DPP4抑制剂与α糖苷酶抑制剂治疗2型糖尿病有效性及安全性的Meta分析

发布时间：2018-03-25 00:18

本文选题：糖尿病　切入点：型　出处：《重庆医学》2016年26期

【摘要】：目的系统评价T细胞表面抗原CD26(DPP4)抑制剂与α糖苷酶抑制剂治疗2型糖尿病的有效性、安全性。方法计算机全面检索Cochrane、EMbase、PubMed、CBM、VIP、万方数据库,检索时间设定为自建库至2015年7月。收集DPP4抑制剂与α糖苷酶抑制剂比较治疗2型糖尿病的随机对照试验(RCT)。由两位研究者根据纳入与排除标准筛选研究、提取资料,并根据Cochrane系统评价员手册进行质量评价后,采用RevMan 5.3软件进行Meta分析。结果共纳入18个RCTs,Meta分析显示,无论是单药治疗还是联合治疗,DPP4抑制剂组降低HbA1c水平的疗效均优于α糖苷酶抑制剂组,其差异有统计学意义[MD=-0.29,95%CI(-0.48,-0.10);MD=-0.23,95%CI(-0.36,-0.10)];无论是单药治疗还是联合治疗,DPP4抑制剂组降低FPG水平的疗效均优于α糖苷酶抑制剂组,其差异有统计学意义[MD=-0.48,95%CI(-0.94,-0.03);MD=-0.25,95%CI(-0.47,-0.03)]。在提高HOMA-B方面,DPP4抑制剂组优于α糖苷酶抑制剂组,差异有统计学意义[MD=9.22,95%CI(5.61,12.84)];在改善HOMA-IR方面,两组差异无统计学意义[MD=0.13,95%CI(-0.17,0.44)]。在体质量控制方面,α糖苷酶抑制剂组优于DPP4抑制剂组,其差异有统计学意义[MD=0.72,95%CI(0.51,0.94);MD=1.30,95%CI(1.28,1.32)]。DPP4抑制剂组总不良反应发生率低于α糖苷酶抑制剂组,差异有统计学意义[OR=0.49,95%CI(0.36,0.66)];但两者在心血管事件发生率与低血糖发生率方面,差异无统计学意义[OR=1.83,95%CI(0.92,3.66);OR=0.97,95%CI(0.46,2.07)]。结论 DPP4抑制剂较α糖苷酶抑制剂能更有效控制血糖,改善胰岛功能,总体不良反应少,低血糖发生率低,安全性良好,但α糖苷酶抑制剂对减重更有优势。
[Abstract]:Objective to evaluate the efficacy and safety of T cell surface antigen CD26DPP4) inhibitor and 伪 glucosidase inhibitor in the treatment of type 2 diabetes mellitus. The retrieval time was set up from the database to July 2015. The randomized controlled trial of DPP4 inhibitor and 伪 -glucosidase inhibitor in the treatment of type 2 diabetes mellitus was collected. The data were extracted by two researchers according to the screening study of inclusion and exclusion criteria. After the quality evaluation was carried out according to the manual of Cochrane system evaluators, the Meta analysis was carried out with RevMan 5.3 software. The results were included in 18 RCTs Meta-analysis. Both monotherapy and combination therapy of DPP4 inhibitor group were superior to 伪 -glucosidase inhibitor group in reducing HbA1c level. The difference was statistically significant [MD-0.29995] [MD-0.23995] [MD-0.29995] [MD-0.23995]; both monotherapy and combined treatment with DPP4 inhibitor had better effect on reducing FPG level than 伪 -glucosidase inhibitor group, and the effect was better than that of 伪 -glucosidase inhibitor group, both in monotherapy group and in combination treatment group, the effect was better than that in 伪 -glucosidase inhibitor group. The difference was statistically significant [MD-0.48CI-0.94 ~ 0.03]. In improving HOMA-B, DPP4 inhibitor group was better than 伪 -glucosidase inhibitor group (MD9.2295CI5.61C12.84); in improving HOMA-IR, DPP4 inhibitor group was better than 伪 -glucosidase inhibitor group (MD9.2295CI5.6112.84); in improving HOMA-IR, DPP4 inhibitor group was better than 伪 -glucosidase inhibitor group (MD9.2295CI5.6112.84); in improving HOMA-IR, DPP4 inhibitor was better than 伪 glucosidase inhibitor group. There was no significant difference between the two groups [MD0.1395 CI-0.170.44]. In body quality control, the 伪 -glucosidase inhibitor group was superior to the DPP4 inhibitor group, and the difference was statistically significant. The difference was statistically significant (ORO 0.49 ~ 95CII 0.36 / 0.66), but there was no significant difference in the incidence of cardiovascular events and hypoglycemia between the two groups [ORX 1.8395CII 0.923.66CI0.99795 CI 0.462.07]. Conclusion DPP4 inhibitor is more effective than 伪 -glucosidase inhibitor in controlling blood glucose and improving islet function. The overall adverse effects were low, the incidence of hypoglycemia was low, and the safety was good, but 伪 -glucosidase inhibitor had more advantages in weight loss.
【作者单位】：昆明医科大学第一附属医院糖尿病科;
【分类号】：R587.1

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