二甲双胍改善糖尿病患者认知功能有效性和安全性的Meta分析

Meta-Analysis of the Efficacy and Safety of Metformin in Improving Cognitive Function in Patients with Diabetes Mellitus

目的:系统评价二甲双胍治疗糖尿病对患者认知情况的影响。方法:对中国生物医药文献服务平台(CBM)、CNKI、PubMed等数据库进行检索,搜索收集自建库至2022年12月31日发表的与二甲双胍改善糖尿病患者认知功能有关的随机对照试验,利用RevMan5.3进行数据的统计和分析,简易精神智力状态评分(mini-mental state examination, MMSE)、蒙特利尔认知评定(montreal cognitive assessment, MoCA)、美国国立卫生研究院卒中量表(NIH stroke scale, NIHSS)及不良反应等结果进行分析。结果:在符合纳入标准的十篇文献中,共1 328名患者被纳入研究,其中治疗组663例,对照组665例。Meta分析结果提示:磺脲类降糖药观察组的MMSE评分优于对照组,且数据结果有显著性差异,但胰岛素类降糖药组其观察组MMSE评分低于对照组,差异显著。MoCA评分观察组与对照组无证据支持有统计学差异;观察组的NIHSS评分显著高于对照组,组间差异有统计学意义;观察组与对照组之间的不良反应比较无显著性差异。结论:二甲双胍对改善糖尿病患者的认知功能具有良好的作用,可以促进神经功能的恢复,但与胰岛素相比未体现明显的神经认知功能改善作用,但具有较好的安全性,可以用于糖尿病伴认知障碍的治疗。

Objective:To systematically evaluate the effect of metformin treatment for diabetes on patients’cognitive condition.Methods:The databases of CBM、CNKI and PubMed were searched to collect randomized controlled trials of metformin for the treatment of diabetes mellitus published between the date of establishment and December 31,2022,and the data were statistically analyzed by RevMan 5.3 software,according to MMSE scores,MoCA scores,NIHSS scores and adverse effects were analyzed.Results:These 1o papers contain 1328 patients,and there are 663 patients in the treatment group while 665 patients in the control group.Meta-analysis showed that the MMSE scores in the observation group of sulfonylureas were higher than those in the control group,and there was significant differ-ence,but in the insulin group the MMSE scores in the observation group were lower than those in the control group,and the difference was statistically significant.The difference be-tween the MoCA scores and the control group was not statistically significant;the NIHSS scores of treatment group were significantly higher than those in the control group,and the difference between groups was statistically significant;and the adverse effects between the treatment group and the control group were statistically significant.No statistically significant difference was observed in adverse events between two groups.Conclusion:Metformin can improve the cognitive function and promote the recovery of neurological function in diabetic patients.However,no significant improvement in cognitive function was observed compared with insulin.Metformin has a good safety profile,so it can be used in the treatment of diabetes mellitus with cognitive impairment.