GLP-1类似物与磺脲类对比治疗2型糖尿病的疗效与安全系统评价

发布时间：2018-02-02 20:48

本文关键词： GLP-1类似物磺脲类 2型糖尿病疗效安全性系统评价　出处：《广西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：系统评价GLP-1类似物与磺脲类对比在治疗2型糖尿病的疗效与安全。方法：计算机检索PubMed、EMBASE、Cochrane Library databases、重庆维普数据库、清华同方数据库、中国生物医学文献数据库、万方数据库,时间为截止至2015年3月2日。纳入GLP-1类似物与磺脲类对比治疗2型糖尿病患者的随机对照试验,采用Review Manager5.2软件进行meta分析。疗效观察指标为：糖化血红蛋白、空腹血糖、餐后2h血糖、体重、收缩压,安全性观察指标为：低血糖事件、胃肠道不良反应。结果：纳入符合要求的13个随机对照研究,共5100名患者,其中有7个研究均联合了二甲双胍治疗进行对比。Meta分析结果显示,在疗效方面：①降低糖化血红蛋白方面,GLP-1类似物与磺脲类药物对比无显著差异,[SMD=-O.14,95%CI(-0.28,0.01),P=0.06]；进行亚组分析提示无论是否联合使用二甲双胍,无论利拉鲁肽还是其他种类GLP-1类似物与磺脲类对比均无显著差异。②降低空腹血糖方面,GLP-1类似物与磺脲类对比无显著差异,[SMD=-0.1,95%CI=(-0.27,-0.07),P=0.24]；进行亚组分析提示无论是否联合使用二甲双胍,无论利拉鲁肽还是其他种类GLP-1类似物与磺脲类对比均无显著差异。③降低餐后2小时血糖方面,GLP-1类似物与磺脲对比无显著差异,[SMD=-O.04,95%CI=(-0.13,-0.05), P=0.41]。④降低收缩压方面,GLP-1类似物优于磺脲类,[SMD=-O.22,95%CI=(-0.30,-0.15), P0.00001]。⑤减轻体重方面,GLP-1类似物优于磺脲类,[SMD=-1.55, 95%CI=(-2.51,-0.59),P=0.001];进行亚组分析提示无论是否联合二甲双胍治疗、无论利拉鲁肽还是其他种类GLP-1类似物均优于磺脲类。⑥低血糖风险,GLP-1类似物小于磺脲类,[RR=0.25,95%CI=(0.15,0.41), P 0.00001];进行亚组分析提示无论是否联合二甲双胍治疗、无论利拉鲁肽还是其他种类GLP-1类似物低血糖风险均小于磺脲类。⑦胃肠道不良反应,GLP-1类似物较磺脲类明显,[RR=2.10,95%CI=(1.34,3.29), P=0.001];进行亚组分析提示当单独使用GLP-1类似物和磺脲类进行对比时,两者胃肠道反应物对比无显著差异,当均联合使用二甲双胍治疗进行对比时,GLP-1类似物治疗2型糖尿病胃肠道不良反应较磺脲类明显,利拉鲁肽胃肠道不良反应较磺脲类明显。结论：对于2型糖尿病患者,GLP-1类似物与磺脲类降糖药物对比,在疗效方面,降低糖化血红蛋白、空腹血糖及餐后2小时血糖无显著差异,降低血压及减轻体重更明显。安全性方面,低血糖风险更低,当联合二甲双胍治疗时,胃肠道不良反应较明显。
[Abstract]:Objective: to systematically evaluate the efficacy and safety of GLP-1 analogues and sulfonylureas in the treatment of type 2 diabetes mellitus. Methods: a computer-based search of PubMedus EMBASE Cochrane Library database, Chongqing Weip database, Tsinghua Tongfang database, Chinese biomedical literature database and Wanfang database was conducted. The time was up to March 2nd 2015. The randomized controlled trial of GLP-1 analogues and sulfonylureas in the treatment of type 2 diabetes mellitus was carried out with Review Manager5.2 software. The therapeutic effects were as follows: glycosylated hemoglobin, fasting blood glucose, 2 h postprandial blood glucose, body weight, systolic blood pressure and safety were observed as follows: hypoglycemia, gastrointestinal adverse reactions. Results: a total of 5100 patients were enrolled in 13 randomized controlled trials. Seven of the studies combined with metformin were compared with metformin therapy. Meta-analysis showed that, There was no significant difference between GLP-1 analogues and sulfonylurea drugs in reducing glycosylated hemoglobin. [SMD-O.149CI-0.28CI-0.06]; subgroup analysis showed that whether or not metformin was used in combination, There was no significant difference between GLP-1 analogues and sulfonylureas. 2 there was no significant difference between GLP-1 analogues and sulfonylureas in lowering fasting blood glucose. There was no significant difference between GLP-1 analogues and sulfonylureas. 3 there was no significant difference between GLP-1 analogues and sulfonylureas in reducing blood glucose at 2 hours after meal. [SMD-O.04C95CIK- 0.13- 0.05U, P0. 41] .4 GLP-1 analogues were superior to sulfonylurea in reducing systolic blood pressure (SBP). Ureas, [SMD-O.2295], [SMD-0.30U -0.15U, P0.00001] .5 GLP-1 analogues are superior to sulfonylureas in weight loss, [SMD-1.55, 95CIZ-2.51U -0.59Pn0.001]; subgroup analysis showed that whether or not combined with metformin, Both Lilaru peptide and other GLP-1 analogues were superior to sulfonylureas in hypoglycemia risk. GLP-1 analogue was less than sulfonylurea, [RRRN 0.25 ~ 95 CIQ 0.150.41, P 0.00001]. Subgroup analysis showed that whether combined with metformin or not, The hypoglycemic risk of both liraud and other GLP-1 analogues was lower than that of sulfonylurea .7 gastrointestinal adverse reactions. GLP-1 analogue was significantly higher than that of sulfonylurea. [RRRN 2.101095 CIQ 1.343.29, P0. 001]. The subgroup analysis showed that when compared with sulfonylurea alone, the subgroup analysis showed that the risk of hypoglycemia was lower than that of sulfonylurea. There was no significant difference in gastrointestinal reaction between the two groups. When both patients were treated with metformin, GLP-1 analogue was more effective than sulfonylurea in the treatment of type 2 diabetes mellitus. Conclusion: in comparison of GLP-1 analogue with sulfonylurea, glycosylated hemoglobin can be decreased in patients with type 2 diabetes mellitus. There was no significant difference in fasting blood glucose and 2 hours postprandial blood glucose, but it was more obvious to lower blood pressure and weight. In terms of safety, hypoglycemia risk was lower, and gastrointestinal adverse reactions were more obvious when combined with metformin.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

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