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二肽基肽酶-4抑制剂治疗2型糖尿病患者增加胆囊炎风险
作者:小柯机器人 发布时间:2022/6/30 19:45:47

中国医学科学院、北京协和医学院张化冰团队研究了二肽基肽酶-4抑制剂与2型糖尿病胆囊或胆道疾病的相关性。这一研究成果于2022年6月28日发表在《英国医学杂志》上。

为了探讨二肽基肽酶-4抑制剂与胆囊或胆道疾病之间的相关性,研究组在PubMed、EMBASE、科学引文索引和CENTRAL等大型数据库中检索从成立到2021年7月31日的相关文献,筛选出与安慰剂或其他抗糖尿病药物相比,接受二肽基肽酶-4抑制剂、胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运蛋白-2抑制剂的成年2型糖尿病患者的随机对照试验,进行系统回顾和配对及网络荟萃分析。

主要观察指标为胆囊或胆道疾病、胆囊炎、胆石症和胆道疾病的综合结局。由两名评审员独立提取数据并评估研究质量。使用建议分级、评估、发展和评价框架(GRADE)方法来评估每个结局的证据质量。荟萃分析使用合并优势比和95%置信区间。

共有82项随机对照试验,104833名参与者被纳入配对荟萃分析。与安慰剂或非肠促胰岛素药物相比,二肽基肽酶-4抑制剂与胆囊或胆道疾病(优势比为1.22)和胆囊炎(优势比为1.43)的综合风险增加显著相关,但未增加胆石症和胆道疾病的风险。

二肽基肽酶-4抑制剂治疗时间较长的患者往往会观察到这种相关性。在184项试验的网络荟萃分析中,二肽基肽酶-4抑制剂与钠-葡萄糖共转运蛋白-2抑制剂相比,增加了胆囊或胆道疾病和胆囊炎的综合风险,但与胰高血糖素样肽-1受体激动剂相比风险未增加。

研究结果表明,在随机对照试验中,二肽基肽酶-4抑制剂增加了胆囊炎的风险,尤其是在治疗时间较长的情况下,这需要医生在临床实践中给予更多的关注。

附:英文原文

Title: Dipeptidyl peptidase-4 inhibitors and gallbladder or biliary disease in type 2 diabetes: systematic review and pairwise and network meta-analysis of randomised controlled trials

Author: Liyun He, Jialu Wang, Fan Ping, Na Yang, Jingyue Huang, Wei Li, Lingling Xu, Huabing Zhang, Yuxiu Li

Issue&Volume: 2022/06/28

Abstract:

Objective To examine the association between dipeptidyl peptidase-4 inhibitors and gallbladder or biliary diseases.

Design Systematic review and pairwise and network meta-analysis.

Data sources PubMed, EMBASE, Web of Science, and CENTRAL from inception until 31 July 2021.

Eligibility criteria Randomised controlled trials of adult patients with type 2 diabetes who received dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter-2 inhibitors compared with placebo or other antidiabetes drugs.

Main outcome measures Composite of gallbladder or biliary diseases, cholecystitis, cholelithiasis, and biliary diseases.

Data extraction and data synthesis Two reviewers independently extracted the data and assessed the quality of the studies. The quality of the evidence for each outcome was assessed using the Grading of Recommendations, Assessment, Development and Evaluations framework (GRADE) approach. The meta-analysis used pooled odds ratios and 95% confidence intervals.

Results A total of 82 randomised controlled trials with 104833 participants were included in the pairwise meta-analysis. Compared with placebo or non-incretin drugs, dipeptidyl peptidase-4 inhibitors were significantly associated with an increased risk of the composite of gallbladder or biliary diseases (odds ratio 1.22 (95%confidence interval 1.04 to 1.43); risk difference 11 (2 to 21) more events per 10000 person years) and cholecystitis (odds ratio 1.43 (1.14 to 1.79); risk difference 15 (5 to 27) more events per 10000 person years) but not with the risk of cholelithiasis and biliary diseases. The associations tended to be observed in patients with a longer duration of dipeptidyl peptidase-4 inhibitor treatment. In the network meta-analysis of 184 trials, dipeptidyl peptidase-4 inhibitors increased the risk of the composite of gallbladder or biliary diseases and cholecystitis compared with sodium-glucose cotransporter-2 inhibitors but not compared with glucagon-like peptide-1 receptor agonists.

Conclusions Dipeptidyl peptidase-4 inhibitors increased the risk of cholecystitis in randomised controlled trials, especially with a longer treatment duration, which requires more attention from physicians in clinical practice.

DOI: 10.1136/bmj-2021-068882

Source: https://www.bmj.com/content/377/bmj-2021-068882

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj