视黄醇结合蛋白 4（RBP4）循环水平与妊娠期糖尿病：系统评价和荟萃分析。
Retinol-binding protein 4 (RBP4) circulating levels and gestational diabetes mellitus: a systematic review and meta-analysis.
机构信息
Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom.
Warwick Medical School, University of Warwick, Coventry, United Kingdom.
出版信息
Front Public Health. 2024 Mar 12;12:1348970. doi: 10.3389/fpubh.2024.1348970. eCollection 2024.
BACKGROUND
Gestational diabetes mellitus (GDM) is a prevalent condition where diabetes is diagnosed during pregnancy, affecting both maternal and fetal outcomes. Retinol-binding protein 4 (RBP4) is a circulating adipokine which belongs to the lipocalin family and acts as a specific carrier protein that delivers retinol (vitamin A) from the liver to the peripheral tissues. Growing data indicate that circulating RBP4 levels may positively correlate with GDM. Thus, this systematic review and meta-analysis aimed to investigate the potential relationship between circulating RBP4 levels and GDM when measured at various stages of pregnancy.
METHODS
MEDLINE, CINAHL, EMCARE, EMBASE, Scopus, and Web of Science databases were searched to identify studies comparing pregnant women with and without GDM, whose circulating RBP4 levels were measured in at least one pregnancy trimester. Findings were reported using standardized mean difference (SMD) and random-effects models were used to account for variability among studies. Furthermore, the risk of bias was assessed using the RoBANS tool.
RESULTS
Out of the 34 studies identified, 32 were included in the meta-analysis (seven with circulating RBP4 levels measured in the first trimester, 19 at 24-28 weeks, and 14 at >28 weeks of pregnancy). RBP4 levels were statistically higher in the GDM group than in controls when measured during all these pregnancy stages, with the noted RBP4 SMD being 0.322 in the first trimester (95% CI: 0.126-0.517; < 0.001; 946 GDM cases vs. 1701 non-GDM controls); 0.628 at 24-28 weeks of gestation (95% CI: 0.290-0.966; < 0.001; 1776 GDM cases vs. 1942 controls); and 0.875 at >28 weeks of gestation (95% CI: 0.252-1.498; = 0.006; 870 GDM cases vs. 1942 non-GDM controls). Significant study heterogeneity was noted for all three pregnancy timepoints.
CONCLUSION
The present findings indicate consistently higher circulating RBP4 levels in GDM cases compared to non-GDM controls, suggesting the potential relevance of RBP4 as a biomarker for GDM. However, the documented substantial study heterogeneity, alongside imprecision in effect estimates, underscores the need for further research and standardization of measurement methods to elucidate whether RBP4 can be utilized in clinical practice as a potential GDM biomarker.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD42022340097: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022340097).
背景
妊娠期糖尿病（GDM）是一种常见的疾病，即糖尿病在妊娠期间被诊断出，会影响母婴结局。视黄醇结合蛋白 4（RBP4）是一种循环脂肪因子，属于脂联素家族，作为一种特异性载体蛋白，将视黄醇（维生素 A）从肝脏输送到外周组织。越来越多的数据表明，循环 RBP4 水平可能与 GDM 呈正相关。因此，本系统评价和荟萃分析旨在研究在妊娠的不同阶段测量时，循环 RBP4 水平与 GDM 之间的潜在关系。
方法
检索 MEDLINE、CINAHL、EMCARE、EMBASE、Scopus 和 Web of Science 数据库，以确定比较患有和不患有 GDM 的孕妇的研究，这些孕妇在至少一个妊娠期间测量了循环 RBP4 水平。使用标准化均数差（SMD）报告研究结果，并使用随机效应模型来解释研究之间的变异性。此外，使用 RoBANS 工具评估偏倚风险。
结果
在确定的 34 项研究中，有 32 项研究被纳入荟萃分析（7 项研究在妊娠早期测量循环 RBP4 水平，19 项研究在 24-28 周测量，14 项研究在 >28 周测量）。在所有这些妊娠阶段，GDM 组的 RBP4 水平均高于对照组，其中 RBP4 的 SMD 在妊娠早期为 0.322（95%CI：0.126-0.517； <0.001；946 例 GDM 病例与 1701 例非 GDM 对照组）；在妊娠 24-28 周时为 0.628（95%CI：0.290-0.966； <0.001；1776 例 GDM 病例与 1942 例对照组）；在妊娠 >28 周时为 0.875（95%CI：0.252-1.498； = 0.006；870 例 GDM 病例与 1942 例非 GDM 对照组）。所有三个妊娠时间点均存在显著的研究异质性。
结论
目前的研究结果表明，GDM 病例的循环 RBP4 水平明显高于非 GDM 对照组，提示 RBP4 作为 GDM 生物标志物的潜在相关性。然而，有记录的大量研究异质性，以及效应估计的不精确性，强调需要进一步研究和测量方法的标准化，以阐明 RBP4 是否可以作为一种潜在的 GDM 生物标志物在临床实践中得到应用。
系统评价注册
PROSPERO（CRD42022340097：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022340097）。
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