DPP-4抑制剂联合二甲双胍治疗2型糖尿病合并非酒精性脂肪性肝病的疗效和安全性的Meta分析

The efficacy and safety of DPP-4 inhibitor combined with Metformin in the treatment of type 2 diabetes with non-alcoholic fatty liver disease:a Meta-analysis

目的系统评价DPP-4抑制剂联合二甲双胍治疗2型糖尿病合并非酒精性脂肪性肝病(non-alcoholic fatty liver diseases,NAFLD)的疗效和安全性。方法检索知网(CNKI)、维普(VIP)、万方数据(Wan Fang Data)、Pub Med、EMbase数据库,检索时限设计为从建库至2017年10月,采用Rev Man 5. 3处理软件进行Meta分析。结果共纳入6项随机对照试验(randomized controlled trial,RCTs),试验组给予DPP-4抑制剂+二甲双胍,对照组给予二甲双胍治疗,Meta结果显示:试验组在降低BMI水平、FPG水平、2hPG水平及不良反应发生率方面与对照组比较,差异无统计学意义(P均> 0. 05);试验组在降低HOMA-IR水平、HBA1c水平、AST水平、ALT水平、GGT水平、TC水平、TG水平及脂肪肝有效率方面与对照组比较,差异有统计学意义(P均<0. 05)。结论 DPP-4抑制剂联合二甲双胍治疗2型糖尿病合并NAFLD较单用二甲双胍疗效较好,不增加不良反应,安全可靠,值得推广。受纳入研究质量限制,上述结论亟待多中心、高质量的随机对照试验进一步验证。

Objective To systematically evaluate the efficacy and safety of DPP-4 inhibitor combined with Metformin in the treatment of type 2 diabetes with non-alcoholic fatty liver disease （NAFLD）.Methods CNKI, VIP, WanFang Data, PubMed, EMbase from inception to Oct. 2017 were retrieved. RevMan 5.3 software was used to make Meta- analysis .Results Six randomized controlled trials （ RCTs ） were finally included, the results showed that the experimental group was equivalent to the control group in reducing BMI levels, FPG levels, 2hPG levels, and adverse effects rate （all P 〉0.05）. There were significant differences in reducding HOMA-IR levels, HBA1c levels, AST levels, ALT levels, GGT levels, TC levels, TG levels and effective rate of treatment of fatty liver between two groups （all P 〈 0.05 ）.Conclusion The efficacy of DPP-4 inhibitor combined with Metformin in the treatment of type 2 diabetes with NAFLD is better, and does not increase the adverse reactions. Because of the limitation of methodological quality of the included studies and sample size, multicenter, high-quality RCTs with large sample are required.