Jia-Yi Clinic, Taoyuan, Taiwan.
UCLA Stroke Center, Los Angeles, California, USA.
BMJ Open. 2017 Jan 5;7(1):e013927. doi: 10.1136/bmjopen-2016-013927.
To evaluate the effect of pioglitazone in people with insulin resistance, pre-diabetes and type 2 diabetes.
Systematic review and meta-analysis of randomised, controlled trials.
Literature searches were performed across PubMed, EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials from 1966 to May 2016 to identify randomised, controlled trials with more than 1 year follow-up.
Relative risk (RR) with 95% CI was used to evaluate the association between pioglitazone and the risk of major adverse cardiovascular events (MACE: composite of non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and safety outcomes, after pooling data across trials in a fixed-effects model.
Nine trials with 12 026 participants were enrolled in the current meta-analysis. Pioglitazone therapy was associated with a lower risk of MACE in patients with pre-diabetes or insulin resistance (RR 0.77, 95% CI 0.64 to 0.93), and diabetes (RR 0.83, 95% CI 0.72 to 0.97). Risks of heart failure (RR 1.32; CI 1.14 to 1.54), bone fracture (RR 1.52, 95% CI 1.17 to 1.99), oedema (RR, 1.63; CI 1.52 to 1.75) and weight gain (RR 1.60; CI 1.50 to 1.72) increased in pioglitazone group.
Pioglitazone was associated with reduced risk of MACE in people with insulin resistance, pre-diabetes and diabetes mellitus. However, the risks of heart failure, bone fracture, oedema and weight gain were increased.
评估吡格列酮在胰岛素抵抗、糖尿病前期和 2 型糖尿病患者中的作用。
系统评价和随机对照试验的荟萃分析。
从 1966 年到 2016 年 5 月，通过对 PubMed、EMBASE、MEDLINE 和 Cochrane 对照试验中心注册库进行文献检索，以确定随访时间超过 1 年的随机对照试验。
采用相对风险（RR）及其 95%可信区间（CI）评估吡格列酮与主要不良心血管事件（MACE：非致死性心肌梗死、非致死性卒中和心血管死亡的复合终点）风险及安全性结局之间的相关性，在固定效应模型中对各试验数据进行合并。
共有 9 项纳入 12026 例患者的试验纳入本荟萃分析。在糖尿病前期或胰岛素抵抗患者（RR 0.77，95%CI 0.64 至 0.93）和糖尿病患者（RR 0.83，95%CI 0.72 至 0.97）中，吡格列酮治疗与 MACE 风险降低相关。心力衰竭（RR 1.32；95%CI 1.14 至 1.54）、骨折（RR 1.52，95%CI 1.17 至 1.99）、水肿（RR，1.63；95%CI 1.52 至 1.75）和体重增加（RR 1.60；95%CI 1.50 至 1.72）的风险在吡格列酮组增加。
吡格列酮与胰岛素抵抗、糖尿病前期和糖尿病患者的 MACE 风险降低相关。然而，心力衰竭、骨折、水肿和体重增加的风险增加。
