目的 系统评价胰高血糖素样肽-1受体激动剂(GLP-1RA)类降糖药的心血管安全性。方法 计算机检索Medline、Embase、ClinicalTrails.gov、Cochrane Liabrary、CBM和中国知网数据库(CNKI);收集研究周期≥24周的比较GLP-1RA与其他降糖药或安慰剂的随机对照试验(RCT);利用RevMan5.3软件对纳入资料进行Meta分析。结果 共纳入文献51篇，2型糖尿病患者26 140例，Meta结果显示，使用GLP-1 RA后，相比总对照组主要心血管事件(MACE)的发生率有减少的趋势，但未达到统计学意义，OR值为0.78(0.57，1.08)，而相比安慰剂MACE的发生率显著降低，OR值为0.5 (0.28，0.87);相比总对照组，GLP-1RA能显著降低全因死亡率和心血管死亡率，OR值分别为:0.53(0.27，0.93)和0.38(0.16，0.90);在心血管危险因素方面，相比总对照组，GLP-1RA能显著降低HbA1c、体重、TC、LDL、SBP，显著增加心率。结论 相比总对照组，尤其与安慰剂相比，GLP-1 RA可能具有一定的心血管保护作用。
Abstract
OBJECTIVE To evaluate the cardiovascular safety of glucagon-like peptide-1 receptor agonists (GLP-1 RA) for diabetes systematically. METHODS Medline, Embase, ClinicalTrails.gov, Cochrane Liabrary, CBM, and CNKI were retrieved to collect all the randomized controlled trials (RCT) with a duration of at least 24 weeks, comparing a GLP-1RA with a non-GLP-1 RA agent in type 2 diabetes, and then a Meta-analysis was performed with RevMan5.3 software. RESULTS Fifty-one RCTs, invovling 26 140 individuals with type 2 diabetes, were included in the analysis. The difference in the incidence of major adverse cadiovascular events (MACE) between GLP-1RA and comparators did not reach statistical significance, and the odds ratio was 0.78 (0.57, 1.08), although a favorable trend was observed; while in comparisons with placebo, the incidence of MACE was significantly decreased and the odds ratio was 0.5 (0.28, 0.87); compared with comparators, a significant decrease of the incidence of all-cause and cardiovascular mortality were detected and the odds ratio were 0.53 (0.27, 0.93) and 0.38 (0.16, 0.90), respectively. As for the cardiovascular risk factors, GLP-1 RA significantly decreased the HbA1c, weight, TG, LDL, SBP, but increased the heart rates. CONCLUSION GLP-1 RA may have a protective effect on cardiovascular diseases, compared with the comparators, especially compared with placebo.
关键词
GLP-1受体激动剂 /
2型糖尿病 /
心血管疾病 /
Meta分析
{{custom_keyword}} /
Key words
glucagon-like peptide-1 receptor agonists /
type 2 diabetes /
cardiovascular diseases /
Meta-analysis
{{custom_keyword}} /
中图分类号：
R969
{{custom_clc.code}}
({{custom_clc.text}})
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] LAAKSO M. Cardiovascular disease in type 2 diabetes from population to man to mechanisms: the Kelly West Award Lecture 2008. Diabetes Care, 2010, 33(2):442-429.
[2] RAO A D, KUHADIYA N, REYNOLDS K, et al. Is the combination of sulfonylureas and metformi-n associated with an increased risk of cardiovascular diseaseor all-cause mortality?: a Meta-analysis of observational studies. Diabetes Care,2008, 31(8):1672-1678.
[3] MALMBERG K, RYDEN L,WEDEL H, et al. Intensemetabolic control by means of insulin in pat-ients with diabetes mellitus and acute myocardial infarction(DIGAMI 2): effects on mortality and morbidity. Eur Heart J, 2005, 26(7):650-661.
[4] LAGO R M, SINGH P P, NESTO R W. Congestive heart failure and cardiovascular death in patient-s with prediabetes and type 2 diabetes giventhiazolidinediones: a Meta-analysis of randomised clinical trials. Lancet, 2007, 370(9593):1129-1136.
[5] NISSEN S E, WOLSKI K. Effect of rosiglitazone on the risk of myocardial infarction and deat-h from cardiovascular causes. N Engl J Med, 2007, 356(24):2457-2471.
[6] DRUCKER D J, NAUCK M A. The incretin system: glucagon-like peptide-1 receptor agonists an-d dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Lancet, 2006, 368(9548):1696-1705.
[7] SHYANGDAN D S, ROYLE P, CLAR C. Glucagon-like peptide analogues for type 2 diabetes mell-itus. Cochrane Database Syst Rev, 2011, 10:CD006423.
[8] ENG C, KRAMER C K, ZINMAN B. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and Meta-analysis. Lancet, 2014, 384(9961):2228-2234.
[9] ROBINSON L E, HOLT T A, REES K. Effects of exenatide and liraglutide on heart rate, blood pr-essure and body weight: systematic review and meta-analysis. BMJ, 2013, 3(1):e001986. doi:10.1136/bmjopen-2012-001986.
KATOUT M, ZHU H, RUTSKY J. Effect of GLP-1 mimetics on blood pressure and relationship t-o weight loss and glycemia lowering: results of asystematic meta-analysis and meta-regression. Am J Hypertens, 2014, 27(1):130-139.
SUN F, WU S, GUO S. Impact of GLP-1 receptor agonists on blood pressure, heart rate and hy-pertension among patients with type 2diabetes: a systematic review and network meta-analysi-s. Diabetes Res Clin Pract, 2015, 110(1):26-37.
SUN F, WU S, WANG J. Effect of glucagon-like peptide-1 receptor agonists on lipid profiles among type 2 diabetes: a systematic review and network Meta-analysis. Clin Ther, 2015, 37(1):225-241.
BOUSSAGEON R, BEJAN-ANGOULVANT T, SAADATIAN-ELAHI M. Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascularevents in type 2 diabetes: meta-analysis of randomised controlled trials. BMJ, 2011, 343:d4169.
MANNUCCI E. Incretin-based therapies and cardiovascular outcome: analyses, pooled analyses and meta-analyses. G Ital Cardiol (Rome), 2012, 13(12 suppl1):4-8.
STEIN P K, BARZILAY J I, DOMITROVICH P P, et al. The relationship of heart rate and heart rat-e variability to non-diabetic fasting glucose levels and the metabolic syndrome: the Car-diovascular Health Study. Diabet Med, 2007, 24(8): 855-863.
MONAMI M, DICEMBRINI I, NARDINI C. Effects of glucagon-like peptide-1 receptor agonists on cardiovascular risk: a meta-analysis of randomized clinical trials. Diabetes Obes Metab, 2014, 16(1): 38-47.
{{custom_fnGroup.title_cn}}
脚注
{{custom_fn.content}}
PDF(1990 KB)
