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目的系统地评价胰高血糖素样肽1受体激动剂(GLP-1 RA)对2型糖尿病患者合并非酒精性脂肪肝的有效性。方法检索截止2016年3月Cochrane Library、EMBASE,Pub Med、Web of Science、中国期刊全文数据库(CNKI)、万方数据库、维普数据库和中国生物医学文献数据库中关于GLP-1 RA对于2型糖尿病合并非酒精性脂肪肝的随机对照试验,对于符合纳入标准的文献进行质量评价及筛选,采用Rev Man 5.2软件对数据进行合并分析。结果共纳入4项随机对照试验,共计145例患者。Meta分析结果显示,GLP-1RA与对照组相比可以明显改善2型糖尿病合并非酒精性脂肪肝患者的肝酶ALT[MD:-8.36,95%CI(-13.41-3.31),P=0.001],糖代谢指标Hb A1c[MD:-0.43%,95%CI(-0.73-0.31),P=0.005]、FBG[MD:-0.71%,95%CI(-1.39-0.03),P=0.04],BMI[MD:-1.38%,95%CI(-2.18-0.58),P=0.000 8],脂代谢指标TG[MD:-0.49%,95%CI(-0.82-0.16),P=0.004]。结论 GLP-1RA可以明显改善2型糖尿病合并非酒精性脂肪肝的代谢指标,鉴于纳入文献的数量和质量,尚需大型的RCT进一步验证。
Objective To systematically evaluate the efficacy of glucagon-like peptide 1 receptor agonist (GLP-1 RA) in patients with type 2 diabetes complicated with non-alcoholic fatty liver disease. Methods To search for the association of GLP-1 RA with type 2 diabetes in the Cochrane Library, EMBASE, Pub Med, Web of Science, Chinese Journal Full-text Database (CNKI), Wanfang Database, VIP Database and China Biomedical Literature Database Randomized controlled trials of non-alcoholic fatty liver disease were conducted to evaluate the quality and screening of eligible literature, and the data were analyzed by using Rev Man 5.2 software. Results A total of 4 randomized controlled trials were included, totaling 145 patients. Meta-analysis showed that compared with the control group, GLP-1RA significantly improved ALT in patients with type 2 diabetes and non-alcoholic fatty liver disease [MD: -8.36, 95% CI (-13.41-3.31), P = 0.001] , Glucose metabolism index Hb A1c [MD: -0.43%, 95% CI (-0.73-0.31), P = 0.005], FBG [MD: -0.71%, 95% CI -1.39-0.03, P = 0.04] , BMI [MD: -1.38%, 95% CI (-2.18-0.58), P = 0.0008], lipid metabolism TG [MD: -0.49%, 95% CI -0.82-0.16, P = 0.004] . Conclusion GLP-1RA can significantly improve the metabolic indices of type 2 diabetes mellitus patients with non-alcoholic fatty liver. Due to the quantity and quality of the incorporated literature, large RCTs still need further validation.