肠道菌群与妊娠期糖尿病(GDM)发生的关联性Meta分析

Meta-Analysis for Relationship between Intestinal Flora and Gestational Diabetes Mellitus (GDM)

摘要: 目的：使用Cochrane协作网提供的Review Manager 5.3软件包对妊娠期糖尿病(GDM)的发生与六种肠道菌群和两种炎症因子之间的关联进行Meta分析，确定肠道菌群水平变化是妊娠期糖尿病(GDM)发生的重要原因之一，推测益生菌是致使妊娠期糖尿病发生的主要菌群，且肠道菌群通过改变炎症影响因子水平致使妊娠期糖尿病发生，并推测可通过改变肠道菌群构成同时治疗炎症性肠病(Inflammatory Bowel Disease, IBD)和GDM。方法：研究过程中利用了中国知网(CNKI)、万方数据知识服务平台、维普中文科技期刊数据库(VIP)等9个数据库检索文献，总共纳入12篇文献，主要对肠杆菌、肠球菌、双歧杆菌、乳杆菌、拟杆菌、梭杆菌、炎症影响因子IL-6和炎症影响因子TNF-α的变化进行了Meta分析，总共纳入实验对象1705例，GDM组纳入697例，妊娠期糖耐量正常组纳入1008例。Meta分析结果：1) 肠杆菌：MD = 1.75，95%CI [1.32, 2.18]，P < 0.00001；2) 肠球菌：MD = 1.33，95%CI [1.16, 1.50]，P < 0.00001；3) 双歧杆菌：MD = −1.86，95%CI [−2.65, −2.09]，P < 0.00001；4) 乳杆菌：MD = −1.57，95%CI [−1.65, −1.49]，P < 0.00001；5) 拟杆菌：MD = −0.59，95%CI [−1.41, 0.24]，P = 0.16；6) 梭杆菌：MD = 0.02，95%CI [−0.07, 0.11]，P = 0.70；7) 炎症影响因子IL-6：MD = 71.42，95% CI [49.55, 93.29]，P < 0.00001；8) 炎症影响因子TNF-α：MD = 113.66，95%CI [58.91 ,168.40]，P < 0.0001。结论：肠杆菌和肠球菌水平的增加与双歧杆菌和乳杆菌水平的减少与妊娠期糖尿病的发生有着明显的关联，肠道菌群的变化是妊娠期糖尿病发生的重要原因之一。推测双歧杆菌和乳杆菌等益生菌的水平变化可能是导致妊娠期糖尿病发生的重要原因，并且肠道菌群通过改变炎症因子水平导致妊娠期糖尿病的发生。

Abstract: Objective: Using the Review Manager 5.3 software package that provided by Cochrane collaboration network to analyze the associations between the occurrence of GDM and six Microbiota and two inflammatory factors, to make sure that the changes of intestinal flora level is one of the important reasons of GDM, it is suggested that probiotics are the main flora that cause GDM, and intestinal flora of GDM by affecting the level of inflammatory factors, and treatment of Inflammatory Bowel Disease (IBD) and GDM by altering the composition of intestinal flora. Methods: In the course of the study, 9 databases were used to retrieve the literature, such as China Knowledge Network (CNKI), Wanfang Data Knowledge Service Platform and VIP Chinese Science and Technology Journal Database (VIP), including a total of 12 documents, the changes of Enterobacter, Enterococcus, Bifidobacterium, Lactobacillus, Bacteroides, Clostridium, the Inflammatory factor IL-6 and the Inflammatory factor TNF-α were Meta analyzed. A total of 1705 cases were included in the experimental group, 697 cases in the GDM group and 1008 cases in the normal glucose tolerance group during pregnancy. Meta analyze results: 1) Enterobacter: MD = 1.75, 95%CI [1.32, 2.18], P < 0.00001; 2) Enterococcus: MD = 1.33, 95%CI [1.16, 1.50], P < 0.00001; 3) Bifidobacterium: MD = −1.86, 95%CI [−2.65, −2.09], P < 0.00001; 4) Lactobacillus: MD = −1.57, 95%CI [−1.65, −1.49], P < 0.00001; 5) Bacteroides: MD = −0.59, 95%CI [−1.41, 0.24], P = 0.16; 6) Clostridium: MD = 0.02, 95%CI [−0.07, 0.11], P = 0.70; 7) Inflammatory factor IL-6: MD = 71.42, 95%CI [49.55, 93.29], P < 0.00001; 8) Inflammatory factor TNF-α: MD = 113.66, 95%CI [58.91, 168.40], P < 0.0001. Conclusions: The increased levels of Enterobacter, Enterococcus and the decreased levels of Bifidobacterium, Lactobacillus were significantly associate with the GDM; the change of intestinal flora is one of the important reasons of GDM. It is suggested that the level of probiotics such as Bifidobacterium and Lactobacillus may be an important cause of GDM, and Microbiota leads to GDM by changing the level of inflammatory factors.