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目的系统评价二肽基肽酶-4(DPP-4)抑制剂与胰高血糖素样肽-1(GLP-1)受体激动剂在2型糖尿病患者中的疗效和安全性。方法计算机检索EMbase、Pub Med、The Cochrane Library、Clinical Trial、CBM、CNKI和万方数据库,纳入DPP-4抑制剂与GLP-1受体激动剂比较治疗2型糖尿病的随机对照试验,检索时间截至2015年12月。由2位研究者按照纳入与排除标准筛选文献、提取资料并评价纳入研究的方法学质量后,采用Revman5.3软件进行Meta分析。结果共纳入13项RCT。荟萃分析结果显示:GLP-1受体激动剂在降低空腹血糖、糖化血红蛋白和体重指数的方面优于DPP-4抑制剂[均数差(MD)=0.93,95%CI(0.48,1.38),P<0.000 1;MD=0.53,95%CI(0.34,0.73),P<0.000 01;MD=1.53,95%CI(0.83,2.22),P<0.001];DPP-4抑制剂降低餐后2 h血糖的疗效优于GLP-1受体激动剂[MD=-0.63,95%CI(-1.11,-0.16),P=0.009],且其发生胃肠道不良反应的相对危险度低于GLP-1受体激动剂[RR=0.44,95%CI(0.33,0.59),P<0.000 1]。结论 GLP-1受体激动剂降低空腹血糖、糖化血红蛋白和体重的效果更好,而DPP-4抑制剂降低餐后2 h血糖效果更好,且耐受性更佳。
Objective To evaluate the efficacy and safety of DPP-4 inhibitor and glucagon-like peptide-1 (GLP-1) receptor agonist in type 2 diabetes. Methods Randomized controlled trials comparing DPP-4 inhibitor and GLP-1 receptor agonist in the treatment of type 2 diabetes were collected by computer retrieval from EMbase, Pub Med, The Cochrane Library, Clinical Trial, CBM, CNKI and Wanfang database. December 2015. Two researchers screened the literature according to inclusion and exclusion criteria, extracted data and evaluated the quality of the methodology included in the study. Meta-analysis was performed using Revman 5.3 software. Results A total of 13 RCTs were included. A meta-analysis showed that GLP-1 receptor agonists were superior to DPP-4 inhibitors in reducing fasting plasma glucose, glycosylated hemoglobin, and body mass index [mean difference (MD) = 0.93, 95% CI, 0.48, P <0.0001; MD = 0.53, 95% CI (0.34, 0.73), P <0.000 01; MD = 1.53, 95% CI (0.83, 2.22), P <0.001] h blood glucose was superior to GLP-1 receptor agonist [MD = -0.63,95% CI (-1.11, -0.16), P = 0.009], and its relative risk of gastrointestinal adverse reactions was lower than that of GLP -1 receptor agonist [RR = 0.44, 95% CI (0.33, 0.59), P <0.000 1]. CONCLUSION: GLP-1 receptor agonist is more effective in reducing fasting blood glucose, glycosylated hemoglobin and body weight, while DPP-4 inhibitor is more effective and tolerated at 2 h postprandial blood glucose.