西格列汀联合二甲双胍对2型糖尿病疗效和安全性的Meta分析Meta-analysis of the Efficacy and Safety of Sitagliptin Combined with Metformin in Obese Type 2 Diabetes Mellitus
潘纯红,赵方允
PAN Chunhong,ZHAO Fangyun
摘要(Abstract)：
目的运用Meta分析评价西格列汀联合二甲双胍对肥胖2型糖尿病疗效和安全性。方法检索中国知识资源总库(CNKI)、中国学术期刊数据库(万方数据库)、中文科技期刊数据库(VIP),收集西格列汀联合二甲双胍对肥胖2型糖尿病的随机对照试验(RCT)。采用Rev Man 5.4统计软件进行Meta分析。结果共纳入10个研究,涵盖1 156例患者。Meta分析结果显示,西格列汀联合二甲双胍试验组与二甲双胍对照组相比,能更有效降低糖化血红蛋白(HBA1C)[SMD=-0.71,95%CI(-0.95,-0.48),P<0.000 01],空腹血糖(FBG)[SMD=-1.10,95%CI(-1.67,-0.54),P=0.000 1],餐后2 h血糖(2hPG)[SMD=-0.9,95%CI(-1.22,-0.58),P<0.000 01],胰岛素抵抗指数(HOMA-IR)[SMD=-0.79,95%CI(-1.35,-0.24),P=0.005],体重指数(BMI)[SMD=-0.37,95%CI(-0.68,-0.06),P=0.02],总胆固醇(TC)[SMD=-0.56,95%CI(-0.88,-0.24),P=0.000 7],三酰甘油(TG)[SMD=-1.03,95%CI(-1.24,-0.82),P=0.000 01]。结果显示,消化系统不良反应[OR=0.75,95%CI(0.46,1.24),P=0.27]两组间差异无统计学意义,试验组与对照组的消化系统不良反应发生情况相当。结论西格列汀联合二甲双胍治疗肥胖2型糖尿病疗效和安全性较高。
OBJECTIVE To evaluate the efficacy and safety of sitagliptin combined with metformin in the treatment of obese type 2 diabetes mellitus by using Meta analysis. METHODS Randomized controlled trials(RCTs) of sitagliptin combined with metformin on obese type 2 diabetes were collected from CNKI, Wanfang database and VIP database.Rev Man 5.4 statistical software was used for Meta analysis. RESULTS A total of 10 studies covering 1 156 patients were included.Meta-analysis results showed that sitagliptin combined with metformin group were more effectively in reducing hemoglobin(HbA1 c) [SMD=-0.71, 95%CI(-0.95,-0.48), P=0.000 01]compared with metformin control group. Fasting blood glucose(FBG)[SMD=-1.10, 95%CI(-1.67,-0.54),P=0.000 1]. Postprandial blood glucose(2 HPG) 2 h [SMD=0.9, 95% CI(1.22, 0.58), P=0.000 01]. Indexes of insulin resistance(HOMA IR) [SMD=0.79, 95% CI(1.35, 0.24), P=0.005], Body mass index(BMI) [SMD=-0.37,95%CI(-0.68,-00.06),P=0.02], Total cholesterol(TC) [SMD=-0.56,95%CI(-0.88,-0.24),P=0.000 7]. Triacylglycerol(TG)[ SMD=-1.03,95%CI(-1.24,-0.82),P=0.000 01]. ADR of digestive system[ OR=0.75,95%CI(0.46,1.24),P=0.27], and the difference between the two groups was not statistically significant. The incidence of adverse reactions in digestive system was similar between the experimental group and the control group. CONCLUSION Sitagliptin combined with metformin is effective and safety in the treatment of obese type 2 diabetes.
关键词(KeyWords)：
西格列汀;二甲双胍;2型糖尿病;Meta分析
sitagliptin;metformin;type 2 diabetes;Meta analysis
基金项目(Foundation): 云南省高层次卫生计生技术人才培养经费资助(H-2019026)
作者(Author):
潘纯红,赵方允
PAN Chunhong,ZHAO Fangyun
参考文献(References)：
- [1] 项坤三.糖尿病的病因异质性及分型[J].中华内分泌代谢杂志，2005,21(4):397-401.
- [2] Mohanty S,Mohanty P,Di Biase L,et al.Impact of metabolic syndrome on procedural outcomes in patients with atrial fibrillation undergoing catheter ablation[J].J Am Coll Cardiol,2012,59(14):1295-1301.
- [3] 田朝伟，陶丽丽，林珮仪，等.广州市海珠区社区居民代谢综合征及危险因素调查分析[J].广州医科大学学报，2014(6):9-13.
- [4] Drucker D,Easley C,Kirkpatrick P.Sitagliptin[J].Nat Rev Drug Discov,2007,6(2):109-110.
- [5] 肖康，冯其乡.二甲双胍联合西格列汀治疗2型糖尿病伴代谢综合征疗效评价[J].中国药业，2018,27(7):47-49.
- [6] 王芬，陈开宁，郑小瑛，等.二甲双胍联合西格列汀治疗2型糖尿病的疗效观察[J].中国热带医学，2018,18(8):819-822.
- [7] 杨卫东.二甲双胍联合西格列汀对初诊T2DM患者临床疗效分析[J].药物评价研究，2018,41(4):643-647.
- [8] 韩秀平，孙涛，贺钰梅，等.磷酸西格列汀联合二甲双胍治疗初发2型糖尿病的临床效果[J].中国医药导报，2016,13(12):165-168.
- [9] 胡田颖，郭伟.西格列汀联合二甲双胍对2型糖尿病合并非酒精性脂肪肝的疗效及安全性[J].药物评价研究，2017,40(6):844-847.
- [10] 孟琼，黄昊，傅晓东.西格列汀联合二甲双胍对2型糖尿病合并非酒精性脂肪肝患者的疗效观察[J].中国临床医学，2017,24(6):939-942.
- [11] 干异，杨成会.西格列汀联合二甲双胍对2型糖尿病患者糖、脂代谢及胰岛素抵抗的影响[J].中国煤炭工业医学杂志，2017,20(12):1442-1446.
- [12] 李斐，曲震理.西格列汀联合二甲双胍治疗2型糖尿病伴非酒精性脂肪肝的临床研究[J].中国临床药理学杂志，2018,34(5):518-520.
- [13] 张坤，任巧华，吴韬，等.西格列汀联合二甲双胍治疗2型糖尿病合并代谢综合征的临床观察[J].中国药房，2016,27(17):2364-2366.
- [14] 陈红霞，史婷婷，袁群，等.西格列汀与二甲双胍联用治疗老年2型糖尿病的疗治效观察[J].微循环学杂志，2019,29(1):18-22.
- [15] 苗婷，刘子艳，刘玉媛，等.二甲双胍药理作用及其机制研究[J].医学信息，2019,32(14):53-56.
- [16] 邢颖，郑策，甄健存.二肽基肽酶DPP-4抑制剂—西格列汀治疗2型糖尿病的安全性国内外文献分析[J].中国医院药学杂志，2012,32(6):480-481.