胰高血糖素样肽1受体激动剂类降糖药致2型糖尿病患者鼻咽炎和上呼吸道感染的网状meta分析

目的：使用网状meta分析系统评价胰高血糖素样肽1受体激动剂（glucagon-like peptide-1 receptor agonists，GLP-1 RAs）类降糖药对两种常见的呼吸系统不良事件（respiratory system adverse event，RSAE，包括鼻咽炎和上呼吸道感染）的影响。方法：系统检索Medline、Embase、Clinical trials和Cochrane数据库中（截止2015年5月）比较GLP-1 RAs与传统降糖药或安慰剂对鼻咽炎和上呼吸道感染发生风险影响的随机对照研究，采用网状meta分析方法对纳入的研究结果进行加权合并。结果： 共纳入50个研究，包括13种干预措施：7种GLP-1 RAs类药（艾塞那肽、艾塞那肽缓释剂、利拉鲁肽、利西拉来、他司鲁肽、阿必鲁肽、杜拉鲁肽）、5种传统降糖药（胰岛素、二甲双胍、磺脲类、西格列汀、噻唑烷二酮类）和安慰剂。网状meta分析结果显示，与胰岛素相比，他司鲁肽显著降低了鼻咽炎（OR=0.67，95%CI：0.46~0.96）和上呼吸道感染（OR=0.39，95%CI：0.23~0.73）的发生风险；与安慰剂相比，他司鲁肽显著降低了上呼吸道感染（OR=0.57，95%CI：0.34~0.99）的发生风险。此外，基于贝叶斯理论的网状meta分析显示，鼻咽炎和上呼吸道感染发生风险排最末位的均为他司鲁肽。结论： 他司鲁肽显著降低了鼻咽炎和上呼吸道感染的发生风险，但仍有待专门针对RSAE设计的大型前瞻性研究加以验证。

Impact of glucagon-like peptide-1 receptor agonists on nasopharyngitis and upper re-spiratory tract infection among patients with type 2 diabetes:a network meta-analy-sis

Objective:To systematically review the effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs)on two common respiratory system adverse events (RSAE:nasopharyngitis and upper re-spiratory tract infection)among type 2 diabetes (T2DM).Methods:Medline,Embase,Clinical trials and Cochrane library were searched from inception through May 201 5 to identify randomized clinical trials (RCTs)assessed safety of GLP-1 RAs versus placebo or other anti-diabetic drugs in T2DM.Network meta-analysis within a Bayesian framework was performed to calculate odds ratios for the incidence of RSAE.Results:In the study,50 RCTs were included,including 1 3 treatments:7 GLP-1 RAs (exenati-de,exenatide-long-release-agent,liraglutide,lixisenatide,taspoglutide,albiglutide and dulaglutide), placebo and 5 traditional anti-diabetic drugs(insulin,metformin,sulfonylureas,sitagliptin and thiazo-lidinediones ketones).Compared with insulin,taspoglutide significantly decreased the incidence of naso-pharyngitis (OR =0.67,95%CI:0.46 -0.96).Significant lowering effects on upper respiratory tract infection were found when taspoglutide versus placebo (OR =0.57,95%CI:0.34 -0.99)and insulin (OR =0.39,95%CI:0.23 -0.73).The result from the network meta-analysis based on Bayesian theo-ry could be used to rank all the treatments included,which showed that taspoglutide ranked last with mi-nimum risk on nasopharyngitis and upper respiratory tract infection.Conclusion:Taspoglutide was associ-ated with significantly lowering effect on RSAE.