二甲双胍与吡格列酮对非酒精性脂肪性肝病疗效的Meta分析  

Meta-analysis of metformin versus pioglitazone in treatment of nonalcoholic fatty liver disease

作　　者：李月[1] 李锐[2] 何平[1] 田文广[3] 袁喆[4] 

机构地区：[1]重庆医科大学附属永川医院消化内科,重庆400016 [2]重庆医科大学附属永川医院肿瘤内科,重庆400016 [3]重庆医科大学附属永川医院感染科,重庆402160 [4]重庆医科大学第一附属医院感染科,重庆400016

出　　处：《西部医学》2017年第1期97-102,共6页Medical Journal of West China

基　　金：重庆永川区科委课题(YCSTC;2011BE5015)

摘　　要：目的比较二甲双胍与吡格列酮治疗非酒精性脂肪性肝病(NAFLD)的临床疗效。方法检索PubMed、EMbase、Cochrane Library、中国知网、万方数据库、维普及中国生物医学文献数据库(CBM)2016年2月前发表的有关二甲双胍与吡格列酮治疗非酒精性脂肪性肝病的随机对照试验(RCT)。两名研究者独立、严格按照纳入排除标准进行文献筛选。根据Cochrane协助网RCT评价手册进行文献质量评价。结果最终纳入6篇RCT,共372名患者。Meta分析结果显示:在改善丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆固醇(TC)、甘油三酯(TG)、稳态胰岛素评价指数(HOMA-IR)等指标上,二者无统计学差异,加权均数差(WMD)值分别-0.05U/L(95%CI:-0.40,0.31,P=0.97)、0.29(95%CI:-2.46,3.04,P=0.84)、-0.04(95%CI:-0.22,0.14,P=0.68)、0.28(95%CI:-0.23,0.80,P=0.28)、-0.04(95%CI:-0.42~0.34,P=0.84);二者临床总有效率(RR=1.74,95%CI:1.83~3.64,P=0.14)无统计学差异;但二甲双胍可显著降低患者体重指数(BMI),加权均数差(WMD)值为3.08(95%CI:0.94,5.21,P=0.005)。结论本研究发现二甲双胍与吡格列酮在改善非酒精性脂肪性肝病患者的ALT、AST、TC、TG、HOMA-IR及临床总有效率方面,二者疗效相似;但在降低BMI方面,二甲双胍优于吡格列酮。故非酒精性脂肪性肝病伴肥胖者,更推荐使用二甲双胍。Objective To compare the clinical efficacy and safety of metformin versus pioglitazone treatment for nonalcoholic fatty liver disease （NAFLD）. Methods Retrieved from PubMed,EMbase,Cochrane Library,CNKI,WANFANG,VIP,and CBM about metformin versus Pioglitazone in the treatment of NAFLD were collected. The time limit was from the estalishing of these database to February 2016. After data extraction and quality evaluation,Meta-analysis was performed by using Rev Man 5.2 statistics software. Results A total of 6 studies were included, involving 372 patients. Meta-analysis data showed that：there were no significant differences between metformin and Pioglitazone groups in terms of Alanine transaminase （ALT）, aspartate aminotransferase （AST）, Total cholesterol（TC）, serum triglyceride （TG）,Homeostasis model assessment of insulin resistance （HOMA-IR）, the weighted mean difference （WMDs） were -0.05U/L（95% CI：-0. 40,0. 31,P=0. 97）,0. 29（95% CI：-2. 46,3. 04,P=0. 84）,-0. 04（95% CI： -0. 22,0.14, P=0. 68）,0. 28（95% CI：-0. 23,0. 80,P=0. 28）,-0. 04（95% CI：-0.42-0.34,P=0.84）;There were no significant differences in total effective rate（RR = 1.74,95 % CI： 1.83 - 3.64, P = 0.14）. However, metformin can significantly reduced body mass index （BMI）, the weighted mean difference （WMD） is 3.08 （95% CI： 0.94,5.21, P=0. 005）.Conclusion In the aspects of improving alanine transaminase, aspartate aminotransferase, total cholesterol, serum tri- glyceride, Homeostasis model assessment of insulin resistance （HOMA-IR） and total effective rate were similar between metformin and pioglitazone groups. However, metformin can decrease the body mass index （BMI）. Due to the limited quanlity and quanlity of the included studies, the above conclusion still needs to be futher verified by performing more high quality study. Therefore, for alcoholic liver disease with obesity, we prefer metformin.

关 键 词：脂肪肝 二甲双胍 吡格列酮 META分析 

分 类 号：R575.5[医药卫生—消化系统]