Pace Nikolai P, Bonello Antonia, Roshan Mohsin H, Vassallo Josanne
Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta -
Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta.
Minerva Ginecol. 2019 Aug;71(4):329-343. doi: 10.23736/S0026-4784.18.04293-4.
There are multiple published conflicting associations of the adipocytokine visfatin with gestational diabetes. In this study, we attempted to investigate this relationship via a systematic review of the published literature.
Literature retrieval using PubMed, Google Scholar, Scopus and Hydi databases followed by article selection and data extraction were conducted. Relevant studies published up to June 2018 were included. In total, 29 cohorts that were published in 27 articles were analyzed. Three studies carried out in early pregnancy were excluded. A total of 2365 individuals, with 1069 gestational diabetes (GDM) cases and 1296 controls from studies describing visfatin in the second or third trimester of gestation were included.
The difference in visfatin levels between women with GDM and the controls in the second and third trimester was measured by weighted mean difference (WMD) and 95% confidence intervals (CI). Heterogeneity was inspected by using both subgroup and meta-regression analysis. Analysis was restricted to studies describing singleton pregnancies. The quality of included studies was assessed by the Newcastle-Ottawa Scale.
No significant difference in circulating visfatin levels in GDM during the second trimester of pregnancy (WMD -0.30 ng/mL, 95% CI: -2.06, 1.45, SE=0.895, P=0.733) was detected. Meta-analysis of the studies in the third trimester revealed a significant negative effect, that was however driven by only one study. This finding limits the meaningful interpretation of the pooled analysis. Significant heterogeneity was identified between studies, and meta-regression analysis showed that homeostatic model assessment for insulin resistance contributes significantly to heterogeneity. In conclusion, our findings suggest that peripheral blood visfatin concentration cannot be robustly associated with gestational diabetes status in the second and third trimesters of pregnancy.
已发表的多项研究中，脂肪细胞因子内脂素与妊娠期糖尿病之间的关联存在冲突。在本研究中，我们试图通过对已发表文献进行系统综述来探究这种关系。
利用PubMed、谷歌学术、Scopus和Hydi数据库进行文献检索，随后进行文章筛选和数据提取。纳入截至2018年6月发表的相关研究。总共分析了27篇文章中发表的29个队列。排除了三项在孕早期进行的研究。纳入了来自描述妊娠中期或晚期内脂素的研究中的总共2365名个体，其中1069例妊娠期糖尿病（GDM）病例和1296名对照。
采用加权平均差（WMD）和95%置信区间（CI）来衡量妊娠中期和晚期GDM女性与对照组之间内脂素水平的差异。通过亚组分析和Meta回归分析检查异质性。分析仅限于描述单胎妊娠的研究。采用纽卡斯尔-渥太华量表评估纳入研究的质量。
未检测到妊娠中期GDM患者循环内脂素水平有显著差异（WMD -0.30 ng/mL，95% CI：-2.06，1.45，SE = 0.895，P = 0.733）。对晚期研究的Meta分析显示出显著的负效应，但这仅由一项研究驱动。这一发现限制了汇总分析的有意义解释。研究之间存在显著异质性，Meta回归分析表明胰岛素抵抗的稳态模型评估对异质性有显著贡献。总之，我们的研究结果表明，妊娠中期和晚期外周血内脂素浓度与妊娠期糖尿病状态之间不存在稳固关联。
