基于回顾性队列研究的2型糖尿病的药物效果评价

Evaluation of Effectiveness of Drugs for Type 2 Diabetes Mellitus Based on Historic Cohort Survey

目的:基于回顾性队列研究,比较二甲双胍与阿卡波糖和二甲双胍与瑞格列奈两种治疗方案的效果。方法:对北京市某三甲医院内分泌科住院患者病案进行研究,收集患者人口学资料和指标变化情况,并分为二甲双胍与阿卡波糖组(A组)和二甲双胍与瑞格列奈组(B组);对计数资料使用频数分析,使用χ~2检验和Wilcoxon秩和检验确定差异;对计量资料使用均数±标准差(±s)进行统计描述,配对t检验和Wilcoxon符号秩检验确定差异。结果:治疗前后效果比较中,A组患者治疗前后餐后2h血糖差异无统计学意义(P>0.05),空腹血糖和糖化血红蛋白均降低(P<0.05);B组患者治疗前后空腹血糖、餐后2h血糖和糖化血红蛋白均降低(P<0.05)。治疗效果组间比较中,B组治疗方案的糖化血红蛋白有效率高于A组治疗方案(P<0.05)。结论:基于回顾性队列研究具有较高的实际参考价值;二甲双胍与瑞格列奈联用的治疗效果优于二甲双胍与阿卡波糖;胰岛素促泌剂类药物与葡萄糖吸收抑制剂类药物联用可能具有更好的效果;混杂因素的存在可能降低治疗效果差异程度。

Objective： The purpose of this paper is to compare the effectiveness of metformin with acarbose and metformin with repaglinide under non-randomized trails. Methods： Medical records of inpatients in endocrinology department in a Beijing′s hospital were analyzed, we collect the demographic data and conditions of change of index, and patients were divided into metformin with acarbose group（group A）and metformin with repaglinide group （group B）. We use frequencies analysis method to deal enumeration data, as well as chi-square test and Wilcoxon rank sum test to ensure the difference;We use mean ± standard deviation （±s）to deal measurement data, as well as paired t-test and Wilcoxon signed ranks test to ensure difference.Results：In the comparison of effectiveness in the same group, Patients in group A suggested that there was no statistically significant difference in two hour postprandial blood glucose（2h PBG）before and after treatment （P〉0.05）; fasting blood-glucose（FBG）（P〈0.05）and glycosylated hemoglobin （HbA1c）（P〈0.05）had a great improvement. At the same time, the 2h PBG, FBG and HbA1c had a great improvement in group B（P〈0.05）. In the comparison of effectiveness in the different group, the improvement of HbA1c in group A was better than group B. Conclusion：The historic cohort studies have a high practical reference value; metformin with repaglinide is better than metformin with acarbose in cure process; insulin secretagogue drugs and glucose absorption inhibitor drugs may have better effectiveness than other plan; the confounding factors may reduce the level of effectiveness differences.