二甲双胍联合DPP-4抑制剂对比二甲双胍联合磺脲类药物对2型糖尿病患者心血管疾病风险、心血管相关死亡率和/或全因死亡率影响的荟萃分析

目的:由于目前多个临床试验在评估二甲双胍+DPP-4抑制剂与二甲双胍+磺酰脲类药物在降低2型糖尿病患者心血管病风险、心血管病死亡率和/或全因死亡率的结果上有所冲突,因此我们荟萃评价二甲双胍分别联合两类药物对2型糖尿病患者心血管病风险、心血管病死亡率和/或全因死亡率的影响.方法:按英文限定词系统搜索Medline/PubMed、EMBASE和互联网数据库(从2000年~2015年9月)发布的与二甲双胍联合DPP-4抑制剂或两类磺酰脲类药物对2型糖尿病患者心血管病风险、心血管病死亡率和/或全因死亡率的影响研究.从203篇相关报道中,最终判定纳入8篇进行分析.在这些研究中,对二甲双胍+磺酰脲类和二甲双胍+DPP-4抑制剂联合治疗的心血管病风险事件,心血管病死亡率和或全因死亡率进行了报道,并调整相对危险度(RR)或同等(危险比和优势比)和相应的方差.结果:二甲双胍联合DPP-4抑制剂相比二甲双胍联合磺酰脲类治疗的非致死性心血管事件合并相关风险RRs(95%CIs)为0.71(0.56~0.90),致死性心血管事件合并相关风险RRs为1.001(0.85~1.18),心血管病死亡率RRs为0.58(0.41~0.82).结论:二甲双胍联合DPP-4抑制剂相比二甲双胍联合磺酰脲类治疗能显著降低2型糖尿病患者的非致死性心血管事件风险(RR),心血管死亡率和全因死亡率.但是两种治疗方法在致命性心血管事件(心衰)上没有统计学差异.

Metformin plus Dipeptidyl Peptidase-4 inhibitors Therapy versus Metformin plus Sulfonylureas associated with a Decreased Risk of Cardiovascular Disease,Cardiovascular Mortality and/or All-Cause Mortality: A meta-analysis

Objective To evaluate the combination therapy of metformin plus dipeptidyl peptidase-4(DPP-4) inhibitor ver-sus metformin plus sulfonylurea on the risks of cardiovascular disease (CVD), CVD mortality, and/or all-cause mortality in type 2 diabetes mellitus (T2DM) patients. Methods A systematic search of Medline/PubMed (from 2000 to September 2015), EMBASE (from 2000 to September 2015), and Web of Knowledge (from 2000 to September 2015) for research articles published in English was carried out to examine how combination therapy affects the risk of CVD mortality and/or all-cause mortality in T2DM patients. In addition, the risks of cardiovascular events, CVD mortality, and/or all-cause mortality as well as the adjusted relative risk (RR) or equivalent (hazard ratio or odds ratio) and the corresponding variance or equivalent are reported. Results The accumulative RRs (95% confidence intervals, CIs) for T2DM patients treated with the combination therapy of metformin plus DPP-4 inhibitor versus metformin plus sulfonylurea were 0.71(0.56~0.90) for nonfatal cardiovascular events, 1.001(0.85~1.18) for fatal cardiovascular events, 0.58(0.41~0.82) for CVD mortality, and 0.72(0.59~0.87) for all-cause mortality. Conclusions The combination therapy of metformin plus DPP-4 inhibitor significantly decreased the RR of nonfatal cardiovascular events, CVD mortality, and all-cause mortality, compared with the combination therapy of metformin plus sulfonylurea. However, the number fatal cardiovascular events (e. g. , heart failure) was not significantly different between the two groups.