卡格列净对2型糖尿病患者心血管因素影响的Meta分析

Effects of Canagliflozin on Cardiovascular in Type 2 Diabetes Mellitus:a Meta-analysis

目的:系统评价卡格列净对2型糖尿病患者心血管因素的影响。方法:计算机检索Medline、PubMed、the Cochrane Library、Embase、SinoMed、VIP、WanFang Data、CNKI数据库,搜集有关卡格列净用于治疗2型糖尿病的随机对照试验(RCT),检索时限均为从建库至2020年4月2日,由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入10个RCT,总计4080例患者。Meta分析结果显示,与安慰剂或其他口服降糖药相比,卡格列净(300 mg,qd)可显著降低体重[MD=-2.70,95%CI(-4.15,-1.25),P=0.0003]、收缩压[MD=-4.11,95%CI(-5.40,-2.82),P<0.00001]、舒张压[MD=-1.77,95%CI(-2.27,-1.26),P<0.00001]、三酰甘油水平[MD=-0.15,95%CI(-0.25,-0.04),P=0.005],可升高低密度脂蛋白胆固醇[MD=0.14,95%CI(0.06,0.22),P=0.0004]、高密度脂蛋白胆固醇[MD=0.08,95%CI(0.07,0.10),P<0.00001],两组低密度比高密度脂蛋白胆固醇差异无统计学意义[MD=-0.03,95%CI(-0.08,0.01),P=0.18]。结论:卡格列净对2型糖尿病有一定的心血管获益,表现为降低体重、血压、三酰甘油水平,升高高密度脂蛋白胆固醇,因此临床医生在治疗伴有高血压高血脂的2型糖尿病患者时可选用卡格列净,同时关注降压和调脂药剂量的调整,但也应警惕由于卡格列净对低密度脂蛋白胆固醇升高而可能增加的心血管风险。

Objective:To systematically review the effect of canagliflozin on cardiovascular with type 2 diabetes mellitus.Methods:Medline,PubMed,the Cochrane Library,Embase,SinoMed,VIP,WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials(RCTs)of canagliflozin on cardiovascular with type 2 diabetes mellitus from inception to April 2,2020.Two reviewers independently screened studies,extracted data and assessed risk of bias of included studies.Then,Meta-analysis was performed using RevMan 5.3 software.Results:A total of 10 RCTs were included,totaling 4080 patients.Meta-analysis showed that,compared with placebo or other oral hypoglycemic agents,canagliflozin 300 mg/qd could significantly reduced body weight(MD=-2.70,95%CI-4.15 to-1.25,P=0.0003),systolic blood pressure(MD=-4.11,95%CI-5.40 to-2.82,P<0.00001),diastolic blood pressure(MD=-1.77,95%CI-2.27 to-1.26,P<0.00001),triglycerides(MD=-0.15,95%CI-0.25 to-0.04,P=0.005),increased LDL cholesterol(MD=0.14,95%CI 0.06 to 0.22,P=0.0004),elevated HDL cholesterol(MD=0.08,95%CI 0.07 to 0.10,P<0.00001),there was no statistically significant difference between LDL cholesterol to HDL cholesterol ratio(MD=-0.03,95%CI-0.08 to 0.01,P=0.18).Conclusion:Caglitazine has some cardiovascular benefits for type 2 diabetes,such as weight loss,improvement of blood pressure and blood lipids.Therefore,clinicians should pay attention to the adjustment of the dosage of antihypertensive and lipid regulation agents in the treatment of type 2 diabetic patients with hypertension and hyperlipidemia.