Wang Ruihong,Zuo Jian,Sun Zilan,et al.Correlation between neonatal patent ductus arteriosus and infants of diabetic mothers: a Meta-analysis[J].Journal of Clinical Pediatric Surgery,2022,21(11):1067-1074.[doi:10.3760/cma.j.cn101785-202109037-013]
新生儿先天性动脉导管未闭与新生儿母亲糖尿病相关性的Meta分析
- Title:
- Correlation between neonatal patent ductus arteriosus and infants of diabetic mothers: a Meta-analysis
- Keywords:
- Infant; Newborn; Ductus Arteriosus; Patent; Maternal Nutritional Physiological Phenomena; Diabetes; Gestational
- 摘要:
- 目的 通过Meta分析探究新生儿先天性动脉导管未闭（patent ductus arteriosus，PDA）与新生儿母亲糖尿病（infants of diabetic mothers，IDM）的相关性，为新生儿PDA预防提供理论依据。方法 计算机检索Web of Science、PubMed、Scopus、Embase、Cochrane、ProQuest、OVID、CNKI、WanFang、VIP、SinoMed数据库，检索词：动脉导管未闭、动脉导管开放、先天性动脉导管未闭、糖尿病、妊娠期糖尿病。检索时间为建库至2021年8月。由两位研究者独立筛检出符合纳入标准的文献，提取文献资料、评价文献质量。以医嘱诊断为准，将新生儿分为PDA组和非PDA组。按病例所在区域、研究设计、糖尿病类型进行亚组分析。采用Stata 14.0进行统计分析。结果 最终纳入Meta分析的文献共11篇（样本总数为1 014 399例）。Meta分析显示，新生儿PDA组IDM患病率是新生儿非PDA组的1.25倍，差异无统计学意义[RR=1.25，95%CI：（0.97~1.61），P=0.086]。按病例所在区域分组的亚组分析结果显示，亚洲组新生儿PDA的发生与是否存在IDM无关[RR=1.05，95%CI：（0.92~1.21），P=0.471]，欧洲组新生儿PDA患儿母亲IDM的患病率是新生儿非PDA组的2.45倍，差异有统计学意义[RR=2.45，95%CI：（1.98~3.02），P<0.001]；队列研究亚组与病例对照研究亚组、妊娠期糖尿病（gestational diabetes mellitus，GDM）亚组与孕前糖尿病（pregestational diabetes mellitus，PGDM）亚组相比较，均提示新生儿PDA的发生与是否存在IDM无关。敏感性分析显示研究结果稳定可靠，无显著发表偏倚。结论 新生儿PDA的发生与是否存在IDM无关。
- Abstract:
- Objective To explore the correlation between neonatal patent ductus arteriosus (PDA) and infants of diabetic mothers (IDM) through a Meta-analysis to provide theoretical rationales for preventing neonatal PDA.Methods The databases of Web of Science, PubMed, Scopus, Embase, Cochrane, ProQuest, OVID, CNKI, WanFang, VIP and SinoMed were searched from the inceptions to August 2021.The search terms included patent ductus arteriosus, ductus arteriosus, patent of arterious ductus, diabetes, diabetes mellitus, hyperglycemia, maternal hyperglycemia and maternal diabetes mellitus.Two independent researchers conducted literature screening, data extracting and quality evaluations.The neonates were assigned into two groups of PDA and no-PDA according to the diagnosis.Subgroup analysis was conducted according to case locality, study design and type of diabetes.And Stata 14.0 was utilized for statistical prcoessing.Results Eleven studies with a total of 1 014 399 samples were included.Meta-analysis indicated that the prevalence of IDM was 1.25 folds higher in neonatal PDA group than that in neonatal non-PDA group.The difference was not statistically significant (RR=1.25, 95%CI:0.97-1.61, P=0.086).Subgroup analysis revealed no significant difference in neonatal PDA or IDM in Asian subgroups (RR=1.05, 95%CI:0.92-1.21, P=0.471) and the prevalence of IDM was 2.45 folds in neonatal PDA group than that in neonatal no-PDA group (RR=2.45, 95%CI:1.98-3.02, P<0.001).Comparing cohort study, case-control study, gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM) subgroups revealed no significant difference in neonatal PDA or IDM.The sensitivity of each study was robust and publication bias stable.Conclusion No statistically significant correlation exists between IDM and neonatal PDA in overall studies.
参考文献/References:
[1] 杨学勇.先天性心脏病的预防[D].北京:中国协和医科大学, 2009. Yang XY.Prevention of congenital heart disease[D].Beijing:Peking Union Medical College, 2009.
