药学服务对糖尿病治疗有效性的荟萃分析及对药学服务工作的思考  

Meta analysis of the efficacy of pharmaceutical care in treatment of diabetes mellitus and thinking on pharmaceutical care

作　　者：王美玲[1] 符映均 WANG Meiling;FU Yingjun(Department of Pharmacy,Nantong Hospital of Traditional Chinese Medicine,Jiangsu Nantong 226001,China)

机构地区：[1]南通市中医院药剂科,江苏南通226001

出　　处：《药学服务与研究》2022年第1期50-57,共8页Pharmaceutical Care and Research

基　　金：江苏省南通市药学会-常州四药医院药学科研基金资助项目(ntyx1904);江苏省南通市科技局科研项目(JCZ19098)。

摘　　要：目的:评价药学服务对糖尿病治疗的有效性以及对药学服务工作的指导意义。方法:检索PubMed、Cochrane Library、EMbase、万方数据-数字化期刊群、中国期刊全文数据库(中国知网),搜集对糖尿病患者自建库至2020年10月的提供药学服务的随机对照试验(randomized controlled trial, RCT)。提取符合纳入标准的文献资料。使用Cochrane系统评价手册5.1.0进行质量评价,采用Stata 16.0软件进行荟萃分析(meta分析)。结果:共纳入23项RCT,药学干预组的糖化血红蛋白[SMD=-0.54,95%CI(-0.69,-0.39),P<0.001]、空腹血糖[SMD=-0.54,95%CI(-0.74,-0.34),P<0.001]、糖化血红蛋白<7%达标率[RR=1.53,95%CI(1.16,2.04),P=0.003]、收缩压[SMD=-0.35,95%CI(-0.54,-0.16),P<0.001]、舒张压[SMD=-0.3,95%CI(-0.52,-0.08),P=0.008]、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)[SMD=-0.23,95%CI(-0.43,-0.03),P=0.024]、三酰甘油(triglyceride, TG)[SMD=-0.20,95%CI(-0.39,-0.02),P=0.031]均优于对照组,且差异均有统计学意义。体重指数(body mass index, BMI)[SMD=-0.39,95%CI(-1.00,0.21),P=0.203]、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)[SMD=-0.01,95%CI(-0.21,0.20),P=0.926]、总胆固醇(total cholesterol, TC)[SMD=-0.28,95%CI(-0.59,0.02),P=0.067]差异无统计学意义。结论:药学服务能帮助降低糖尿病患者的血糖、血压、LDL-C、TG水平。亚组分析和meta回归分析显示,药师要从药学服务培训、频繁的药学干预、药物审查、关注年轻患者和HbA1C基线水平高的患者等方面入手,提供高质量的药学服务。Objective:To evaluate the efficacy of pharmaceutical care in treating diabetes mellitus patients and its significance to pharmaceutical care.Methods:Information was retrieved from the databases of PubMed,Cochrane Library,EMbase,Wanfang data-digitalization and China National Knowledge Infrastructure(CNKI)from inception to October 2020 to collect randomized controlled trials(RCTs)with pharmaceutical care in treatment of diabetes mellitus,and the literature that met the inclusion criteria were extracted in the process.The Cochrane Manual of Systematic Review 5.1.0 was used for quality evaluation and Stata 16.0 software was used for meta analysis.Results:Totally,23 RCTs were included in the study.The levels of glycated hemoglobin[SMD=-0.54,95%CI(-0.69,-0.39),P<0.001],fasting blood glucose[SMD=-0.54,95%CI(-0.74,-0.34),P<0.001],glycated hemoglobin<7%compliance rate[RR=1.53,95%CI(1.16,2.04),P=0.003],systolic blood pressure[SMD=-0.35,95%CI(-0.54,-0.16),P<0.001],diastolic blood pressure[SMD=-0.3,95%CI(-0.52,-0.08),P=0􀆰008],low-density lipoprotein cholesterol(LDL-C)and triglyceride(TG)in the pharmaceutical intervention group were all superior to those in the control group,all with statistical significance.However,there was no statistical significance in body mass index(BMI)[SMD=-0.39,95%CI(-1.00,0.21),P=0.203],high-density lipoprotein cholesterol(HDL-C)[SMD=-0.01,95%CI(-0.21,0.20),P=0.926],and total cholesterol(TC)[SMD=-0.28,95%CI(-0.59,0.02),P=0􀆰067]..Conclusion:Pharmaceutical care could help lower the levels of blood sugar,blood pressure,LDL-C and TG in the patients with diabetes mellitus.Subgroup analysis and meta regression analysis showed that pharmacists could approach from the aspects of frequent pharmaceutical intervention,drug review,close attention to young patients and patients with high HbA1C baseline level,so as to provide high quality pharmaceutical care.

关 键 词：药学服务 糖尿病 随机对照试验 荟萃分析 

分 类 号：R587.1[医药卫生—内分泌] R969.3[医药卫生—内科学]