摘要
目的观察比较从脾论治法方药联合胰高血糖素样肽-1受体激动剂(Glucagon-like peptide-1 receptor agonists,GLP-1 RA)和单独使用GLP-1 RA对2型糖尿病(Type 2 diabetes mellitus,T2DM)人群的有效性和安全性差异。方法检索中国期刊全文数据库(CNKI)、万方数据库(WanFang Data)、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、PubMed、Cochrane Library、Web of Science 7个数据库中,比较从脾论治法联合GLP-1 RA(观察组)与GLP-1 RA(对照组)治疗T2DM的随机对照试验(Randomized controlled trial,RCT),完成文献筛查、资料提取与质量评价;对主要结局指标胰岛素抵抗指数(Homeostatic model assessment of insulin resistance,HOMA-IR)、胰岛β细胞功能指数(Homeostasis model assessment ofβ-cell function,HOMA-β)等,通过STATA 17.0软件完成计算与制图。结果最终纳入17项RCT,包含1370例研究对象,Meta分析结果显示:观察组HOMA-IR水平较对照组更低[MD=-1.64,95%CI(-2.22,-1.05),P<0.05],HOMA-β水平较对照组更高[MD=1.88,95%CI(1.36,2.39),P<0.05],观察组的空腹血糖[MD=-1.30,95%CI(-1.79,-0.81),P<0.05]、餐后血糖[MD=-1.05,95%CI(-1.52,-0.59),P<0.05]、糖化血红蛋白[MD=-1.07,95%CI(-1.49,-0.66),P<0.05]、体质指数[MD=-0.79,95%CI(-1.31,-0.27),P<0.05]水平更低,临床有效率[RR=1.20,95%CI(1.08,1.34),P<0.05]更高,观察组胃肠道反应发生率均低于对照组(P<0.05),头晕、乏力与低血糖发生率无显著差异。结论从脾论治法联合GLP-1 RA能明显改善胰岛素抵抗,增强胰岛β细胞功能,促进调节血糖代谢,发挥减重效应,降低胃肠道反应发生的风险。
Objective To compare the efficacy and safety of integrating spleen-based treatment with glucagon-like peptide-1 receptor agonists(GLP-1 RA)and using GLP-1 RA alone in the treatment of type 2 diabetes mellitus(T2DM).Methods A systematic search was conducted in seven databases,including China National Knowledge Infrastructure(CNKI),WanFang Data Resource System,China Biological Medicine(CBM),VIP Information Chinese Science and Technology Journal Database,PubMed,Cochrane Library,and Web of Science,so as to identify randomized controlled trials(RCTs)comparing the spleen-based approach combined with GLP-1 RA(observation group)and GLP-1 RA alone(control group)in treating T2DM.Literature screening,data extraction,and quality evaluation were performed.The main outcome measures,including homeostatic model assessment of insulin resistance(HOMA-IR)and homeostasis model assessment ofβ-cell function(HOMA-β),were calculated and visualized using STATA 17.0 software.Results A total of 17 RCTs involving 1370 subjects were included.Meta-analysis showed that the observation group has lower HOMA-IR levels[MD=-1.64,95%CI(-2.22,-1.05),P<0.05]and higher HOMA-βlevels compared to the control group[MD=1.88,95%CI(1.36,2.39),P<0.05].The fasting blood glucose[MD=-1.30,95%CI(-1.79,-0.81),P<0.05],postprandial blood glucose[MD=-1.05,95%CI(-1.52,-0.59),P<0.05],glycated hemoglobin[MD=-1.07,95%CI(-1.49,-0.66),P<0.05],and body mass index[MD=-0.79,95%CI(-1.31,-0.27),P<0.05]levels were significantly lower in the observation group,while the clinical ffective rate was significantly higher[RR=1.20,95%CI(1.08,1.34),P<0.05].The incidence of gastrointestinal reactions in the observation group was lower than that in the control group(P<0.05),while no significant differences were observed in the incidence of fatigue,dizziness,or hypoglycemia.Conclusion Integrating spleen-based treatment with GLP-1 RA can significantly improve insulin resistance,enhanceβ-cell function,regulate glucose metabolism,promote weight loss,and reduce the risk of gastrointestinal reactions.
作者
邬倩颖
刘婧
吴恩行
苏冠旬
刘晓玉
杨瑞耕
尚冬梅
王世东
WU Qian-ying;LIU Jing;WU En-hang;SU Guan-xun;LIU Xiao-yu;YANG Rui-geng;SHANG Dong-mei;WANG Shi-dong(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700)
出处
《世界中西医结合杂志》
2025年第2期251-259,共9页
World Journal of Integrated Traditional and Western Medicine
基金
中央高水平中医医院临床科研业务费资助——北京中医药大学东直门医院领军人才培养项目(DZMG-LCRC0005)
国家重点研发计划(2018YFC1704402)
北京市科技计划-G20工程创新研究项目(Z171100001717023)。
作者简介
通信作者:王世东,Email:wsd3122@126.com。
