本文關鍵詞： GLP-1類似物 磺脲類 2型糖尿病 療效 安全性 系統評價　出處：《廣西醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的：系統評價GLP-1類似物與磺脲類對比在治療2型糖尿病的療效與安全。方法：計算機檢索PubMed、EMBASE、Cochrane Library databases、重慶維普數據庫、清華同方數據庫、中國生物醫(yī)學文獻數據庫、萬方數據庫,時間為截止至2015年3月2日。納入GLP-1類似物與磺脲類對比治療2型糖尿病患者的隨機對照試驗,采用Review Manager5.2軟件進行meta分析。療效觀察指標為：糖化血紅蛋白、空腹血糖、餐后2h血糖、體重、收縮壓,安全性觀察指標為：低血糖事件、胃腸道不良反應。結果：納入符合要求的13個隨機對照研究,共5100名患者,其中有7個研究均聯合了二甲雙胍治療進行對比。Meta分析結果顯示,在療效方面：①降低糖化血紅蛋白方面,GLP-1類似物與磺脲類藥物對比無顯著差異,[SMD=-O.14,95%CI(-0.28,0.01),P=0.06]；進行亞組分析提示無論是否聯合使用二甲雙胍,無論利拉魯肽還是其他種類GLP-1類似物與磺脲類對比均無顯著差異。②降低空腹血糖方面,GLP-1類似物與磺脲類對比無顯著差異,[SMD=-0.1,95%CI=(-0.27,-0.07),P=0.24]；進行亞組分析提示無論是否聯合使用二甲雙胍,無論利拉魯肽還是其他種類GLP-1類似物與磺脲類對比均無顯著差異。③降低餐后2小時血糖方面,GLP-1類似物與磺脲對比無顯著差異,[SMD=-O.04,95%CI=(-0.13,-0.05), P=0.41]。④降低收縮壓方面,GLP-1類似物優(yōu)于磺脲類,[SMD=-O.22,95%CI=(-0.30,-0.15), P0.00001]。⑤減輕體重方面,GLP-1類似物優(yōu)于磺脲類,[SMD=-1.55, 95%CI=(-2.51,-0.59),P=0.001];進行亞組分析提示無論是否聯合二甲雙胍治療、無論利拉魯肽還是其他種類GLP-1類似物均優(yōu)于磺脲類。⑥低血糖風險,GLP-1類似物小于磺脲類,[RR=0.25,95%CI=(0.15,0.41), P 0.00001];進行亞組分析提示無論是否聯合二甲雙胍治療、無論利拉魯肽還是其他種類GLP-1類似物低血糖風險均小于磺脲類。⑦胃腸道不良反應,GLP-1類似物較磺脲類明顯,[RR=2.10,95%CI=(1.34,3.29), P=0.001];進行亞組分析提示當單獨使用GLP-1類似物和磺脲類進行對比時,兩者胃腸道反應物對比無顯著差異,當均聯合使用二甲雙胍治療進行對比時,GLP-1類似物治療2型糖尿病胃腸道不良反應較磺脲類明顯,利拉魯肽胃腸道不良反應較磺脲類明顯。結論：對于2型糖尿病患者,GLP-1類似物與磺脲類降糖藥物對比,在療效方面,降低糖化血紅蛋白、空腹血糖及餐后2小時血糖無顯著差異,降低血壓及減輕體重更明顯。安全性方面,低血糖風險更低,當聯合二甲雙胍治療時,胃腸道不良反應較明顯。
[Abstract]:Objective: to systematically evaluate the efficacy and safety of GLP-1 analogues and sulfonylureas in the treatment of type 2 diabetes mellitus. Methods: a computer-based search of PubMedus EMBASE Cochrane Library database, Chongqing Weip database, Tsinghua Tongfang database, Chinese biomedical literature database and Wanfang database was conducted. The time was up to March 2nd 2015. The randomized controlled trial of GLP-1 analogues and sulfonylureas in the treatment of type 2 diabetes mellitus was carried out with Review Manager5.2 software. The therapeutic effects were as follows: glycosylated hemoglobin, fasting blood glucose, 2 h postprandial blood glucose, body weight, systolic blood pressure and safety were observed as follows: hypoglycemia, gastrointestinal adverse reactions. Results: a total of 5100 patients were enrolled in 13 randomized controlled trials. Seven of the studies combined with metformin were compared with metformin therapy. Meta-analysis showed that, There was no significant difference between GLP-1 analogues and sulfonylurea drugs in reducing glycosylated hemoglobin. [SMD-O.149CI-0.28CI-0.06]; subgroup analysis showed that whether or not metformin was used in combination, There was no significant difference between GLP-1 analogues and sulfonylureas. 2 there was no significant difference between GLP-1 analogues and sulfonylureas in lowering fasting blood glucose. There was no significant difference between GLP-1 analogues and sulfonylureas. 3 there was no significant difference between GLP-1 analogues and sulfonylureas in reducing blood glucose at 2 hours after meal. [SMD-O.04C95CIK- 0.13- 0.05U, P0. 41] .4 GLP-1 analogues were superior to sulfonylurea in reducing systolic blood pressure (SBP). Ureas, [SMD-O.2295], [SMD-0.30U -0.15U, P0.00001] .5 GLP-1 analogues are superior to sulfonylureas in weight loss, [SMD-1.55, 95CIZ-2.51U -0.59Pn0.001]; subgroup analysis showed that whether or not combined with metformin, Both Lilaru peptide and other GLP-1 analogues were superior to sulfonylureas in hypoglycemia risk. GLP-1 analogue was less than sulfonylurea, [RRRN 0.25 ~ 95 CIQ 0.150.41, P 0.00001]. Subgroup analysis showed that whether combined with metformin or not, The hypoglycemic risk of both liraud and other GLP-1 analogues was lower than that of sulfonylurea .7 gastrointestinal adverse reactions. GLP-1 analogue was significantly higher than that of sulfonylurea. [RRRN 2.101095 CIQ 1.343.29, P0. 001]. The subgroup analysis showed that when compared with sulfonylurea alone, the subgroup analysis showed that the risk of hypoglycemia was lower than that of sulfonylurea. There was no significant difference in gastrointestinal reaction between the two groups. When both patients were treated with metformin, GLP-1 analogue was more effective than sulfonylurea in the treatment of type 2 diabetes mellitus. Conclusion: in comparison of GLP-1 analogue with sulfonylurea, glycosylated hemoglobin can be decreased in patients with type 2 diabetes mellitus. There was no significant difference in fasting blood glucose and 2 hours postprandial blood glucose, but it was more obvious to lower blood pressure and weight. In terms of safety, hypoglycemia risk was lower, and gastrointestinal adverse reactions were more obvious when combined with metformin.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R587.1

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