金芪降糖片治疗2型糖尿病胰岛素抵抗的Meta分析

Meta-analysis of effect of Jinqi Jiangtang Tablets on treating insulin resistance in type 2 diabetes

系统评价金芪降糖片对2型糖尿病患者胰岛素抵抗的疗效和安全性。在PubMed,EMbase,Cochrane Library,中国知网(CNKI),万方数据信息网站,中国生物医学数据库(CBM),维普进行文献搜索,检索时间自数据库建立至2018年11月。Review Manager 5.3软件用于评估偏倚风险、数据分析和亚组分析。Stata 14.0用于Begg′s和Egger′s检验以评估漏斗图对称性。GRADE系统用于评估证据质量。最终符合条件的文献共10篇,涉及797例患者。与单独西药相比,金芪降糖片治疗FBG有统计学意义(WMD=-0.63,95%CI[-1.00,-0.26],P=0.0009)。至于2 h BG,金芪降糖片联合西药有显著下降(WMD=-1.46,95%CI[-1.71,-1.21],P<0.00001);HbA1c(WMD=-0.75,95%CI[-0.97,-0.53],P<0.00001),FINS(WMD=-0.65,95%CI[-0.80,-0.50],P<0.00001),2 h INS(SMD=-1.67,95%CI[-2.26,-1.09],P<0.00001)和HOMA-IR(WMD=-1.22,95%CI[-1.67,-0.76],P<0.00001)也有下降。金芪降糖片对胰岛素敏感性(ISI)改善(WMD=1.00,95%CI[0.84,1.17],P<0.00001)。Egger′s和Begg′s的测试表明没有发表偏倚(P=0.379)。敏感性分析表明,没有一项研究影响整体结果。但GRADE质量偏低。尽管有明显的阳性结果,但由于证据等级不高,尚不能得出金芪降糖片对2型糖尿病胰岛素抵抗患者有积极作用的合理结论。

To systematically assess the efficacy and safety of Jinqi Jiangtang Tablets for patients with insulin resistance in type 2 diabetes,literatures were retrieved in 7 databases:PubMed,EMbase,Cochrane Library,Chinese National Knowledge Infrastructure(CNKI),WanFang database,Chinese BioMedical Database(CBM),VIP Chinese Science and Technique Journals Database,from the date of its inception up to November 2018.Review Manager 5.3 software was used for risk bias assessment,data synthesis and subgroup analysis.Begg′s and Egger′s tests were performed for assessing symmetries of funnel plot by software Stata 14.0.GRADE system was used to assess the quality of evidence.A total of 10 trials involving 797 participants were eligible.Compared with Western medicine alone,Jinqi Jiangtang Tablets showed a statistical significance in FBG(WMD=-0.63,95%CI[-1.00,-0.26]).Jinqi Jiangtang Tablets showed a significant decrease in 2 h BG combined with Western medicine compared with Western medicine alone(WMD=-1.46,95%CI[-1.71,-1.21],P<0.00001).Jinqi Jiangtang Tablets combined with Western medicine showed a significant decrease in HbA1 c(WMD=-0.75,95%CI[-0.97,-0.53],P<0.00001),FINS(WMD=-0.65,95%CI[-0.80,-0.50],P<0.00001),2 h INS(SMD=-1.67,95%CI[-2.26,-1.09],P<0.00001)and HOMA-IR(WMD=-1.22,95%CI[-1.67,-0.76],P<0.00001).Jinqi Jiangtang Tablets combined with Western medicine was beneficial for ISI(WMD=1.00,95%CI[0.84,1.17],P<0.00001).Egger′s and Begg′s test showed no publication bias(P=0.379).Sensitivity analysis showed no impact on the overall results.The GRADE quality of the evidence was low.Despite of the apparently positive results,we cannot draw a rational conclusion that Jinqi Jiangtang Tablets has a positive effect in patients with IR,because of the low evidence grade.