目的 系统评价二肽基肽酶-4(DPP-4)抑制剂与胰高血糖素样肽-1(GLP-1)受体激动剂在2型糖尿病患者中的疗效和安全性。方法 计算机检索EMbase、PubMed、The Cochrane Library、Clinical Trial、CBM 、CNKI和万方数据库,纳入DPP-4抑制剂与GLP-1受体激动剂比较治疗2型糖尿病的随机对照试验,检索时间截至2015年12月。由2位研究者按照纳入与排除标准筛选文献、提取资料并评价纳入研究的方法学质量后,采用Revman5.3软件进行Meta分析。结果 共纳入13项RCT。荟萃分析结果显示:GLP-1受体激动剂在降低空腹血糖、糖化血红蛋白和体重指数的方面优于DPP-4抑制剂[均数差(MD)=0.93, 95%CI(0.48,1.38), P<0.000 1;MD=0.53,95%CI(0.34,0.73), P<0.000 01;MD=1.53,95%CI(0.83,2.22),P<0.001];DPP-4抑制剂降低餐后2 h血糖的疗效优于GLP-1受体激动剂[MD=-0.63,95%CI(-1.11,-0.16),P=0.009],且其发生胃肠道不良反应的相对危险度低于GLP-1受体激动剂[RR=0.44,95%CI(0.33, 0.59), P<0.000 1]。结论 GLP-1受体激动剂降低空腹血糖、糖化血红蛋白和体重的效果更好,而DPP-4抑制剂降低餐后2 h血糖效果更好,且耐受性更佳。
Abstract
OBJECTIVE To systematically review the efficacy and safety of dipeptidyl peptidase-4(DPP-4) inhibitors versus glucagon like peptide-1(GLP-1) receptor agonists for type 2 diabetes mellitus(T2DM). METHODS Databases including EMbase,PubMed, The Cochrane Library, Clinical Trial, CBM,CNKI and WanFang Data, were searched electronically for randomized controlled trials (RCTs) of DPP-4 inhibitors versus GLP-1 receptor agonists for T2DM up to December 2015. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then Meta-analysis was performed using RevMan 5.3 soft ware. RESULTS A total of 13 RCTs were included. The RESULTS of Meta-analysis showed that compared with DPP-4 inhibitors, GLP-1 receptor agonists were more effective in reducing the levels of fasting plasma glucose [MD=0.93, 95%CI(0.48,1.38), P＜0.000 1] and glycated hemoglobin [MD=0.53,95%CI(0.34,0.73), P＜0.000 01] and BMI [MD=1.53,95%CI(0.83,2.22),P＜0.001]. However, DPP-4 inhibitors were more effective than GLP-1 receptor agonists in the reducing the 2-hour postprandial blood glucose level. And GLP-1 receptor agonists were more prone to cause gastrointestinal adverse reactions than DPP-4 inhibitors [RR=0.44,95% CI (0.33, 0.59), P<0.000 1]. CONCLUSION GLP-1 receptor agonists are superior to DPP-4 inhibitors in controlling the fasting plasma glucose and glycated hemoglobin levels and reducing the body weight of T2DM patients, while DPP-4 inhibitors have better efficacy in reducing 2-hour postprandial blood glucose level, with better tolerability.
关键词
DPP-4抑制剂 /
GLP-1受体激动剂 /
2型糖尿病 /
系统评价 /
Meta分析
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Key words
DPP-4 inhibitor /
GLP-1 receptor agonist /
type 2 diabetes mellitus /
systematic review /
Meta-analysis
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中图分类号：
R969.3
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参考文献
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