胰高血糖素样肽-1受体激动剂与钠-葡萄糖协同转运蛋白-2抑制剂治疗2型糖尿病疗效及安全性的系统评价

目的：系统评价胰高血糖素样肽-1受体激动剂（GLP-1RA）与钠-葡萄糖协同转运蛋白-2抑制剂（SGLT-2i）治疗2型糖尿病（T2DM）的疗效及安全性，为临床治疗提供循证参考。方法：计算机检索相关的随机对照试验。采用Stata 14.0软件进行Meta分析，并运用成本-效果分析方法进行短期经济学评价。结果：共纳入6项RCT，合计2 248例患者，纳入药物包括利拉鲁肽、艾塞那肽、司美格鲁肽、卡格列净、达格列净和恩格列净。Meta分析结果显示：GLP-1RA能更有效地降低糖化血红蛋白（HbA1c）水平[SMD=-0.28，95% CI （-0.40，-0.16），P<0.01]，且HbA1c<7%的达标率更高，而SGLT-2i能更有效地控制患者的收缩压、舒张压和脉搏；GLP-1RA治疗组导致停药、腹泻、恶心、呕吐等不良反应的发生率均显著高于SGLT-2i治疗组，而SGLT-2i治疗组患者出现生殖器感染的发生率更高，差异均有统计学意义。SGLT-2i的成本-效果比更低。结论：GLP-1RA降低T2DM患者HbA1c水平的疗效更好，但SGLT-2i控制患者血压和脉搏的效果更优、耐受性更佳且具有较高的经济学优势，临床治疗中应根据患者的具体情况选择合适的药物。

Systematic review of efficacy and safety of glucagon-like peptide-1 receptor agonists versus sodium-glucose co-transporter-2 inhibitors in treatment of type 2 diabetes mellitus

OBJECTIVE To systematically evaluate the efficacy and safety of GLP-1 receptor agonists versus SGLT-2 inhibitors in the treatment of T2DM, and to provide evidence-based reference for the clinical treatment of T2DM.METHODS Chinese and English databases were searched for relevant randomized controlled trials.Then Meta-analysis was performed using Stata 14.0 software, and cost-effectiveness analysis was used to evaluate the short-term economics of the two drugs.RESULTS A total of 6 RCTs were included, involving 2 248 patients.Liraglutide, exenatide, semaglutide, canagliflozin, dapagliflozin and empagliflozin were included.The results of Meta-analysis showed that, compared with SGLT-2 inhibitors, GLP-1 receptor agonists were more effective in reducing HbA1c levels[SMD=-0.28, 95%CI(-0.40, -0.16), P<0.01], with a higher number of patients achieved HbA1c<7%;while the control on SBP, DBP and pulse rate was better in the SGLT-2 inhibitors group.The incidence of drug discontinuation, diarrhea, nausea and vomiting in the GLP-1 receptor agonists group was significantly higher than the SGLT-2 inhibitors group, however, the incidence of genital infection in the SGLT-2 inhibitors group was much higher.All of these differences were statistically significant.The cost-effectiveness ratio of SGLT-2 inhibitors was lower.CONCLUSION GLP-1 receptor agonists are superior to SGLT-2 inhibitors in controlling the glycated hemoglobin levels, while SGLT-2 inhibitors have better efficacy in controlling the blood pressure and pulse rate, with better tolerability and higher economic effects, and appropriate drugs should be selected according to the specific situation of patients in clinical treatment.