胰升糖素样肽1类似物治疗2型糖尿病有效性和安全性的系统评价

摘要

Objective To systematically review the efficacy and safety of glucagon-like peptide (GLP)-1analogue in the treatment of type 2 diabetes. Methods Literature search was conducted through Pubmed, Ovid, SpringerLink, Cochrane, CBM and Wanfang data by the end of September 2010. The selection of studies, assessment of methodological quality and data extraction were performed according to Cochrane Handbook for systematic reviews and predefined criteria. Meta analysis was carried out by the use of software RevMan4.2 and descriptive qualitative analysis was done when necessary. Results Twenty-three clinical trials met the inclusion criteria. The results of Meta-analysis indicated that GLP-1 analogue group showed better clinical outcomes than placebo group and other antidiabetic drug group, regarding the reduction of HbA1c and loss of body weight. Compared with placebo group, GLP-1 analogue group had higher hypoglycaemia rate, which was similar to the rate in other antidiabetic drug group. GLP-1 analogue group had high risk of gastrointestinal side effects. Conclusions The evidence currently available suggests that GLP-1 analogue has good efficacy and tolerability. The common adverse effects are gastrointestinal side effects.%目的 系统评价胰升糖素样1肽(GLP-1)类似物治疗2型糖尿病的有效性和安全性.方法 计算机检索Pubmed、Ovid、SpringerLink、Cochrane图书馆、中国生物医学文献数据库(CBM)及万方数据库.检索时间由建库截至2010年9月.按Cochrane系统评价的方法 评价研究的质量,应用RevMan4.2软件进行Meta分析;不能合并的数据,进行描述性分析.结果 本研究共纳入23个随机对照试验进行分析.Meta分析结果 显示在降低糖化血红蛋白[加权均数差(WMD)=-0.89,95%可信区间(CI)-1.02～-0.77,P＜0.01]和降低体重方面(WMD=-1.16,95% CI-1.75～-0.56,P＜0.01),GLP-1类似物组均优于安慰剂组或其他降糖药组.GLP-1类似物组的低血糖事件发生率高于安慰剂组(RR=1.81,95%CI 1.32～2.49,P＜0.01),但与其他降糖药组相当(RR=0.59,95%CI 0.34,1.01,P=0.06).GLP-1类似物组的胃肠道的不良反应率高于安慰剂组(RR=3.30,95%CI2.43～4.49,P＜0.01).结论 现有的临床证据显示,GLP-1类似物治疗2型糖尿病疗效较好,且相对安全,主要的不良反应为胃肠道不良反应.