论文部分内容阅读
目的对二肽基肽酶Ⅳ(DPP-4)抑制剂治疗2型糖尿病的有效性及安全性进行评价。方法计算机检索Cochrane图书馆、PubMed、EMBASE、Science Citation Index、中国期刊全文数据库、中文科技期刊数据库、中国生物医学文献数据库、万方医学数据库,检索时间截至2013年8月。英文检索词包括sitagliptin、vildagliptin、saxagliptin、linagliptin、alogliptin、dipeptidyl-peptidaseⅣ、systematic reviews和meta-analysis,中文检索词包括西格列汀、维格列汀、沙格列汀、利格列汀、阿格列汀、二肽基肽酶Ⅳ抑制剂、系统评价和meta分析。根据纳入和排除标准,提取符合标准的系统评价/meta分析,用OQAQ量表评价其方法学质量并赋分(1~7分,分数高者质量好),用描述性分析的方法分析资料,主要结局指标包括糖尿病患者糖化血红蛋白(HbA1c)、稳态模型的β细胞功能指数(HOMA-β)和不良事件发生率。结果共纳入18个系统评价/meta分析,方法学质量评分为6.0~7.0者16个占89%。18篇文献中13篇评价了DPP-4抑制剂对2型糖尿病患者HbA1c水平的影响,西格列汀、维格列汀、沙格列汀和利拉列汀在降低HbA1c水平方面与其他口服降糖药相似,沙格列汀与西格列汀降低HbA1c疗效相似。5篇文献评价了DPP-4抑制剂对2型糖尿病患者HOMA-β的影响。与安慰剂相比,西格列汀、维格列汀、沙格列汀能有效改善2型糖尿病患者的HOMA-β水平;西格列汀改善2型糖尿病患者HOMA-β水平的疗效不优于其他口服降糖药。14篇文献评价了DPP-4抑制剂治疗过程中的不良事件发生率,应用西格列汀、维格列汀、沙格列汀和利拉列汀治疗的患者不良事件发生率和低血糖发生率与应用安慰剂的患者比较差异无统计学意义;西格列汀和维格列汀诱发低血糖的概率低于其他口服降糖药。结论 DPP-4抑制剂能有效控制2型糖尿病患者的血糖,短期安全性较好。
Objective To evaluate the efficacy and safety of dipeptidyl peptidase IV (DPP-4) inhibitor in the treatment of type 2 diabetes mellitus. Methods We searched the Cochrane Library, PubMed, EMBASE, Science Citation Index, Chinese Journal Full-text Database, Chinese Science and Technology Periodical Database, Chinese Biomedical Literature Database and Wanfang Medical Database. The search time was up to August 2013. The English search terms include sitagliptin, vildagliptin, saxagliptin, linagliptin, alogliptin, dipeptidyl-peptidaseⅣ, systematic reviews and meta-analysis. The Chinese terms include sitagliptin, vildagliptin, saxagliptin, Mitalin, Dipeptidyl peptidase IV inhibitor, systematic review and meta-analysis. According to inclusion and exclusion criteria, systematic reviews / meta-analyzes were extracted and criteria were evaluated. OQAQ was used to evaluate the methodological quality and assigned a score of 1 to 7 (high scores were good). Descriptive analysis was used to analyze the data, The primary outcome measures included HbA1c in diabetic patients, β-cell function index (HOMA-β) in steady-state models, and incidence of adverse events. Results A total of 18 systematic reviews / meta-analyzes were included. The methodological quality score was 6.0 to 7.0 and 16 to 89%. Thirteen of the 18 articles evaluated the effect of DPP-4 inhibitors on HbA1c levels in patients with type 2 diabetes. Sitagliptin, vildagliptin, saxagliptin, and linagliptin were shown to be effective in reducing HbA1c levels compared with other oral Hypoglycemic drugs are similar, saxagliptin and sitagliptin reduce HbA1c similar efficacy. Five articles evaluated the effect of DPP-4 inhibitors on HOMA-beta in patients with type 2 diabetes. Compared with placebo, sitagliptin, vildagliptin, saxagliptin can effectively improve the HOMA-βlevel in type 2 diabetic patients; and sitagliptin is not effective in improving HOMA-βlevel in type 2 diabetic patients Other oral hypoglycemic agents. Fourteen articles evaluated the incidence of adverse events during the DPP-4 inhibitor treatment, the incidence of adverse events and the incidence of hypoglycemia in patients treated with sitagliptin, vildagliptin, saxagliptin, and linagliptin There was no significant difference between the two groups in the rate of hypoglycaemia and placebo. The lower the incidence of hypoglycaemia with sitagliptin and vildagliptin than the other oral hypoglycemic agents. Conclusions DPP-4 inhibitor can effectively control the blood sugar of type 2 diabetic patients, and its short-term safety is better.