螺内酯对胰岛素及糖代谢的影响  

Effect of Spironolactone on Insulin and Glucose Metabolism

作　　者：宋忆 黄诗媛 范澄 向春华 盛玉玲 李萍[1] 黄彩鸿 刘坤[2] 王朝晖[1] Song Yi;Huang Shiyuan;Fan Cheng(Department of Geriatrics,Union Hospital,Tongji Medical College,Hua zhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院综合科,武汉430022 [2]华中科技大学同济医学院附属协和医院心内科,武汉430022

出　　处：《华中科技大学学报（医学版）》2020年第3期343-350,共8页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.81901429)。

摘　　要：目的评估螺内酯对胰岛素以及糖代谢的影响。方法通过检索PubMed、Web of Science、Embase、ClinicalTrials数据库,收集截至2016年3月的相关文献,纳入探究螺内酯对胰岛素敏感性或血糖影响的随机对照试验。结果共有20项随机平行对照以及随机交叉对照试验被纳入。Meta分析结果显示:螺内酯不影响空腹血糖水平[标准化均数差(SMD)为-0.03(95%CI:-0.18~0.12)]、空腹胰岛素水平[SMD为-0.04(95%CI:-0.24~0.16)]或胰岛素抵抗指数[SMD为-0.09(95%CI:-0.24~0.06)],随机平行对照试验合并的糖化血红蛋白SMD为0.03(95%CI:-0.23~0.28)。结论螺内酯对空腹血糖、空腹胰岛素、胰岛素抵抗指数以及糖化血红蛋白均无明显影响。有糖代谢紊乱风险的患者使用螺内酯相对安全,并不会进一步加重糖代谢紊乱或胰岛素抵抗。Objective To evaluate the effect of spironolactone on insulin and glucose metabolism by conducting a systematic review and meta-analysis of randomized controlled studies.Methods A literature search was conducted in PubMed,Web of Science,Embase and Clinical Trials together with a historical search through the reference lists of relevant articles up to the end of Mar.2016.Randomized controlled trials about the effect of spironolactone on biological markers of insulin sensitivity or glycemic status in subjects with risk of metabolic disorder were included.Results A total of 20 randomized controlled parallel or crossover trials were included.Spironolactone did not influence estimated fasting glucose[SMD-0.03(-0.18 to 0.12)],fasting insulin concentrations[SMD-0.04(-0.24 to 0.16)]or HOMA-IR[SMD-0.09(-0.24 to 0.06)].Estimate effect of HbA1 c was SMD 0.03(-0.23 to 0.28)in randomized controlled parallel studies.Conclusion No significant effect of spironolactone on fasting glucose,fasting insulin,insulin sensitivity or HbA1 c was identified.Spironolactone is relatively safe in patients with risk of glucose metabolic disorder and does not further deteriorate glucose metabolic dysfunction or insulin resistance.

关 键 词：盐皮质激素受体拮抗剂 醛固酮受体阻断剂 螺内酯 糖代谢 

分 类 号：R977[医药卫生—药品]