格列美脲对比格列本脲治疗2型糖尿病疗效和安全性的系统评价  

Efficacy and Safety of Glimepiride versus Glibenclamide for Type 2 Diabetes Mellitus:A Systematic Review

作　　者：夏伦祝[1] 李颖[1] 罗欢[1] 薛雪[1] 李翔[1] 汪永忠[1] 

机构地区：[1]安徽中医药大学第一附属医院,合肥230031

出　　处：《中国药房》2014年第36期3382-3386,共5页China Pharmacy

基　　金：国家科技支撑计划子课题(No.2013BAI06B04Y023032)

摘　　要：目的:系统评价格列美脲对比格列本脲治疗2型糖尿病的疗效与安全性,以为临床提供循证参考。方法:计算机检索PubMed、The Cochrane library、Medline、EMBase、中国期刊全文数据库、万方数据库、维普数据库,纳入格列美脲对比格列本脲治疗2型糖尿病的随机对照试验(RCT),按Cochrane系统评价的方法评价纳入研究的质量,对结果采用Rev Man 5.2统计软件进行Meta分析。结果:共纳入14项RCT,合计3 398例患者。Meta分析结果显示,试验组在降低患者糖化血红蛋白[MD=0.08,95%CI(-0.18,0.02),P=0.13]、餐后血糖[MD=0.07,95%CI(-0.09,0.22),P=0.40]、总胆固醇[MD=-0.19,95%CI(-0.46,0.08),P=0.16]、甘油三酯[MD=-0.26,95%CI(-0.55,0.02),P=0.07]、低密度脂蛋白[MD=-0.10,95%CI(-0.22,0.01),P=0.08]方面与对照组比较差异无统计学意义;在降低空腹血糖[MD=-0.08,95%CI(-0.15,-0.01),P=0.03]、空腹胰岛素[MD=-0.82,95%CI(-1.13,-0.50),P<0.000]、餐后胰岛素[MD=-5.63,95%CI(-7.71,-3.55),P<0.000]、体质量指数[MD=-1.53,95%CI(-2.95,-0.12),P=0.03]、低血糖发生率[RR=0.45,95%CI(0.30,0.68),P<0.000]和改善高密度脂蛋白[MD=0.04,95%CI(0.00,0.07),P=0.04]等方面,与对照组比较差异有统计学意义。结论:与格列本脲相比,格列美脲可以显著改善2型糖尿病患者空腹血糖、体质量指数、高密度脂蛋白、空腹胰岛素、餐后胰岛素水平,且低血糖发生率较低。受纳入研究数量较少和质量的限制,尚需开展设计严谨的长期随访的大样本RCT,以为临床提供更多科学证据。OBJECTIVE：To evaluate therapeutic efficacy and safety of glimepiride versus glibenclamide in treatment of type 2diabetes mellitus systematically,and to provide evidence-based reference for clinical use. METHODS：Retrieved from PubMed,The Cochrane library,Medline,EMBase,CNKI,VIP and Wanfang database,RCT about glimepiride versus glibenclamide in the treatment of type 2 diabetes mellitus were collected. he quality of included study was evaluated according to Cochrane systematic reviews,and Meta-analysis was completed by Rev Man 5.2 software. RESULTS：A total of 14 RCT were included,involving 3 398 patients in total. The results of Meta-analysis showed that there were no statistical significance in HbA1 c [MD=0.08,95% CI（-0.18,0.02）,P=0.13],PG [MD=0.07,95%CI（-0.09,0.22）,P=0.40],TC [MD=-0.19,95%CI（-0.46,0.08）,P=0.16],TG [MD=-0.26,95%CI（-0.55,0.02）,P=0.07] and LDL-C [MD=-0.10,95%CI（-0.22,0.01）,P=0.08] of trial group,compared with control group. There was statistical significance in the reduction of FPG [MD=-0.08,95%CI（-0.15,-0.01）,P=0.03],FPI [MD=-0.82,95%CI（-1.13,-0.50）,P〈0.000],PPI [MD=-5.63,95%CI（-7.71,-3.55）,P〈0.000],BMI [MD=-1.53,95%CI（-2.95,-0.12）,P=0.03] and the incidence of hypoglycemia [RR=0.45,95%CI（0.30,0.68）,P〈0.000] and the improvement of HDL-C [MD=0.04,95%CI（0.00,0.07）,P=0.04] in trial group,compared with control group. CONCLUSIONS：Compared with glibenclamide,glimepiride can improve FPG,BMI,HDL-C,FPI and PPI with low incidence of hypoglycemia. Due to small-scale and low quality included studies,the conclusion still need to be confirmed by more high quality and large-scale RCT.

关 键 词：格列美脲 格列本脲 2型糖尿病 META分析 系统评价 疗效 安全性 

分 类 号：R969.4[医药卫生—药理学]