非诺贝特对糖尿病视网膜病变治疗的有效性及安全性的Meta分析

Efficacy and safety of fenofibrate treatment for diabetic retinopathy:a meta-analysis

目的 评价非诺贝特治疗及预防DR的有效性及安全性. 方法 检索PubMed、Cochrane Library、Embase、CNKI、万方数据库和Sinomed自建库至2012年4月的有关文献.在严格质量评价的基础上运用Revman 5.0软件对所提取的数据进行分析. 结果 纳入3项随机对照临床试验（n=2685）,Meta分析结果显示,非诺贝特可以：（1）降低眼科主要观察终点事件的发生率（OR：0.63,95％CI：0.49～0.82,P=0.0005）；（2）延缓DR进展（OR：0.64,95％CI：0.48～0.86,P=0.003）.排除强化降糖因素后,这一作用仍存在（OR：0.66,95％CI：0.48～0.89,P=0.007）,并且对已存在的非增殖性糖尿病视网膜病变（NPDR）的患者,作用显著（OR：0.40,95％CI：0.26～0.63,P＜0.0001）;（3）降低DR患者激光治疗的需求（OR：0.39,95％CI：0.24～0.63,P=0.0001）. 结论 非诺贝特降低眼科观察终点事件的发生率,延缓DR的进展,减少患者对激光治疗的需求.

Objective To assess the efficacy and safety of fenofibrate for diabetic retinopathy （DR）. Methods The relevant data from Randomized Clinical Controlled Trials about the efficacy and safety of fenofibrate for DR were collected by searching MEDLINE, Embase, The Cochrane Library, CNKI, Wangfangdata and CBM （the deadline to April 2012）. The quality of included studies was critically evaluated, and the data analyses were performed with The Cochrane Collaboration＇ s RevMan 5. 0 software. Results Three studies were finally included, with a total of 2685 participants. Meta-analysis showed that ： （1） Fenofibrate reduced the risk of the composite endpoint of retinal pathology significantly （OR： 0. 63,95% CI： O. 49-0. 82,P=0. 0005）. （2） Fenofibrate delayed the progress of DR （OR： O; 64,95% CI： O. 48-0. 86,P=0. 003）, after adjusting intensive treatment to glycemia, the effect of fenofibrate was still present （OR： O. 66,95MCI： 0. 48-0. 89, P=0. 007）. Its benefit was more significant in patients with pre-existing retinopathy （OR： O. 40, 95%CI： 0. 26-0. 63,P〈0. 0001）. （3） The requirement for laser treatment for all retinopathy decreased significantly in the fenofibrate group than in the control group （OR： O. 39,95%CI： 0. 24-0. 63,P=0. 0001）. Conclusion Fenofibrate significantly reduces the risk of the composite ophthalmology endpoint and postpones the progress of DR, and simultaneously fenofibrate cuts down the requirement for laser treatment for DR.