格列吡嗪对比瑞格列奈治疗2型糖尿病疗效和安全性的Meta分析

摘要

OBJECTIVE:To systematically review the efficacy and safety of glipiaide versus repaglinide in treatment of type 2 diabetes and provide evidence-based reference for the clinical treatment. METHODS:PubMed,EMBase,Medline,Cochrane Li-brary,CJFD,VIP and WanFang database were retrieved to collect the randomized controlled trials(RCT)of the efficacy and safety of glipizide(test group)versus repaglinide(control group)in the treatment of type 2 diabetes. After the quality evaluation and in-formation collection of clinical studies with inclusion criteria,Rev Man 5.2 software was conducted for Meta-analysis. RESULTS:There were totally 10 RCTs,involving 1 022 patients. Meta-analysis results showed that the HbA1c levels [MD=0.43,95%CI (0.20,0.65),P<0.001],2 h postprandial plasma glucose levels [MD=0.49,95% CI(0.04,0.94),P=0.03] and hypoglycemia inci-dence [OR=2.99,95%CI(1.83,4.88),P<0.001] in test group were significantly higher than control group. There was no signifi-cant difference in the fasting plasma glucose level in 2 groups[MD=-0.14,95%CI(-0.44,0.16),P=0.35]. CONCLUSIONS:Re-paglinide has better efficacy and safety than glipizide in the treatment of type 2 diabetes. Limited by the methodological quality and sample amount of included studies,it remains to be verified by RCT with large sample,strict design and long-term follow-up.%目的：系统评价格列吡嗪对比瑞格列奈治疗2型糖尿病的疗效和安全性，以为临床治疗提供循证参考。方法：计算机检索PubMed、EMBase、Medline、Cochrane图书馆、中国期刊全文数据库、中文科技期刊全文数据库和万方数字化期刊全文数据库，收集格列吡嗪（试验组）对比瑞格列奈（对照组）治疗2型糖尿病疗效和安全性的随机对照试验（RCT），对符合纳入标准的临床研究进行质量评价和资料提取后，采用Rev Man 5.2统计软件进行Meta分析。结果：共纳入10项RCT，合计1022例患者。Meta分析结果显示，试验组患者糖化血红蛋白水平[MD＝0.43，95％CI（0.20，0.65），P＜0.001]、餐后2 h血糖水平[MD＝0.49，95％CI（0.04，0.94），P＝0.03]和低血糖发生率[OR＝2.99，95％CI（1.83，4.88），P＜0.001]均显著高于对照组，而两组患者空腹血糖水平比较差异无统计学意义[MD＝－0.14，95％CI（－0.44，0.16），P＝0.35]。结论：瑞格列奈治疗2型糖尿病疗效和安全性优于格列吡嗪。受纳入研究方法学质量和样本量限制，该结论有待更多设计严格、长期随访的大样本RCT加以验证。