基于肠促胰素药物治疗2型糖尿病合并非酒精性肝病的疗效和安全性的系统评价和meta分析

doi:10.5246/jcps.2016.03.025

摘要/Abstract

摘要：

本文旨在对基于肠促胰素药物治疗2型糖尿病合并非酒精性肝病的疗效和安全性进行系统评价和meta分析。全面检索Cochrane Library、EMBASE、PubMed、CNKI、中国生物医学文献数据库CBM和万方中华医学会期刊数据库,纳入2015年7月之前发表的全部随机对照试验(RCT)。共纳入7个RCT的532名患者(干预组: 264, 对照组: 268)。肠促胰素组显著降低患者谷丙转氨酶ALT (WMD–12.30, 95% CI –17.53~–7.06)和BMI (WMD–2.64, 95% CI –4.35~–0.94)。两组对患者血红蛋白(HbA1c%)、天门冬氨酸转移酶(AST)、总胆固醇(TC)、甘油三酯(TG)和胰岛素抵抗指数(HOMA-RA)的改变无显著差别。有限的安全性资料显示不良反应可耐受。基于肠促胰素药物对ALT和BMI的改善效果较好,安全性尚可,可作为2型糖尿病合并非酒精性肝病患者的治疗选择,但研究质量有限。

关键词: 肠促胰素, DPP-4酶抑制剂, GLP-1受体拮抗剂, 2型糖尿病, 非酒精性肝病, meta分析, 随机对照试验

Abstract:

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the effectiveness and safety of incretin-based therapies (IBTs) for the treatment of type 2 diabetes (T2DM) with nonalcoholic fatty liver disease (NAFLD). Electronic databases such as the Cochrane library, EMbase, PubMed, and three Chinese databases were searched for RCTs that compared IBTs with other treatments or placebo for T2DM with NAFLD. Two reviewers independently assessed the risk of bias, extracted, and analyzed the data. A meta-analysis was performed using Revman 5.2. Publication bias was evaluated. Seven RCTs involving 532 patients were ultimately included. The results of meta-analysis (random-effects model)revealed that IBTs had a significant reduction in serum ALT (WMD –12.30, 95% CI –17.53~–7.06) and BMI (WMD –2.64, 95% CI –4.35~–0.94). However, there was no significant difference in other outcomes including HbA1c, AST, TC, TG and HOMA-RA. IBTs were well tolerated by patients but the evidence was limited. The significant decrease in hepatic biochemical markers following treatment with IBTs, as well as improvements in BMI, suggested that IBTs may be an effective option for T2DM with NAFLD.

Key words: Incretin-based therapies, Dipeptidyl peptidase-4 inhibitor, Glucagon-like peptide-1 receptor agonist, Type 2 diabetes, Nonalcoholic fatty liver disease, Meta-analysis, Randomized controlled trial

中图分类号:

R977

Supporting:

胡琴, 唐惠林, 邵宏. 基于肠促胰素药物治疗2型糖尿病合并非酒精性肝病的疗效和安全性的系统评价和meta分析[J]. 中国药学(英文版), 2016, 25(3): 206-214.

Qin Hu, Hulin Tang, Hong Shao. Incretin-based therapies for type 2 diabetes with nonalcoholic fatty liver disease: a systematic review and meta-analysis[J]. Journal of Chinese Pharmaceutical Sciences, 2016, 25(3): 206-214.

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