月	②③
田俊红2023^[25]	50/50	门冬胰岛素+VD，400 U，1次/d。当25(OH)D3＞100 ng/mL，停用VD，改强的松龙1~2 mg/(kg·d)	门冬胰岛素	1个月	②③⑤⑥
李云霞2023^[26]	47/47	门冬胰岛素+VD，400 U/次，2次/d	门冬胰岛素	1个月	②③⑥
王翠静2023^[27]	31/31	门冬胰岛素+VD，400 U/次，2次/d	门冬胰岛素	至分娩	②③⑥
林玉英2024^[28]	44/44	门冬胰岛素+VD，400 U/次，2次/d	门冬胰岛素	1个月	①④⑥
赵春艳2024^[29]	40/40	门冬胰岛素+VD，800 U/次，1次/d	门冬胰岛素	1个月	②③⑥
董珊珊2025^[30]	58/58	门冬胰岛素+VD，400~800 U/d	门冬胰岛素	1个月	⑤
注：T表示治疗组，C表示对照组。结局指标有①FBG、②FPG、③2hPG、④2hBG、⑤HbA1c、⑥HOMA-IR。

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