中西医结合治疗2型糖尿病合并非酒精性脂肪肝病疗效Meta分析

Integrated Traditional Chinese and Western Medicine for Type 2 Diabetes Mellitus with Nonalcoholic Fatty Liver Disease: Meta-Analysis

目的:系统评价中西医结合治疗2型糖尿病合并非酒精性脂肪性肝病(NAFLD)的临床疗效。方法:对PubMed、Cochrane Library、Web of science、知网、维普、万方数据库进行检索,筛选出相关的随机对照试验,用RevMan5.4软件进行Meta分析。结局指标包括丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、空腹血糖(FBG)、餐后2小时血糖(2hPG)、稳态模型评估胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)。结果:涉及2494名患者的35个随机对照试验被纳入meta分析。meta分析表明,中西医结合治疗2型糖尿病合并非酒精性脂肪肝病的干预措施对结局指标有显著影响。ALT加权均数差((WMD) = −6.30,95%置信区间(confidence interval, CI) [−7.51, −5.09],p < 0.00001)、AST (WMD = −5.26, 95% CI [−6.21, −4.32], p < 0.00001)、FBG (WMD = −0.68, 95% CI [−0.83, −0.53], p < 0.00001)、2hPG (WMD = −1.16, 95% CI [−1.44, −0.88], p < 0.00001)、HOMA-IR (WMD = −0.99, 95% CI [−1.25, −0.74], p < 0.00001)、TG (WMD = −0.56, 95% CI [−0.69, −0.43], p < 0.00001)、TC (WMD = −0.65, 95% CI [−0.84, −0.46], p < 0.00001)、LDL-C (WMD = −0.44, 95% CI [−0.56, −0.32], p < 0.00001)、HDL-C (WMD = 0.19, 95% CI [0.09, 0.29], p < 0.00001)。结论:当前证据显示,中药联合西药对T2DM合并NAFLD患者在改善糖脂代谢、肝功能和胰岛素抵抗方面更有利。

Objective: To systematically evaluate the clinical efficacy of integrated traditional Chinese and western medicine in the treatment of type 2 diabetes with nonalcoholic fatty liver disease. Method: Search PubMed, Cochrane Library, Web of Science, CNKI, VIP, and Wanfang databases to select rel-evant randomized controlled trials and perform meta-analysis using RevMan5.4 software. The out-come measures include alanine aminotransferase (ALT), aspartate aminotransferase (AST), fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG), homeostasis model evaluated insu-lin resistance index (HOMA-IR), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Result: 35 randomized con-trolled trials involving 2494 patients were included in the meta-analysis. Meta analysis showed that the intervention measures of integrated traditional Chinese and western medicine in the treatment of type 2 diabetes with non-alcoholic fatty liver disease had a significant impact on the outcome in-dicators. ALT (Weighted Mean Difference (WMD) = −6.30, 95% confidence interval (CI) [−7.51, −5.09], p < 0.00001), AST (WMD = −5.26, 95% CI [−6.21, −4.32], p < 0.00001), FBG (WMD = −0.68, 95% CI [−0.83, −0.53], p < 0.00001), 2hPG (WMD = −1.16, 95% CI [−1.44, −0.88], p < 0.00001), HOMA-IR (WMD = −0.99, 95% CI [−1.25, −0.74]), p < 0.00001), TG (WMD = −0.56, 95% CI [−0.69, −0.43], p < 0.00001), TC (WMD = −0.65, 95% CI [−0.84, −0.46], p < 0.00001), LDL-C (WMD = −0.44, 95% CI [−0.56, −0.32], p < 0.00001), HDL-C (WMD = 0.19, 95% CI [0.09, 0.29], p < 0.00001). Conclu-sion: Current evidence shows that the combination of traditional Chinese medicine and Western medicine is more beneficial in improving glucose and lipid metabolism, liver function, and insulin resistance in patients with T2DM complicated with NAFLD.