瑞格列奈对比格列美脲分别联合二甲双胍治疗2型糖尿病有效性和安全性的Meta分析  

Meta-analysis of the Effectiveness and Safety of Repaglinide Combined with Metformin versus Glimepiride Combined with Metformin in the Treatment of Type 2 Diabetes

作　　者：卫晋菲[1] 周亮[1] 王明媚[1] 王心慧[1] 李莎[1] 许玉莲[1] WEI Jinfei;ZHOU Liang;WANG Mingmei;WANG Xinhui;LI Sha;XU Yulian(Dept. of Pharmacy and Pharmacology,the First Affiliated Hospital of PLA General Hospital,Beijing 100048,China)

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：《中国药房》2018年第11期1560-1564,共5页China Pharmacy

基　　金：国家科技支撑计划课题(No.2013BAI06B04)

摘　　要：目的:系统评价瑞格列奈对比格列美脲分别联合二甲双胍治疗2型糖尿病的有效性和安全性,为临床提供循证依据。方法:计算机检索中国期刊全文数据库、中文科技期刊数据库、万方数据库、Pub Med、Embase、Medline、Cochrane图书馆,收集瑞格列奈联合二甲双胍(试验组)对比格列美脲联合二甲双胍(对照组)治疗2型糖尿病疗效[糖化血红蛋白(Hb A1c)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)水平]和安全性(不良反应发生率、低血糖反应发生率、胃肠道反应发生率)的随机对照试验(RCT),对符合纳入标准的文献进行资料提取,并采用Cochrane系统评价手册5.1.0进行质量评价后,采用Rev Man 5.2统计软件进行Meta分析。结果:共纳入12项RCT,合计957例患者。Meta分析结果显示,试验组患者2 h PG降低程度显著低于对照组,差异有统计学意义[MD=-0.70,95%CI(-1.02,-0.38),P<0.001];两组患者Hb A1c降低水平[MD=0.00,95%CI(-0.24,0.25),P=0.98]、FPG降低水平[MD=0.10,95%CI(-0.17,0.36),P=0.47]、不良反应发生率[OR=0.54,95%CI(0.28,1.06),P=0.07]、低血糖反应发生率[OR=0.52,95%CI(0.13,2.06),P=0.35]和胃肠道反应发生率[OR=0.60,95%CI(0.15,2.41),P=0.47]比较,差异均无统计学意义。结论:瑞格列奈联合二甲双胍降低2 h PG效果优于格列美脲联合二甲双胍,安全性相当。OBJECTIVE：To evaluate the effectiveness and safety of repaglinide combined with metformin versus glimepiride combined with metformin in the treatment of type 2 diabetes mellitus（T2 DM）,and to provide evidence-based reference for the clinic. METHODS： Retrieved from CJFD, VIP, Wanfang database, Pub Med, Embase, Medline and Cochrane Library,randomized controlled trials（RCTs） about therapeutic efficacy（Hb A1 c, FPG, 2 h PG） and safety（the incidence of ADR,hypoglycemia and gastrointestinal reaction）of repaglinide combined with metformin（trial group）versus glimepiride combined with metformin（control group）in the treatment of T2 DM were collected. Meta-analysis was performed by using Rev Man 5.2 statistical software after data extraction and quality evaluation with Cochrane systematic evaluation manual. RESULTS：A total of 12 RCTs were included,involving 957 patients. Results of Meta-analysis showed that the decrease of 2 h PG in trial group was significantly better than control group,with statistical significance [MD=-0.70,95%CI（-1.02,-0.38）,P〈0.001]. There was no statistical significance in the decrease of Hb A1 c [MD=0.00,95%CI（-0.24,0.25）,P=0.98] or FPG [MD=0.10,95%CI（-0.17,0.36）,P=0.47],the incidence of ADR [OR=0.54,95%CI（0.28,1.06）,P=0.07],hypoglycemia [OR=0.52,95%CI（0.13,2.06）,P=0.35] or gastrointestinal reactions [OR=0.60,95%CI（0.15,2.41）,P=0.47] between 2 groups. CONCLUSIONS：Repaglinide combined with metformin is better than glimepiride combined with metformin in reducing 2 h PG,but both of them have similar safety.

关 键 词：瑞格列奈 格列美脲 二甲双胍 2型糖尿病 META分析 随机对照试验 

分 类 号：R977.6[医药卫生—药品]