Wingate University School of Pharmacy, Wingate, NC, USA.
Ann Pharmacother. 2013 Oct;47(10):1348-52. doi: 10.1177/1060028013503108.
To evaluate the safety and efficacy of metformin in patients with type 2 diabetes mellitus (T2DM) and chronic hepatitis C virus (HCV) with or without cirrhosis and hepatocellular carcinoma (HCC).
A PubMed (1946-August 2013) search using the keywords type 2 diabetes mellitus, metformin, hepatitis C virus, cirrhosis, and hepatocellular carcinoma was conducted. The references in published articles were reviewed to identify additional references for inclusion.
Studies written in English, evaluating metformin use in human patients with T2DM and chronic HCV were included.
Eight studies met criteria for inclusion. Two prospective, randomized controlled trials showed increased benefit with metformin on virological response in patients with insulin resistance receiving HCV treatment. A prospective observational study evaluated metformin exclusively in patients with T2DM and HCV and showed significant reductions in the occurrence of HCC, liver-related death, and liver transplant. Four retrospective case control studies showed a decreased risk of HCC with metformin treatment in patients with T2DM and chronic liver disease. Finally, a retrospective cohort study indicated an increased survival rate in patients with diabetes and HCC undergoing radiofrequency ablation. Although diarrhea was increased in patients receiving metformin, no serious adverse effects, including lactic acidosis, were reported.
Metformin may provide benefit in the treatment of HCV and in reducing the risk of HCC in patients with T2DM and HCV. Further long-term, randomized controlled trials are needed to adequately assess the safety and efficacy of metformin therapy in patients with comorbid diabetes and chronic HCV.
评估二甲双胍在伴有或不伴有肝硬化和肝细胞癌（HCC）的 2 型糖尿病（T2DM）和慢性丙型肝炎病毒（HCV）患者中的安全性和疗效。
使用“2 型糖尿病、二甲双胍、丙型肝炎病毒、肝硬化和肝细胞癌”等关键词，对 PubMed（1946 年-2013 年 8 月）进行检索。查阅已发表文章中的参考文献，以确定纳入的其他参考文献。
纳入评估 T2DM 患者和慢性 HCV 使用二甲双胍的英文文献。
有 8 项研究符合纳入标准。两项前瞻性、随机对照试验显示，在接受 HCV 治疗的伴有胰岛素抵抗的患者中，二甲双胍可提高病毒学应答的获益。一项前瞻性观察性研究专门评估了二甲双胍在 T2DM 和 HCV 患者中的应用，结果显示 HCC、肝相关死亡和肝移植的发生率显著降低。四项回顾性病例对照研究显示，二甲双胍治疗可降低 T2DM 伴慢性肝病患者 HCC 的风险。最后，一项回顾性队列研究表明，接受射频消融术的糖尿病合并 HCC 患者的生存率增加。虽然接受二甲双胍治疗的患者腹泻增加，但未报告严重不良反应，包括乳酸酸中毒。
二甲双胍可能对 HCV 治疗有益，并降低 T2DM 和 HCV 患者 HCC 的风险。需要进一步进行长期、随机对照试验，以充分评估合并糖尿病和慢性 HCV 的患者使用二甲双胍治疗的安全性和疗效。