[2] 陈棱丽, 郑湘榕.先天性心脏病的危险因素分析[J].实用预防医学, 2012, 19(1):32-34.DOI:10.3969/j.issn.1006-3110.2012.01.010. Chen LL, Zheng XR.Analysis on risk factors of congenital heart diseases[J].Pract Prev Med, 2012, 19(1):32-34.DOI:10.3969/j.issn.1006-3110.2012.01.010.
[3] 郭明, 石静云, 易彬, 等.新生儿先天性心脏病危险因素的病例对照研究[J].中国新生儿科杂志, 2014, 29(6):390-393.DOI:10.3969/j.issn.1673-6710.2014.06.007. Guo M, Shi JY, Yi B, et al.Risk factors of neonatal congenital heart disease:a case-control study[J].Chin J Neonatol, 2014, 29(6):390-393.DOI:10.3969/j.issn.1673-6710.2014.06.007.
[4] 陈君, 汪川.德阳市先天性心脏病危险因素分析[J].中国现代医生, 2017, 55(24):108-110, 114. Chen J, Wang C.Analysis on risk factors of congenital heart diseases in Deyang City[J].China Mod Doct, 2017, 55(24):108-110, 114.
[5] Ul Haq F, Jalil F, Hashmi S, et al.Risk factors predisposing to congenital heart defects[J].Ann Pediatr Cardiol, 2011, 4(2):117-121.DOI:10.4103/0974-2069.84641.
[6] Campbell MJ, Lorch S, Rychik J, et al.Socioeconomic barriers to prenatal diagnosis of critical congenital heart disease[J].Prenat Diagn, 2021, 41(3):341-346.DOI:10.1002/pd.5864.
[7] Jeon GW.Risk factors and neonatal outcomes of patent ductus arteriosus ligation in preterm infants in a single center over 6 years[J].Perinatology, 2020, 31(4):191-198.DOI:10.14734/PN.2020.31.4.191.
[8] 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会妊娠合并糖尿病协作组.妊娠合并糖尿病诊治指南(2014)[J].中华妇产科杂志, 2014, 49(8):561-569.DOI:10.3760/cma.j.issn.0529-567x.2014.08.001. Group of Obstetrics, Branch of Obstetrics & Gynecology, Chinese Medical Association.Pregnancy plus Diabetes Collaborative Group, Perinatal Medicine Branch, Chinese Medical Association:Guidelines for Diagnosing and Treating Pregnancy Complicated with Diabetes (2014)[J].Chin J Obstet Gynecol, 2014, 49(8):561-569.DOI:10.3760/cma.j.issn.0529-567x.2014.08.001.
[9] Wells GA, Shea B, O’Connell D, et al.The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses[EB/OL].[2022-5-1].http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
[10] Alyousif SMM, Aldokhel FT, Alkhanbashi OK, et al.The incidence of congenital heart defects in offspring among women with diabetes in Saudi Arabia[J].Cureus, 2021, 13(3):e14225.DOI:10.7759/cureus.14225.
[11] Dani C, Mosca F, Cresi F, et al.Patent ductus arteriosus in preterm infants born at 23-24 weeks’ gestation:should we pay more attention?[J].Early Hum Dev, 2019, 135:16-22.DOI:10.1016/j.earlhumdev.2019.06.002.
[12] Hitaka D, Morisaki N, Miyazono Y, et al.Neonatal outcomes of very low birthweight infants born to mothers with hyperglycaemia in pregnancy:a retrospective cohort study in Japan[J].BMJ Paediatr Open, 2019, 3(1):e000491.DOI:10.1136/bmjpo-2019-000491.
[13] 吴琦.浅谈导致早产儿发生动脉导管未闭的危险因素[J].当代医药论丛, 2019, 17(16):57-58. Wu Q.Risk factors of patent ductus arteriosus in premature infants[J].Contemp Med Symp, 2019, 17(16):57-58.
[14] 谢凯, 陈玉娥, 蔡准顿.实时三维超声心动图在妊娠期糖代谢异常母亲新生儿心脏结构及功能检查中的应用价值[J].临床合理用药杂志, 2018, 11(6):112-114.DOI:10.15887/j.cnki.13-1389/r.2018.06.056. Xie K, Chen YE, Cai ZD.Application of real-time three-dimensional echocardiography in the examination of cardiac structure and function of neonates born to mothers with abnormal glucose metabolism during pregnancy[J].Chin J Clin Ration Drug Use, 2018, 11(6):112-114.DOI:10.15887/j.cnki.13-1389/r.2018.06.056.
[15] Akbariasbagh P, Shariat M, Akbariasbagh N, et al.Cardiovascular malformations in infants of diabetic mothers:a retrospective case-control study[J].Acta Med Iran, 2017, 55(2):103-108.
