Hu Shi-Min, Chen Meng-Shi, Tan Hong-Zhuan
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, Hunan Province, China.
World J Clin Cases. 2019 Mar 6;7(5):585-599. doi: 10.12998/wjcc.v7.i5.585.
Resistin is most likely involved in the pathogenesis of gestational diabetes mellitus (GDM), but the existing findings are inconsistent.
To review the literature investigating the associations of the risk of GDM with serum level of resistin.
A systematic literature search was performed using MEDLINE, EMBASE, and Web of Science (all databases). This meta-analysis included eligible studies that: (1) investigated the relationship between the risk of GDM and serum resistin; (2) included GDM cases and controls without GDM; (3) diagnosed GDM according to the oral glucose-tolerance test; (4) were performed in humans; (5) were published as full text articles in English; and (6) provided data with median and quartile range, median and minimum and maximum values, or mean and standard deviation. The pooled standardized mean difference (SMD) and 95% confidence interval (CI) were calculated to estimate the association between the risk of GDM and serum resistin. To analyze the potential influences of need for insulin in GDM patients and gestational age at blood sampling, we performed a subgroup analysis. Meta-regression with restricted maximum likelihood estimation was performed to assess the potentially important covariate exerting substantial impact on between-study heterogeneity.
The meta-analysis for the association between serum resistin level and GDM risk included 18 studies (22 comparisons) with 1041 cases and 1292 controls. The total results showed that the risk of GDM was associated with higher serum resistin level (SMD = 0.250, 95%CI: 0.116, 0.384). The "after 28 wk" subgroup, "no need for insulin" subgroup, and "need for insulin" subgroup indicated that higher serum resistin level was related to GDM risk ("after 28 wk" subgroup: SMD = 0.394, 95%CI: 0.108, 0.680; "no need for insulin" subgroup: SMD = 0.177, 95%CI: 0.018, 0.336; "need for insulin" subgroup: SMD = 0.403, 95%CI: 0.119, 0.687). The "before 14 wk" subgroup, "14-28 wk" subgroup, and "no information of need for insulin" subgroup showed a nonsignificant association between serum resistin level and GDM risk ("before 14 wk" subgroup: SMD = 0.087, 95%CI: -0.055, 0.230; "14-28 wk" subgroup: SMD = 0.217, 95%CI: -0.003, 0.436; "no information of need for insulin" subgroup: SMD = 0.356, 95%CI: -0.143, 0.855). The postpartum subgroup included only one study and showed that higher serum resistin level was related to GDM risk (SMD = 0.571, 95%CI: 0.054, 1.087) The meta-regression revealed that no need for insulin in GDM patients, age distribution similar between cases and controls, and ELISA all had a significant impact on between-study heterogeneity.
This meta-analysis supports that the maternal serum resistin level is associated with GDM risk.
抵抗素很可能参与妊娠期糖尿病（GDM）的发病机制，但现有研究结果并不一致。
综述关于GDM风险与抵抗素血清水平之间关联的文献。
使用MEDLINE、EMBASE和Web of Science（所有数据库）进行系统的文献检索。这项荟萃分析纳入了符合条件的研究，这些研究：（1）调查了GDM风险与血清抵抗素之间的关系；（2）纳入了GDM病例和非GDM对照；（3）根据口服葡萄糖耐量试验诊断GDM；（4）在人类中进行；（5）以英文全文发表；（6）提供了中位数和四分位数范围、中位数以及最小值和最大值的数据，或均值和标准差的数据。计算合并标准化均数差（SMD）和95%置信区间（CI），以估计GDM风险与血清抵抗素之间的关联。为分析GDM患者对胰岛素的需求和采血时的孕周的潜在影响，我们进行了亚组分析。采用限制最大似然估计进行荟萃回归，以评估对研究间异质性有重大影响的潜在重要协变量。
血清抵抗素水平与GDM风险关联的荟萃分析纳入了18项研究（22项比较），共1041例病例和1292例对照。总体结果显示，GDM风险与较高的血清抵抗素水平相关（SMD = 0.250，95%CI：0.116，0.384）。“28周后”亚组、“无需胰岛素”亚组和“需要胰岛素”亚组表明，较高的血清抵抗素水平与GDM风险相关（“28周后”亚组：SMD = 0.394，95%CI：0.108，0.680；“无需胰岛素”亚组：SMD = 0.177，95%CI：0.018，0.336；“需要胰岛素”亚组：SMD = 0.403，95%CI：0.119，0.687）。“14周前”亚组、“14 - 28周”亚组和“无胰岛素需求信息”亚组显示，血清抵抗素水平与GDM风险之间无显著关联（“14周前”亚组：SMD = 0.087，95%CI： - 0.055，0.230；“14 - 28周”亚组：SMD = 0.217，95%CI： - 0.003，0.436；“无胰岛素需求信息”亚组：SMD = 0.356，95%CI： - 0.143，0.855）。产后亚组仅纳入了一项研究，结果显示较高的血清抵抗素水平与GDM风险相关（SMD = 0.571，95%CI：0.054，1.087）。荟萃回归显示，GDM患者无需胰岛素、病例与对照年龄分布相似以及采用酶联免疫吸附测定法均对研究间异质性有显著影响。
这项荟萃分析支持母体血清抵抗素水平与GDM风险相关。
