临床药师干预糖尿病患者治疗有效性的Meta分析

Meta analysis of the diabetes treatment effectiveness with the intervention of clinical pharmacists

目的评价临床药师干预糖尿病患者治疗效果的有效性。方法检索万方(WANFANG)、维普(VIP)、中国知网、PubMed、Elsevier以及Web of science数据库;采用Cochrane Handbook推荐的标准对纳入文献进行质量评价;应用RevMan 5.1作Meta分析。依据χ2检验和I2统计量评估合并数据的异质性;采用亚组分析或敏感性分析探索异质性的可能原因;以漏斗图检验是否存在发表偏倚。选取HbA1c、低密度脂蛋白、高密度脂蛋白、三酰甘油、总胆固醇、收缩压、舒张压和体质量指数水平作为结局指标。结果最终纳入11项随机对照试验(RCTs),共1 165例。糖化血红蛋白水平[MD=-0.95,95%CI(-1.12,-0.78),P<0.000 01];低密度脂蛋白水平[MD=-7.49,95%CI(-13.41,-1.57),P=0.01];三酰甘油水平[MD=-28.69,95%CI(-45.34,-12.04),P=0.000 7];总胆固醇水平[MD=-12.06,95%CI(-19.01,-5.10),P=0.000 7]和收缩压水平[MD=-10.15,95%CI(-13.67,-6.62),P<0.000 01]等,干预组均优于对照组(P<0.05)。高密度脂蛋白水平[MD=0.19,95%CI(-1.46,1.84),P=0.82],舒张压水平[MD=-1.22,95%CI(-3.20,0.76),P=0.23]和BMI水平[MD=-0.43,95%CI(-1.24,0.37),P=0.29]等指标差异均无统计学意义。结论临床药师在糖尿病患者治疗过程中,对患者糖化血红蛋白和收缩压水平的控制有显著帮助,糖尿病并发症的心血管疾病危险因素,包括低密度脂蛋白、三酰甘油和总胆固醇水平也有明显改善。

Objective To evaluate the effectiveness of clinical pharmacists′intervention in the treatment of patients with diabetes.Methods We searched the Wanfang,VIP,CNKI,PubMed,Elsevier and Web of science database.The quality of included trials was evaluated by the criterion indicated in Cochrane Handbook.Meta-analysis was conducted by using RevMan5.1.Theχ2and I2statistics were used to assess statistical heterogeneity across studies;adopting subgroup analyses or sensitivity analyses to explore the possible differences among studies;funnel plots were drawn to explore a potential publication bias.The HbA1c level,LDL-C level,HDL-C level,triglyceride level,total cholesterol level,systolic blood pressure,diastolic blood pressure and body mass index(BMI)were selected as the outcome measures.Results This study includes11randomized controlled trials(RCTs)with a total of1165patients.For the HbA1c levels[MD=-0.95,95%CI(-1.12,0.78),P<0.00001],LDL-C levels[MD=-7.49,95%CI(-13.41,-1.57),P=0.01],triglyceride levels[MD=-28.69,95%CI(-45.34,-12.04),P=0.0007],total cholesterol(TC)[MD=-12.06,95%CI(-19.01,-5.10),P=0.0007]and systolic blood pressure levels[MD=-10.15,95%CI(-13.67,-6.62),P<0.00001],the outcome of the intervention group was apparently improved when compared with the control group in statistics.On the contrary,HDL-C levels[MD=0.19,95%CI(-1.46,1.84),P=0.82],diastolic blood pressure levels[MD=-1.22,95%CI(-3.20,0.76),P=0.23]and BMI levels[MD=-0.43,95%CI(-1.24,0.37),P=0.29]were not statistically significant.Conclusion During the process of diabetes treatment,clinical pharmacists are significantly helpful in controlling patients′HbA1c and systolic blood pressure.Our results also suggest a substantial improvement regarding the cardiovascular risk factors for diabetic complications,with levels of LDL-C,triglyceride and total cholesterol all included.