磺脲类药物治疗2型糖尿病的安全性和有效性的网状meta分析  

Efficacy and Safety of Sulfonylureas Treatment for Type 2 Diabetes Mellitus: A Bayesian Network Meta-analysis

作　　者：徐信妮[1] 井高静 常锐霞 芦永斌 滕永军[1] 姚佳[1] XU Xinni;JING Gaojing;CHANG Ruixia;LU Yongbin;TENG Yongjun;YAO Jia(The First Hospital of Lanzhou University,Lanzhou 730000,China;Huazhong University of Science and Technology,Wuhan 430074,China)

机构地区：[1]兰州大学第一医院,兰州730000 [2]华中科技大学,武汉430074

出　　处：《中国现代应用药学》2019年第21期2707-2714,共8页Chinese Journal of Modern Applied Pharmacy

基　　金：甘肃省卫生行业科研计划项目(GSWST2011-05)

摘　　要：目的评估使用磺脲类药物治疗2型糖尿病的有效性和安全性。方法使用贝叶斯网状meta分析法比较磺脲类药物治疗糖尿病的疗效,通过治疗前后糖化血红蛋白(heamoglobinA1c,HbA1c)和空腹血糖(fasting blood glucose,FBG)的变化评估磺脲类药物的有效性,通过低血糖事件和总体不良事件评估其安全性。结果共纳入50项RCT,共包括201 339例研究对象。网状meta分析显示,根据累积排序概率曲线下面积(surface under the cumulative ranking,SUCRA)排序结果,与其他治疗组相比,二甲双胍、格列吡嗪和格列本脲降低HbA1c的效果更好,其SUCRA分别为94.3%,83.9%和49.6%;格列吡嗪、格列齐特和格列本脲降低FBG的效果更好,其SUCRA分别为70.7%,59.6%和59.2%。与未治疗组相比,格列本脲和格列齐特不会增加低血糖发生的风险,其OR(95%CI)分别为1.51(0.89~2.16,P>0.05)和1.36(0.68~2.05,P>0.05)。结论格列吡嗪和格列本脲治疗T2DM更有效,但格列吡嗪更容易发生不良反应,其结论有待进一步研究。OBJECTIVE To evaluate the efficacy and safety of sulfonylureas for treating type 2 diabetes(T2 DM). METHODS Bayesian network meta-analysis was used to compare the effects of sulfonylureas on treatment for T2 DM. The effectiveness of sulfonylureas were assessed by changes of heamoglobinA1 c(HbA1 c) and fasting blood glucose(FBG) before and after treatment, and safety were assessed by hypoglycemia events and adverse events. RESULTS A total of 50 RCTs involving 201 339 patients were included. According to the results of surface under the cumulative ranking(SUCRA), network meta-analysis showed that metformin, glipizide and glibenclamide were better in reducing HbA1 c compared with other treatments, and the SUCRA were 94.3%, 83.9% and 49.6%, respectively. Compared with other treatments, glipizide, gliclazide and glibenclamide had better effects in reducing FBG, and the SUCRA were 70.7%, 59.6% and 59.2%, respectively. Glibenclamide and gliclazide did not increase the risk of hypoglycemia compared with the untreated group, and the OR(95%CI) were 1.51(0.89-2.16, P>0.05) and 1.36(0.68-2.05, P>0.05), respectively. CONCLUSION Glipizide and glibenclamide are more effective in the treatment of T2 DM, but glipizide is more prone to adverse events, and its conclusions needs further study.

关 键 词：糖尿病 磺脲类药物 有效性 安全性 网状meta分析 

分 类 号：R969.3[医药卫生—药理学]