【摘要】：目的系統(tǒng)評價SGLT-2抑制劑對2型糖尿病患者大血管病變危險因素的影響,為制定降糖方案提供一定理論依據(jù)。方法計算機檢索PubMed、EMBASE、Cochrane Library、中國知網(wǎng)(CNKI)、萬方、重慶維普(VIP)、中國生物醫(yī)學(xué)文獻數(shù)據(jù)庫(CBM)等數(shù)據(jù)庫建庫截至2015年3月的有關(guān)文獻。納入以SGLT-2抑制劑與安慰劑比較對2型糖尿病(T2DM)患者大血管病變危險因素影響的隨機對照試驗(RCT),根據(jù)Cochrane系統(tǒng)評價手冊5.1質(zhì)量評價標準評價,采用RevMan5.2軟件進行meta分析。二分類變量(計數(shù)資料)采用相對危險度RR、連續(xù)性變量(計量資料)采用標準均數(shù)差(SMD)作為效應(yīng)量,各效應(yīng)量都選用95%可信區(qū)間(CI)及P值表示。采用卡方檢驗分析各研究或各亞組研究之間的統(tǒng)計學(xué)異質(zhì)性,當各研究或各亞組研究之間無統(tǒng)計學(xué)異質(zhì)性(P≥0.1,I2≤50%),采用固定效應(yīng)模型實施Meta分析；當各研究或各亞組研究間存在統(tǒng)計學(xué)異質(zhì)性(P0.1,I250%),分析異質(zhì)性的原因,采用亞組分析進行分析。對異質(zhì)性過大或無法獲得原始數(shù)據(jù)來源時,采用描述性分析。P0.05,表明有統(tǒng)計學(xué)意義。采用漏斗圖(Funnel plot)評價發(fā)表偏倚。結(jié)果共納入15個前瞻性隨機對照試驗進行分析,發(fā)表語種均為英文,包括5220例2型糖尿病患者,其中SGLT-2抑制劑組3393例,對照組1827例,試驗時間最長52周,最短12周。Meta分析結(jié)果顯示,①與安慰劑組相比,SGLT-2抑制劑能更有效降低糖化血紅蛋白,合并效應(yīng)量為[SMD=-0.94,95%CI (-1.14,-0.74), P＜0.00001],異質(zhì)性檢驗提示各研究間存在統(tǒng)計學(xué)異質(zhì)性(P0.00001,I2=90%),進行亞組分析提示無論病程長短、療程長短、合并用藥與否,SGLT-2抑制劑能更有效降低糖化血紅蛋白。②有效減輕體重,合并效應(yīng)量為[SMD=-0.72,95%CI(-0.88,-0.55),P0.00001]。③有一定降低收縮壓、舒張壓的效果,合并效應(yīng)量分別為[SMD=-0.32,95%CI(-0.38,-0.26),P0.00001]、[SMD=-0.28,95%CI(-0.34,-0.21),P0.00001]。④有效減少甘油三酯水平[SMD=-0.17,95%CI(-0.23,-0.11),P0.00001]；增加高密度脂蛋白膽固醇[SMD=0.30,95%CI(0.21,0.38),P0.00001]；有一定增加低密度脂蛋白膽固醇水平的風(fēng)險[SMD=0.17,95%CI(0.11.,0.23),P0.0.0001]。結(jié)論SGLT-2抑制劑可有效降低2型糖尿病患者的糖化血紅蛋白、體重、血壓、甘油三酯,增加高密度脂蛋白膽固醇,有一定增加低密度脂蛋白膽固醇水平的風(fēng)險。
[Abstract]:Objective to evaluate the effect of SGLT-2 inhibitor on the risk factors of macroangiopathy in patients with type 2 diabetes mellitus and to provide a theoretical basis for developing a hypoglycemic regimen. Methods the relevant documents were searched by computer in PubMed,EMBASE,Cochrane Library, (CNKI), Wanfang, Weipu (VIP), Chongqing, China Biomedical Literature Database (CBM), and so on, until March 2015. A randomized controlled trial (RCT), in which SGLT-2 inhibitors were compared with placebo on the risk factors of macrovascular disease in type 2 diabetes mellitus (T2DM) patients, was evaluated according to the Cochrane system evaluation manual 5.1 quality evaluation criteria. Meta analysis was performed with RevMan5.2 software. The second classification variable (counting data) uses the relative risk RR, continuity variable (the measurement data) to adopt the standard mean difference (SMD) as the effect quantity, each effect quantity all uses 95% confidence interval (CI) and the P value to express. The statistical heterogeneity was analyzed by chi-square test. When there was no statistical heterogeneity among the studies or subgroups (P 鈮，

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