目的系统评价胰岛素对不同孕周妊娠期糖尿病患者血糖控制及妊娠结局，为临床治疗提供循证医学依据。方法检索PubMed、Embase、Cochrane Library、中国学术期刊全文数据库（CNKI）、维普中文期刊全文数据库（VIP）、中国生物医学文献数据库（CBM）和万方数据库，收集观察组（孕周≤ 32周）对比对照组（孕周>32周）的妊娠期糖尿病患者使用胰岛素的病例对照研究，检索时间均为建库至2020年10月，筛选文献、提取数据和质量评价后，用RevMan5.3软件进行Meta分析。结果共纳入15项研究，1 637例妊娠期糖尿病患者。Meta分析结果显示，观察组分娩时空腹血糖（SMD=-0.37，95% CI=-0.47~-0.27）、产后2 h血糖（SMD=-0.42，95% CI=-0.52~-0.32）均显著小于对照组（P<0.01）；暴露组早产（OR=0.35，95% CI=0.25~0.48）、剖宫产（OR=0.57，95% CI=0.46~0.71）、妊娠期高血压（OR=0.40，95% CI=0.30~0.54）、羊水过多（OR=0.35，95% CI=0.23~0.52）、产后出血（OR=0.41，95% CI=0.26~0.64）和产后感染（OR=0.22，95% CI=0.12~0.38）均显著小于对照组（P<0.01）；观察组巨大儿（OR=0.41，95% CI=0.31~0.55）、新生儿窒息（OR=0.23，95% CI=0.15~0.35）、新生儿低血糖（OR=0.24，95% CI=0.15~0.37）、高胆红素血症（OR=0.29，95% CI=0.18~0.47）和新生儿低体质量（OR=0.31，95% CI=0.20~0.49）均显著小于对照组（P<0.01）。结论对于GDM患者孕早期（孕周≤ 32周）开始使用胰岛素更能有效控制产妇血糖水平，降低母儿围产期不良结果发生率。

Objective To systematically evaluate the blood glucose control and pregnancy outcome of insulin in the treatment of gestational diabetes mellitus (GDM) in different gestational ages, and provide evidence for clinical treatment of GDM. Methods Case-control studies of the experimental group (gestational age ≤ 32 weeks) was compared with the control group (gestational age > 32 weeks) GDM patients started taking insulin in PubMed, Embase, Cochrane Library, CNKI, CBM, VIP and Wanfang database form database up to October of 2020. Meta-analysis was carried out with RevMan 5.3 software after selecting literature,extracting data, and evaluating quality. Results A total of 15 studies and 1 637 patients was included. Meta-analysis showed that fasting blood glucose (SMD = -0.37, 95%CI = -0.47 to -0.27) and postpartum 2 hours blood glucose (SMD = -0.42, 95%CI = -0.52 to -0.32) in the experimental group were significantly lower than those in the control group (P < 0.01); Preterm birth (OR=0.35, 95%CI = 0.25 to 0.48), cesarean section (OR = 0.57, 95%CI = 0.46 to 0.71), gestational hypertension (OR = 0.40, 95%CI = 0.30 to 0.54], polyhydramnios (OR = 0.35, 95%CI = 0.23 to 0.52), postpartum hemorrhage (OR = 0.41, 95%CI = 0.26 to 0.64) and postpartum infection (OR= 0.22, 95%CI = 0.12 to 0.38) in the experimental group were significantly lower than those in the control group (P < 0.01). Fetal macrosomia (OR = 0.41, 95%CI = 0.31 to 0.55), neonatal asphyxia (OR = 0.23, 95%CI = 0.15 to 0.35), neonatal hypoglycemia (OR = 0.24, 95%CI = 0.15 to 0.37], hyperbilirubinemia (OR = 0.29, 95%CI = 0.18 to 0.47) and low birth weight (OR = 0.31, 95%CI = 0.20 to 0.49) in the experimental group were significantly lower than those in the control group (P < 0.01). Conclusion For the GDM patients, early pregnancy (gestational ages ≤32 weeks) starting insulin is more effective to control maternal blood glucose level and reduce the incidence of perinatal adverse outcomes.

R977

湖北省卫生计生委科研项目（WJ2019H485）