1型糖尿病、糖尿病肾病与妊娠：一项系统评价和荟萃研究
Type 1 diabetes, diabetic nephropathy, and pregnancy: a systematic review and meta-study.
作者信息
Piccoli Giorgina Barbara, Clari Roberta, Ghiotto Sara, Castelluccia Natascia, Colombi Nicoletta, Mauro Giuseppe, Tavassoli Elisabetta, Melluzza Carmela, Cabiddu Gianfranca, Gernone Giuseppe, Mongilardi Elena, Ferraresi Martina, Rolfo Alessandro, Todros Tullia
机构信息
SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Italy.
出版信息
Rev Diabet Stud. 2013 Spring;10(1):6-26. doi: 10.1900/RDS.2013.10.6. Epub 2013 May 10.
BACKGROUND
In the last decade, significant improvements have been achieved in maternal-fetal and diabetic care which make pregnancy possible in an increasing number of type 1 diabetic women with end-organ damage. Optimal counseling is important to make the advancements available to the relevant patients and to ensure the safety of mother and child. A systematic review will help to provide a survey of the available methods and to promote optimal counseling.
OBJECTIVES
To review the literature on diabetic nephropathy and pregnancy in type 1 diabetes.
METHODS
Medline, Embase, and the Cochrane Library were scanned in November 2012 (MESH, Emtree, and free terms on pregnancy and diabetic nephropathy). Studies were selected that report on pregnancy outcomes in type 1 diabetic patients with diabetic nephropathy in 1980-2012 (i.e. since the detection of microalbuminuria). Case reports with less than 5 cases and reports on kidney grafts were excluded. Paper selection and data extraction were performed in duplicate and matched for consistency. As the relevant reports were highly heterogeneous, we decided to perform a narrative review, with discussions oriented towards the period of publication.
RESULTS
Of the 1058 references considered, 34 fulfilled the selection criteria, and one was added from reference lists. The number of cases considered in the reports, which generally involved single-center studies, ranged from 5 to 311. The following issues were significant: (i) the evidence is scattered over many reports of differing format and involving small series (only 2 included over 100 patients), (ii) definitions are non-homogeneous, (iii) risks for pregnancy-related adverse events are increased (preterm delivery, caesarean section, perinatal death, and stillbirth) and do not substantially change over time, except for stillbirth (from over 10% to about 5%), (iv) the increase in risks with nephropathy progression needs confirmation in large homogeneous series, (v) the newly reported increase in malformations in diabetic nephropathy underlines the need for further studies.
CONCLUSIONS
The heterogeneous evidence from studies on diabetic nephropathy in pregnancy emphasizes the need for further perspective studies on this issue.
背景
在过去十年中，母婴护理和糖尿病护理取得了显著进展，这使得越来越多患有终末器官损害的1型糖尿病女性能够怀孕。提供最佳咨询对于让相关患者受益于这些进展并确保母婴安全至关重要。系统评价有助于对现有方法进行综述，并促进最佳咨询。
目的
综述1型糖尿病中糖尿病肾病与妊娠的相关文献。
方法
于2012年11月检索了Medline、Embase和Cochrane图书馆（使用医学主题词、Emtree词表以及关于妊娠和糖尿病肾病的自由词）。选取了1980 - 2012年期间（即自微量白蛋白尿被发现以来）报道1型糖尿病合并糖尿病肾病患者妊娠结局的研究。排除病例数少于5例的病例报告以及关于肾移植的报告。论文筛选和数据提取由两人独立进行，并核对一致性。由于相关报告高度异质性，我们决定进行叙述性综述，讨论以发表时间为导向。
结果
在1058篇参考文献中，34篇符合入选标准，另外从参考文献列表中补充了1篇。报告中所考虑的病例数一般来自单中心研究，范围从5例到311例。以下问题较为显著：（i）证据分散在许多格式不同且涉及小样本系列的报告中（只有2篇纳入了超过100例患者），（ii）定义不统一，（iii）妊娠相关不良事件的风险增加（早产、剖宫产、围产期死亡和死产），且除死产外（从超过10%降至约5%），这些风险随时间变化不大，（iv）肾病进展导致风险增加这一点需要在大型同质性系列研究中得到证实，（v）新报道的糖尿病肾病中畸形发生率增加凸显了进一步研究的必要性。
结论
关于妊娠合并糖尿病肾病研究的异质性证据强调了对此问题进行进一步前瞻性研究的必要性。
Zotero 插件