药师干预对2型糖尿病患者临床结局影响的meta分析

Meta-analysis of the influence of pharmacist intervention on clinical outcomes of patients with type 2 diabetes

目的 系统评价药师干预对2型糖尿病患者临床结局的影响。方法 检索PubMed、Cochrane Library、Web of Science、Embase、知网、万方、维普数据库,时间为2000年1月—2021年8月。搜索药师干预影响2型糖尿病患者临床结局的随机对照试验,提取资料并用RevMan 5.4版软件分析。结果 共纳入20项研究,包含2818名患者。结果显示,与对照组相比,药师干预能显著降低患者的糖化血红蛋白[MD=0.97,95%CI=(0.78,1.17),P<0.000 01]、空腹血糖[MD=1.50,95%CI=(0.93,2.08),P<0.000 01]、收缩压[MD=8.52,95%CI=(4.84,12.21),P<0.000 01]、舒张压[MD=2.51,95%CI=(0.78,4.25),P=0.005]、总胆固醇[MD=0.37,95%CI=(0.09,0.65),P=0.009]和低密度脂蛋白胆固醇[MD=0.20,95%CI=(0.12,0.28),P<0.000 01];但对三酰甘油[MD=0.06,95%CI=(-0.01,0.13),P=0.11]、高密度脂蛋白胆固醇[MD=0.00,95%CI=(-0.03,0.03),P=1.00]、体质量指数[MD=0.16,95%CI=(-0.03,0.35),P=0.11]的改善不明显;患者血糖达标率[OR=0.31,95%CI=(0.23,0.41),P<0.000 01]及用药依从性明显提升。结论 在现有证据下,药师干预能够明显改善2型糖尿病患者的血糖、血压、总胆固醇、低密度脂蛋白胆固醇控制水平及用药依从性,但对三酰甘油、高密度脂蛋白胆固醇、体质量指数的改善并不明显。

Objective To systematically evaluate the effect of pharmacist intervention on the clinical outcomes of patients with type 2 diabetes.Methods We searched PubMed,Cochrane Library,Web of Science,Embase,CNKI,Wanfang and VIP databases from January 2000 to August 2021.We retrieved randomized controlled trials of pharmacist intervention on clinical outcomes of patients with type 2 diabetes,extract the data and analyze with RevMan 5.4 software.Results Twenty studies were included,involving 2818 patients.Compared with the control group,pharmacist intervention significantly reduced the glycosylated hemoglobin[MD=0.97,95%CI= (0.78,1.17),P<0.000 01],fasting blood glucose[MD=1.50,95%CI= (0.93,2.08),P<0.000 01],systolic blood pressure[MD=8.52,95%CI= (4.84,12.21),P<0.000 01],diastolic blood pressure[MD=2.51,95%CI= (0.78,4.25),P=0.005],total cholesterol[MD=0.37,95%CI= (0.09,0.65),P=0.009]and low-density lipoprotein cholesterol[MD=0.20,95%CI= (0.12,0.28),P<0.000 01];But for triglycerides[MD=0.06,95%CI= (-0.01,0.13),P=0.11],high-density lipoprotein cholesterol[MD=0.00,95%CI= (-0.03,0.03),P=1.00],and body mass index[MD=0.16,95%CI= (-0.03,0.35),P=0.11],the improvement was not obvious without statistical difference.In addition,the blood glucose compliance rate of patients in the pharmacist intervention group[OR=0.31,95%CI= (0.23,0.41),P<0.000 01]and medication compliance were increased significantly.Conclusion Based on the existing evidence,pharmacist intervention can significantly improve the blood glucose,blood pressure,total cholesterol,low-density lipoprotein cholesterol control level and medication compliance of patients with type 2 diabetes,but it does not significantly improve triglycerides,high-density lipoprotein cholesterol,and body mass index.