DPP-4抑制剂联合二甲双胍治疗2型糖尿病的胃肠道安全性评价

目的系统评价DPP-4抑制剂联合二甲双胍治疗2型糖尿病的胃肠道安全性,为糖尿病的药物治疗提供证据和建议。方法检索数据库Pub Med、The Cochrane Library和EM-base(OVID)获得DPP-4抑制剂联合二甲双胍治疗2型糖尿病的随机对照试验。提取出胃肠道不良事件的相关数据,使用Revman5.2软件和固定效应模型进行汇总分析,比较DPP-4抑制剂联合二甲双胍与单用二甲双胍治疗2型糖尿病的胃肠道不良事件发生率的差异。结果本研究共纳入了26个RCT和11454例2型糖尿病患者。与单用二甲双胍相比,西格列汀(二甲双胍剂量≥1500mg/d)、维格列汀分别联合二甲双胍可显著减少腹痛的发生(OR 0.53,95%CI:0.35~0.81,P=0.003;OR 0.21,95%CI:0.06~0.73,P=0.01)。在其他类型的胃肠道不良反应(腹泻、反胃、呕吐等)方面,尚不能认为西格列汀、维格列汀、沙格列汀、利格列汀和阿格列汀分别联合二甲双胍相比于单用二甲双胍有优势(P均大于0.05)。结论与单用二甲双胍相比,西格列汀、维格列汀分别联合二甲双胍在降低腹痛发生率上更具优势。

Evaluation of Gastrointestinal Tract Safety of DPP-4 inhibitor Combined with Metformin in the Treatment of Type 2 Diabetes

Objective To systematic evaluate the gastrointestinal tract safety of DPP-4 inhibitors combined with metformin in the treatment of type 2 diabetes,and provide evidence and advice for the treatment of diabetes. Methods Randomized controlled trials of DPP-4 inhibitor combined with metformin in the treatment of type 2 diabetes were performed using databases Pub Med,The Cochrane Library and EM-base( OVID).Data of gastrointestinal adverse events were extracted and analyzed by using Revman5. 2 software and fixed effect model to compare the difference of gastrointestinal adverse events between DPP-4 inhibitor combined metformin and metformin alone in treatment of type 2 diabetes.Results A total of 26 RCT and 11454 patients with type 2 diabetes were included in the study.Compared with metformin alone,sitagliptin( metformin dose more than 1500 mg/d) and vildagliptin respectively combined with metformin can significantly reduce the occurrence of abdominal pain( 0. 53 OR,95% CI: 0. 35 ~0. 81,P = 0. 003; OR 0. 21,95% CI: 0. 06 ~ 0. 73,P = 0. 01). In other types of gastrointestinal adverse reactions( diarrhea,nausea,vomiting,etc.),still can not believe that compared with metformin alone,sitagliptin,vildagliptin,saxagliptin,linagliptin and alogliptin combined with metformin respectively have the advantage( P all more than 0. 05). Conclusion Compared with metformin alone,sitagliptin and vildagliptin combined with metformin had more advantages in reducing the incidence of abdominal pain