瑞格列奈联合二甲双胍和二甲双胍比较治疗2型糖尿病的meta分析  

Repaglinide plus metformin versus metformin in treatment of type 2 diabetes: A meta-analysis

作　　者：卫晋菲[1] 周亮[1] 刘皈阳[1] 吴曼[1] 王心慧[1] 张鑫[1] 王明媚[1] 

机构地区：[1]解放军总医院第一附属医院药剂药理科,北京100048

出　　处：《临床药物治疗杂志》2015年第1期13-17,共5页Clinical Medication Journal

基　　金："十二五"国家科技支撑计划课题项目"安全合理用药评价和干预技术研究与应用"(2013BAI06B04)

摘　　要：目的:探讨比较瑞格列奈联合二甲双胍与二甲双胍治疗2型糖尿病(T2DM)的疗效和安全性。方法:检索Pub Med、EMbase、Medline、Cochrane、万方、CNKI、维普等文献数据库。按照Cochrane Handbook 5.1.0评价系统评价方法查找瑞格列奈联合二甲双胍与二甲双胍治疗2型糖尿病的随机对照试验(RCT),进行数据提取和质量评价后,采用Rev Man 5.2软件进行meta分析。结果:共纳入13个RCT的文献,847名患者。meta分析结果显示:在降低患者糖化血红蛋白[WMD=-1.08,95%CI(-1.27,-0.90),P<0.000 01]、空腹血糖[WMD=-1.79,95%CI(-2.04,-1.54),P<0.000 01]和餐后2 h血糖[WMD=-2.13,95%CI(-2.60,-1.66),P<0.000 01]方面,瑞格列奈联合二甲双胍组优于二甲双胍组。在低血糖反应发生率[WMD=3.00,95%CI(1.36,6.64),P=0.007]方面,联合用药组高于二甲双胍组,但两组在胃肠道反应发生率[WMD=0.70,95%CI(0.37,1.31),P=0.26]方面的差异没有统计学意义。结论:瑞格列奈联合二甲双胍治疗2型糖尿病的疗效优于二甲双胍单独治疗的疗效。上述结论尚待开展更多大样本、高质量研究予以证实。Objective： To evaluate the efficacy and safety of repaglinide plus metformin versus metformin in patients with type 2 diabetes. Methods： Several databases were retrieved, including PubMed, EMbase, Medline, The Cochrane Library, Wangfang, CNKI and VIE The quality of included randomized controlled trials （RCT） was assessed according to the Cochrane Handbook 5.1.0 Collaboration System review, and then meta-analysis was performed using RevMan 5：2. Software. Results： A total of 15 RCTs including 1031 patients met the inclusion criteria. The results of meta-analyses showed that HbAlc [WMD = -1.08, 95%CI （-1.27, -0.90 ） , P〈0.000 01], FPG [WMD = -1.79, 95%CI （ -2.04, -1.54 ） , P〈0.000 01] and PPG [WMD = -2.13, 95%CI （ -2.60, -1.66 ） , P〈0.000 01] were significantly reduced in the repaglinide plus metformin group than that in metformin group. The risk of hypoglycemia[WMD = 3.00, 95%CI （ 1.36, 6.64 ） , P = 0.007]is higher in repaglinide plus metformin treatment than metformin, but the risk of the gastrointestinal disorders[WMD = 0.70, 95%CI （ 0.37, 1.31 ） , P = 0.26] were similar between the two groups. Conclusion： Repaglinide plus metformin is more effective for treatment type 2 diabetes, and is superior to the efficacy of metformin alone. The above conclusion should be verified by more large-scale high-quality studies in future.

关 键 词：瑞格列奈 二甲双胍 2型糖尿病 META分析 随机对照试验 

分 类 号：R977.15[医药卫生—药品]