降糖药物对2型糖尿病患者肿瘤发病风险影响的网络Meta分析  

A network meta- analysis: the protective effect of antidiabetic drugs on tumorigenic risk in patients with type 2 diabetes

作　　者：贾书冰[1] 杨静玉[2] 王洋[1] 祖冬妮 戎智韬 赵明沂[2] 

机构地区：[1]沈阳药科大学药学院,辽宁沈阳110016 [2]沈阳药科大学生命科学与生物制药学院,辽宁沈阳110016

出　　处：《沈阳药科大学学报》2016年第4期326-333,共8页Journal of Shenyang Pharmaceutical University

基　　金：2014年中青年教师事业发展支持计划(No.13);2014年中青年教师事业发展支持计划(No.14)

摘　　要：目的综合评价二甲双胍(metformin,Met)、磺脲类(sulfonylureas,Sus)、噻唑烷二酮类(thiazolidinediones,TZDs)、胰岛素(insulin,Ins)4类降糖药物对2型糖尿病患者肿瘤发病风险的影响。方法计算机检索Cochrane Library,Pub Med,Web of Science,Eslsevier,CNKI,VIP,CBM,万方等数据库,搜集截止到2014年6月已发表的研究,经过检索并排除重复文献后共得到文献239篇。纳入关于2型糖尿病患者中服用二甲双胍、磺脲类、噻唑烷二酮类、胰岛素药物与肿瘤发病风险关系的队列研究进行网络Meta分析。对所纳入的文献进行质量评价与数据提取后,用Stata SE 12.0以及R2.11.1软件对数据进行合并分析。结果共纳入11篇符合标准的文献,将空白组(Placebo)作为对照组,结局指标OR值分别为:Met:0.570(95%CI∶0.450-0.723,P=0.0035).TIF;SUs:0.898(95%CI∶0.687^(-1).17,P=0.462);TZDs:0.741(95%CI∶0.571-0.962,P=0.0657);Ins:0.759(95%CI∶0.578-0.996,P=0.094)。由上述P值可知,与空白组比较,二甲双胍药物具有显著性意义(P<0.05),提示此药物可降低糖尿病患者肿瘤的发生风险;而磺脲类、噻唑烷二酮类、胰岛素则无显著性差异,表明此三者均无降低肿瘤发病风险的作用。结论二甲双胍药物具有显著降低2型糖尿病患者肿瘤发生风险的作用,对人体具有保护作用。而磺脲类、噻唑烷二酮类、胰岛素则不具有降低肿瘤发病风险的作用。但此结果应用于临床仍需大规模的随机对照研究进一步证明。Objective To evaluate the protective effect of four kinds of antidiabetic drugs on the risk of cancer in patients with type 2 diabetes,including metformin（ Met）,sulfonylureas（ SUs）,thiazolidinediones（ TZDs） and insulin（ Ins）. Methods We did a computer search through Cochrane Library,Pub Med,Web of Science,Eslsevier,CNKI,VIP,CBM,Wanfang and other Databases to get 239 papers which were published before June,2014,and these papers were for trials assessing the effects of antidiabetic drugs（ Met,SUs,TZDs or Ins） on tumorigenic risk. A cohort study on patients with type 2 diabetes in taking Met,SUs,TZDs or Ins was carried out. We had a network meta-analysis of the data which had odds ratios（ OR） and 95% CIs. To analyze the data of individual studies,Stata SE 12. 0 software and R2. 11. 1 software were used. Results 11 out of 239 citations identified by the search met the inclusion criteria. Results of the network meta-analysis showed a protective effect of Met on tumorigenic risk in patients with type 2 diabetes（ OR：0. 570,95% CI0. 450- 0. 723,P = 0. 003 5）. No effects of SUs,TZDs and Ins were reported（ ORSUs： 0. 898,95% CI0. 687^-1. 17,P = 0. 462; ORTZDs： 0. 741,95% CI 0. 571- 0. 962,P = 0. 065 7; ORIns： 0. 759,95% CI0. 578- 0. 996,P = 0. 094）. Conclusions Met has a protective effect on reducing the tumorigenic risk in patients with type 2 diabetes significantly,while SUs,TZDs and Ins have no significant difference in reducing tumorigenic risk. But this result should be be further proved by large-scale randomized controlled clinical studies.

关 键 词：2型糖尿病 二甲双胍 磺脲类药物 噻唑烷二酮类 胰岛素 肿瘤 网络Meta分析 

分 类 号：R917[医药卫生—药物分析学]