本文選題：糖尿病　切入點：型　出處：《重慶醫(yī)學》2016年26期

【摘要】：目的系統(tǒng)評價T細胞表面抗原CD26(DPP4)抑制劑與α糖苷酶抑制劑治療2型糖尿病的有效性、安全性。方法計算機全面檢索Cochrane、EMbase、PubMed、CBM、VIP、萬方數(shù)據(jù)庫,檢索時間設定為自建庫至2015年7月。收集DPP4抑制劑與α糖苷酶抑制劑比較治療2型糖尿病的隨機對照試驗(RCT)。由兩位研究者根據(jù)納入與排除標準篩選研究、提取資料,并根據(jù)Cochrane系統(tǒng)評價員手冊進行質量評價后,采用RevMan 5.3軟件進行Meta分析。結果共納入18個RCTs,Meta分析顯示,無論是單藥治療還是聯(lián)合治療,DPP4抑制劑組降低HbA1c水平的療效均優(yōu)于α糖苷酶抑制劑組,其差異有統(tǒng)計學意義[MD=-0.29,95%CI(-0.48,-0.10);MD=-0.23,95%CI(-0.36,-0.10)];無論是單藥治療還是聯(lián)合治療,DPP4抑制劑組降低FPG水平的療效均優(yōu)于α糖苷酶抑制劑組,其差異有統(tǒng)計學意義[MD=-0.48,95%CI(-0.94,-0.03);MD=-0.25,95%CI(-0.47,-0.03)]。在提高HOMA-B方面,DPP4抑制劑組優(yōu)于α糖苷酶抑制劑組,差異有統(tǒng)計學意義[MD=9.22,95%CI(5.61,12.84)];在改善HOMA-IR方面,兩組差異無統(tǒng)計學意義[MD=0.13,95%CI(-0.17,0.44)]。在體質量控制方面,α糖苷酶抑制劑組優(yōu)于DPP4抑制劑組,其差異有統(tǒng)計學意義[MD=0.72,95%CI(0.51,0.94);MD=1.30,95%CI(1.28,1.32)]。DPP4抑制劑組總不良反應發(fā)生率低于α糖苷酶抑制劑組,差異有統(tǒng)計學意義[OR=0.49,95%CI(0.36,0.66)];但兩者在心血管事件發(fā)生率與低血糖發(fā)生率方面,差異無統(tǒng)計學意義[OR=1.83,95%CI(0.92,3.66);OR=0.97,95%CI(0.46,2.07)]。結論 DPP4抑制劑較α糖苷酶抑制劑能更有效控制血糖,改善胰島功能,總體不良反應少,低血糖發(fā)生率低,安全性良好,但α糖苷酶抑制劑對減重更有優(yōu)勢。
[Abstract]:Objective to evaluate the efficacy and safety of T cell surface antigen CD26DPP4) inhibitor and 偽 glucosidase inhibitor in the treatment of type 2 diabetes mellitus. The retrieval time was set up from the database to July 2015. The randomized controlled trial of DPP4 inhibitor and 偽 -glucosidase inhibitor in the treatment of type 2 diabetes mellitus was collected. The data were extracted by two researchers according to the screening study of inclusion and exclusion criteria. After the quality evaluation was carried out according to the manual of Cochrane system evaluators, the Meta analysis was carried out with RevMan 5.3 software. The results were included in 18 RCTs Meta-analysis. Both monotherapy and combination therapy of DPP4 inhibitor group were superior to 偽 -glucosidase inhibitor group in reducing HbA1c level. The difference was statistically significant [MD-0.29995] [MD-0.23995] [MD-0.29995] [MD-0.23995]; both monotherapy and combined treatment with DPP4 inhibitor had better effect on reducing FPG level than 偽 -glucosidase inhibitor group, and the effect was better than that of 偽 -glucosidase inhibitor group, both in monotherapy group and in combination treatment group, the effect was better than that in 偽 -glucosidase inhibitor group. The difference was statistically significant [MD-0.48CI-0.94 ~ 0.03]. In improving HOMA-B, DPP4 inhibitor group was better than 偽 -glucosidase inhibitor group (MD9.2295CI5.61C12.84); in improving HOMA-IR, DPP4 inhibitor group was better than 偽 -glucosidase inhibitor group (MD9.2295CI5.6112.84); in improving HOMA-IR, DPP4 inhibitor group was better than 偽 -glucosidase inhibitor group (MD9.2295CI5.6112.84); in improving HOMA-IR, DPP4 inhibitor was better than 偽 glucosidase inhibitor group. There was no significant difference between the two groups [MD0.1395 CI-0.170.44]. In body quality control, the 偽 -glucosidase inhibitor group was superior to the DPP4 inhibitor group, and the difference was statistically significant. The difference was statistically significant (ORO 0.49 ~ 95CII 0.36 / 0.66), but there was no significant difference in the incidence of cardiovascular events and hypoglycemia between the two groups [ORX 1.8395CII 0.923.66CI0.99795 CI 0.462.07]. Conclusion DPP4 inhibitor is more effective than 偽 -glucosidase inhibitor in controlling blood glucose and improving islet function. The overall adverse effects were low, the incidence of hypoglycemia was low, and the safety was good, but 偽 -glucosidase inhibitor had more advantages in weight loss.
【作者單位】： 昆明醫(yī)科大學第一附屬醫(yī)院糖尿病科;
【分類號】：R587.1

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