艾塞那肽与胰岛素治疗口服降糖药物效果不佳的肥胖2型糖尿病疗效和安全性meta分析

摘要

目的 系统评价艾塞那肽与胰岛素治疗口服降糖药物效果不佳的肥胖2型糖尿病疗效和安全性.方法 根据研究目的制定筛选相关文献的纳入与排除标准;制定检索策略,通过PubMed数据库、中国生物医学文献数据库(the Chinese Biological Medicine Datebase,CBM)、中国期刊全文数据库(CNKI)、万方数据知识服务平台、维普中文科技期刊全文数据库(VIP)检索所有有关艾塞那肽与甘精胰岛素治疗口服降糖药物效果不佳的肥胖2型糖尿病疗效和安全性的文献,选择符合纳入排除标准,且数据信息完整的随机对照试验(RCT)作为研究对象;应用国际常用的Jadad评分方法 对纳入的试验进行质量评价;对纳入的试验进行相关数据资料整理与提取;将提取到的各研究数据应用ReviewManager 5.1软件进行统计分析;分析结果 并提出结论 .结果 共纳入11个RCT,meta分析结果 显示:与艾塞那肽相比,在降低空腹血糖方面胰岛素效果更明显[MD=0.35,95％CI:(0.11,0.59),P=0.004];在控制糖化血红蛋白效果方面,艾塞那肽和胰岛素效果相当,差异无统计学意义[MD=-0.04,95％CI:(-0.20,0.11),P=0.58];与胰岛素相比,艾塞那肽降低BMI效果更明显[MD=-2.77,(95％CI:-3.34,-2.20),P<0.00001];与胰岛素相比,艾塞那肽降低胰岛素抵抗指数效果更明显[MD=-1.67,95％CI:(-1.93,-1.41),P<0.00001];治疗过程中不良反应方面,胰岛素更容易导致低血糖的发生,[OR=0.32,95％CI:(0.19,0.54),P<0.0001];而艾塞那肽则更容易导致胃肠道不良反应的发生[OR=4.04,95％CI:(2.35,6.93),P<0.00001].结论 系统评价结果 初步显示,艾塞那肽可用于治疗口服降糖药物效果不佳的成人肥胖2型糖尿病患者,且治疗胰岛素抵抗效果明显,远期结果 仍需大量样本高质量的RCT进一步验证.%Objective Meta-analysis the efficacy and safety of Exenatide and insulin therapy oral hypoglycemic drugs effect of obesity with type 2 diabetes .Methods According to the research purpose to set up the screening of related literature and exclusion criteria; formulatethe searching strategy, through PubMed、the Chinese Biological Medicine Datebase(CBM)、 CNKI、Wanfang Data Knowledge Service Platform, VIP to retrieve all theliterature selection of efficacy and safety by Exenatide oral hypoglycemic drugs and insulin therapy of obese type 2 diabetes mellitus.Choose met inclusion exclusion criteria, the complete data information randomized controlled trial (RCT) as the research object; Apply to the international commonly used Jadad score method to evaluate quality included in the test; To process the relevant data in the test ; Apply the ReviewManager 5.1 software to analysis the extracted research data.Analysis the results and put forward conclusions.Results Participants included 11 RCT , meta analysis results showed that compared with the Exenatide, in terms of reducing fasting glucose ,insulin effect more apparent [MD = 0.35, 95％CI: (0.11, 0.59), P = 0.004)]. In control effect of glycosylated hemoglobin, there was no statistically significant difference[MD=-0.04 ,95％CI:(-0.20,0.11), P=0.58],between Exenatide and insulin. Compared with the insulin, Exenatide reduce BMI more apparent[MD=-2.77,(95％CI: -3.34,-2.20),P<0.00001]; Compared with the insulin, Exenatide reduce insulin resistance index, the effect is more obvious[MD=-1.67,95％CI:(-1.93,-1.41), P<0.00001]; Adverse reaction in the process of treatment, the insulin is more likely to lead to hypoglycemia, [OR = 0.32, 95％ CI: 0.19, 0.54), P<0.0001]; While Exenatide are more likely to lead to gastrointestinal adverse reaction [OR = 4.04, 95％ CI: 2.35, 6.93), P<0.00001).Conclusion According to the Meta-analysis: Exenatide can be used in the treatment of oral hypoglycemic drugs of adult obesity with type 2 diabetes, and obvious effects of treatment of insulin resistance, long-term results still needs a large number of samples of high quality RCT to verify.