磺脲类药物治疗2型糖尿病的安全性和有效性的网状meta分析

目的 评估使用磺脲类药物治疗2型糖尿病的有效性和安全性。方法 使用贝叶斯网状meta分析法比较磺脲类药物治疗糖尿病的疗效，通过治疗前后糖化血红蛋白（heamoglobinA1c，HbA1c）和空腹血糖（fasting blood glucose，FBG）的变化评估磺脲类药物的有效性，通过低血糖事件和总体不良事件评估其安全性。结果 共纳入50项RCT，共包括201 339例研究对象。网状meta分析显示，根据累积排序概率曲线下面积（surface under the cumulative ranking，SUCRA）排序结果，与其他治疗组相比，二甲双胍、格列吡嗪和格列本脲降低HbA1c的效果更好，其SUCRA分别为94.3%，83.9%和49.6%；格列吡嗪、格列齐特和格列本脲降低FBG的效果更好，其SUCRA分别为70.7%，59.6%和59.2%。与未治疗组相比，格列本脲和格列齐特不会增加低血糖发生的风险，其OR（95%CI）分别为1.51（0.89~2.16，P>0.05）和1.36（0.68~2.05，P>0.05）。结论 格列吡嗪和格列本脲治疗T2DM更有效，但格列吡嗪更容易发生不良反应，其结论有待进一步研究。

Efficacy and Safety of Sulfonylureas Treatment for Type 2 Diabetes Mellitus: A Bayesian Network Meta-analysis

OBJECTIVE To evaluate the efficacy and safety of sulfonylureas for treating type 2 diabetes(T2DM). METHODS Bayesian network meta-analysis was used to compare the effects of sulfonylureas on treatment for T2DM. The effectiveness of sulfonylureas were assessed by changes of heamoglobinA1c(HbA1c) and fasting blood glucose(FBG) before and after treatment, and safety were assessed by hypoglycemia events and adverse events. RESULTS A total of 50 RCTs involving 201 339 patients were included. According to the results of surface under the cumulative ranking(SUCRA), network meta-analysis showed that metformin, glipizide and glibenclamide were better in reducing HbA1c compared with other treatments, and the SUCRA were 94.3%, 83.9% and 49.6%, respectively. Compared with other treatments, glipizide, gliclazide and glibenclamide had better effects in reducing FBG, and the SUCRA were 70.7%, 59.6% and 59.2%, respectively. Glibenclamide and gliclazide did not increase the risk of hypoglycemia compared with the untreated group, and the OR(95%CI) were 1.51(0.89-2.16, P>0.05) and 1.36(0.68-2.05, P>0.05), respectively. CONCLUSION Glipizide and glibenclamide are more effective in the treatment of T2DM, but glipizide is more prone to adverse events, and its conclusions needs further study.