西格列汀治疗二型糖尿病合并非酒精性脂肪肝疗效和安全性的系统评价

Efficacy of Sitagliptin on Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus:A Systematic Review

目的系统评价西格列汀治疗2型糖尿病合并非酒精性脂肪肝的疗效和安全性。方法计算机检索PubMed、The Cochrane Library、Embase、Medline、维普(VIP)、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库,查找有关西格列汀治疗2型糖尿病合并非酒精性脂肪肝的随机对照试验,检索时间为建库至2020年11月,根据文献纳入标准筛选文献,使用Revman 5.3.0软件进行Meta统计分析。结果纳入7篇文献,共计457名患者,meta分析显示,与对照组相比,西格列汀组可明显改善患者的糖化血红蛋白(HbA1c)[MD=-0.79,95%CI(-1.25,-0.33),P=0.0008]、胰岛素抵抗[MD=-0.54,95%CI(-0.82,-0.26),P=0.0001]、甘油三酯(TG)[MD=-0.49,95%CI(-0.74,-0.24),P=0.0001]。西格列汀对患者的体重指数(BMI)[MD=0.14,95%CI(-0.45,0.73),P=0.65]、丙氨酸转氨酶(ALT)[MD=-4.72,95%CI(-9.43,0.00),P=0.05]、谷氨酸转氨酶(AST)[MD=-4,61,95%CI(-10.07,0.85),P=0.1]、总胆固醇(TC)[MD=-0.18,95%CI(-0.39,0.03),P=0.09]无明显作用,不良反应发生率与对照组相比无统计学差异[RR=1.37,95%CI(0.76,2.47),P=0.29]。结论西格列汀能改善2型糖尿病合并非酒精性脂肪肝患者的糖化血红蛋白,对甘油三酯异常的脂代谢患者有改善作用,不增加患者的体重及肝酶水平,且安全性较好。

Objective AIM To evaluate the efficacy of sitagliptin on nonalcoholic fatty liver disease(NAFLD)in patients with type 2 diabetes mellitus(T2DM).Methods The randomized controlled trials(RCT)of sitagliptin for NAFLD in Patients with T2DM were searched from PubMed,The Cochrane Library,Embase,Medline,VIP,CNKI,CBM,Wanfang database.The time was limited from database foundation to November,2020.The literatures were screened out by inclusion criteria and analyzed using RevMan 5.3.0 software.Results Four hundred and fifty-seven patients in seven RCTS were included.The meta analysis showed that compared with control group,sitagliptin can decreased the level of HbA1c[MD=-0.79,95%CI(-1.25,-0.33),P=0.0008],HOMA IR[MD=-0.54,95%CI(-0.82,-0.26),P=0.0001]and TG[MD=-0.49,95%CI(-0.74,-0.24),P=0.0001].There were no significant changes in BMI[MD=0.14,95%CI(-0.45,0.73),P=0.65],ALT[MD=-4.72,95%CI(-9.43,0.00),P=0.05],total cholesterol[MD=-0.18,95%CI(-0.39,0.03),P=0.09]and AST[MD=-4.61,95%CI(-10.07,0.85),P=0.1].There was no significant difference in adverse reactions between sitagliptin group and control group[RR=1.37,95%CI(0.76,2.47),P=0.29].Conclusion Sitagliptin can improve glucose and triglyceride on Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus and has no changes in weight and Liver enzyme levels,with lower incidence of adverse reactions and pretty safety.