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目的系统评价坎格列净(canagliflozin)在二联或三联用药中治疗2型糖尿病的疗效和安全性。方法计算机检索Pub Med、Embase、Medline、Cochrane图书馆、CNKI、万方、维普、CBM共8个数据库,按Cochrane系统评价的方法评价纳入研究质量,并使用Rev Man5.2软件进行Meta分析。结果纳入符合标准的随机对照试验4个,共计患者3 961例。Meta分析结果显示,在二联或三联用药中,坎格列净降糖化血红蛋白疗效与西格列汀和格列美脲相当[MD=-0.15,95%CI(-0.30,-0.00),P=0.05;MD=-0.06,95%CI(-0.14,0.01),P=0.1],降体重作用优于西格列汀和格列美脲[MD=-2.67,95%CI(-2.96,-2.38),P<0.000 01;MD=-5.15,95%CI(-5.54,-4.76),P<0.000 01]。安全性方面,坎格列净引起低血糖事件的风险和西格列汀相当[RR=1.34,95%CI(0.94,1.92),P=0.11],与格列美脲相比风险更低[RR=0.16,95%CI(-0.12,-0.21),P<0.000 01]。结论在二联或三联用药中,坎格列净降低患者糖化血红蛋白的疗效与西格列汀和格列美脲相当,但可显著降低患者体重,发生低血糖事件的风险与西格列汀相当,而低于格列美脲。
Objective To evaluate the efficacy and safety of canagliflozin in the treatment of type 2 diabetes in two or three doses. Methods A total of 8 databases including PubMed, Embase, Medline, Cochrane Library, CNKI, Wanfang, Vipu and CBM were searched by computer. The quality of the included studies was assessed by Cochrane systematic review and Meta-analysis was performed using Rev Man5.2 software. Results A total of 4 961 randomized controlled trials were included. Meta-analysis showed that the efficacy of glyburide hydrochloride HbA1c was comparable to that of sitagliptin and glimepiride (MD = -0.15, 95% CI (-0.30, -0.00), P = 0.05; MD = -0.06,95% CI (-0.14,0.01), P = 0.1], and the effect of lowering body weight was better than that of sitagliptin and glimepiride [MD = -2.67,95% CI , -2.38), P <0.000 01; MD = -5.15, 95% CI (-5.54, -4.76), P <0.000 01]. In terms of safety, the risk of developing hypoglycaemic events with canagliflozin was comparable to that of sitagliptin [RR = 1.34, 95% CI (0.94, 1.92), P = 0.11] and lower risk than glimepiride [ RR = 0.16, 95% CI (-0.12, -0.21), P <0.000 01]. Conclusions In the dual or triple therapy, the effect of canagliflozin on reducing HbA1c in patients is comparable to that of sitagliptin and glimepiride but significantly reduces the patient’s body weight with a comparable risk of developing hypoglycaemia compared with sitagliptin , While lower than glimepiride.