SGLT-2抑制剂与其他降糖药物对比治疗2型糖尿病有效性与安全性的网状Meta分析

目的：采用网状Meta分析研究评价钠-葡萄糖共转运蛋白-2抑制剂（sodium-glucose cotransporter-2 inhibitors，SGLT-2抑制剂）与其他降糖药物对比治疗2型糖尿病（type 2 diabetes，T2DM）的有效性和安全性。方法：计算机检索Embase、PubMed、OVID、clinicaltrials.gov网站、万方、知网和维普数据库。检索时间从建库至2019年5月30日，并筛选研究SGLT-2抑制剂与其他降糖药物治疗T2DM的有效性和安全性的临床随机对照试验（clinicalrandomized trials，RCT）。结果：共纳入12项RCTs，总计8 845名患者。网状Meta分析结果显示，卡格列净、恩格列净、达格列净、埃格列净与二甲双胍、格列美脲、西他列汀、利格列汀相比：（1）恩格列净以及达格列净与二甲双胍相比，未能明显降低患者的HbA1c （P<0.05）；卡格列净300 mg以及埃格列净15 mg对比格列美脲及西他列汀能明显降低患者的HbA1c （P<0.05）；与利格列汀相比，SGLT-2抑制剂均无显著性差异（P>0.05）。（2）仅达格列净在降低患者FPG上与其他降糖药物无显著性差异（P>0.05）。（3）卡格列净及恩格列净能显著降低患者的体质量（P<0.05）。（4） SGLT-2抑制剂均不会增加不良反应发生率，无显著性差异（P>0.05）。（5）与格列美脲相比，SGLT-2抑制剂均不会增加患者低血糖的发生率（P<0.05），但与另外3个降糖药物相比，无显著性差异（P>0.05）。结论：卡格列净、恩格列净、达格列净、埃格列净治疗2型糖尿病有效，且均不会增加患者不良反应及低血糖的发生率。根据4种药物的等级概率排序，其中埃格列净疗效最好，但由于该药物的纳入文献较少，仍需高质量、大样本的RCT再进行更进一步的评估；此外，4种药物的安全性均较高。

Efficacy and safety of SGLT-2 inhibitors compared with other antidiabetic drugs in the treatment of type 2 diabetes: a meta-analysis

OBJECTIVE To evaluate the efficacy and safety of sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) compared with other hypoglycemic agents in patients with type 2 diabetes (T2DM) by network Meta-analysis.METHODS The Embase, PubMed, OVID, clinicaltrials.gov, Wanfang, CNKI and VIP databases were searched from the inception to May 30, 2019. and clinical randomized trials (RCTs) investigating the efficacy and safety of SGLT-2 inhibitors and other antidiabetic agents in the treatment of T2DM were screened.RESULTS Twelve RCTs with a total of 8845 patients were included. In the meta-analysis, results of comparison between canagliflozin, empagliflozin, dapagliflozin, ertugliflozin and metformin, glimepiride, sitagliptin,linagliptin were as follows:(1)Empagliflozin and dapagliflozin did not significantly reduce HbA1c (P<0.05) in patients when compared with metformin; canagliflozin 300 mg and ertugliflozin15 mg can significantly reduce HbA1c in patients (P<0.05) when compared with glimepiride and sitagliptin; there was no significant difference in SGLT-2 inhibitor compared with linagliptin (P>0.05). (2)Only dapagliflozin showed no significantly difference in reducing FPG (P>0.05) compared with other hypoglycemic agents. (3)Canagliflozinn and ertugliflozin significantly reduced the body weight of patients (P<0.05). (4)SGLT-2 inhibitors did not increase the incidence of adverse reactions with no significantly difference (P>0.05). (5)Compared with glimepiride, SGLT-2 inhibitors did not increase the incidence of hypoglycemia in patients (P<0.05), but there was no significantly difference compared with the other three hypoglycemic drugs (P>0.05).CONCLUSION Canagliflozin, empagliflozin, dapagliflozin and ertugliflozin are effective in the treatment of T2DM, and none of them increases the incidence of adverse reactions and hypoglycemia. Ertugliflozin has the best efficacy according to the probability ranking of the four drugs, but due to the few included literatures of this drug, high-quality, large-sample RCTs are still needed for further evaluation; in addition, the safety of all four drugs is high.