[16] Begum S, Dey SK.Clinical profile and pattern of congenital heart disease in infants of diabetic mother and infants of non-diabetic mother at a tertiary care hospital[J].J Neonatal Perinatal Med, 2017, 10(4):403-408.DOI:10.3233/NPM-170176.
[17] 高瑛, 孙岩, 王席娟, 等.极低出生体质量儿动脉导管未闭及动脉导管再次开放的高危因素分析[J].新乡医学院学报, 2017, 34(7):574-578.DOI:10.7683/xxyxyxb.2017.07.005. Gao Y, Sun Y, Wang XJ, et al.Risk factors of patent ductus arteriosus and arterial ductus re-patency in very low birth weight infants[J].J Xinxiang Med Univ, 2017, 34(7):574-578.DOI:10.7683/xxyxyxb.2017.07.005.
[18] Leirgul E, Brodwall K, Greve G, et al.Maternal diabetes, birth weight, and neonatal risk of congenital heart defects in Norway, 1994-2009[J].Obstet Gynecol, 2016, 128(5):1116-1125.DOI:10.1097/AOG.0000000000001694.
[19] Grandi C, Tapia JL, Cardoso VC.Impact of maternal diabetes mellitus on mortality and morbidity of very low birth weight infants:a multicenter Latin America study[J].J Pediatr (Rio J), 2015, 91(3):234-241.DOI:10.1016/j.jped.2014.08.007.
[20] Vereczkey A, Gerencsér B, Czeizel AE, et al.Association of certain chronic maternal diseases with the risk of specific congenital heart defects:a population-based study[J].Eur J Obstet Gynecol Reprod Biol, 2014, 182:1-6.DOI:10.1016/j.ejogrb.2014.08.022.
[21] 李娲.婴幼儿动脉导管未闭治疗进展[J].医学理论与实践, 2021, 34(10):1659-1662.DOI:10.19381/j.issn.1001-7585.2021.10.013. Li W.Advances in the treatment of patent ductus arteriosus in infants[J].J Med Theory Pract, 2021, 34(10):1659-1662.DOI:10.19381/j.issn.1001-7585.2021.10.013.
[22] Qattan M, Duan L, Hekimian A, et al.Maternal glycemic control and risk of fetal congenital heart disease in a multiethnic cohort of women with diabetes[J].J Am Coll Cardiol, 2018, 71(11, Supplement):A572.DOI:10.1016/S0735-1097(18)31113-6.
[23] Antole N, Jacquemart C, Gkiougki E, et al.Cardiac malformations in neonates born from mothers with gestational diabetes[J].Acta Cardiol, 2014, 69(1):88.DOI:10.1080/AC.69.1.3011350.
[24] Khalili Z, Ardekani MB, Jariani A.Congenital heart disease in the newborns of Iranian diabetic mothers[J].Cardiology, 2014, 128(S1):192.DOI:10.1159/000365062.
[25] Tinker SC, Gilboa SM, Moore CA, et al.Specific birth defects in pregnancies of women with diabetes:National Birth Defects Prevention Study, 1997-2011[J].Obstet Gynecol Surv, 2020, 75(7):385-387.DOI:10.1097/OGX.0000000000000821.
[26] Khalid H, Farrukh H, Waqqas A, et al.Assessment of congenital heart disease and related various factors in the neonates of mothers with diabetes[J].Pak Armed Forces Med J, 2020, 70(5):1553-1558.
[27] Wu YQ, Reece EA, Zhong JX, et al.Type 2 diabetes mellitus induces congenital heart defects in murine embryos by increasing oxidative stress, endoplasmic reticulum stress, and apoptosis[J].Am J Obstet Gynecol, 2016, 215(3):366.e1-366.e10.DOI:10.1016/j.ajog.2016.03.036.
[28] Kumar SD, Dheen ST, Tay SSW.Maternal diabetes induces congenital heart defects in mice by altering the expression of genes involved in cardiovascular development[J].Cardiovasc Diabetol, 2007, 6:34.DOI:10.1186/1475-2840-6-34.
[29] Momma K, Toyoshima K, Hayama E, et al.Glibenclamide closes neonatal ductus arteriosus in rats[J].Arch Dis Child, 2014, 99(S2):A412.DOI:10.1136/archdischild-2014-307384.1145.
[30] 段予新, 李玉洁, 徐珊.妊娠期糖尿病的干预治疗对胎儿和婴儿心脏功能的影响[J].现代预防医学, 2012, 39(7):1644-1645, 1647. Duan YX, Li YJ, Xu S.Impact of intervention treatment of gestational diabetes mellitus on cardiac function of fetuses and infants[J].Mod Prev Med, 2012, 39(7):1644-1645, 1647.
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备注/Memo
收稿日期:2021-09-22。
基金项目:国家重点研发计划（2016YFC1301901）
通讯作者:孙子兰,Email:411474990@qq.com