吡格列酮治疗对血液参数、体重和体重指数的影响：一项荟萃分析。
Effects of pioglitazone therapy on blood parameters, weight and BMI: a meta-analysis.
作者信息
Filipova Elena, Uzunova Katya, Kalinov Krassimir, Vekov Toni
机构信息
Science Department, Tchaikapharma High Quality Medicines Inc., 1 G.M. Dimitrov Blvd, 1172 Sofia, Bulgaria.
Department of Informatics, New Bulgarian University, 21 Montevideo Str, 1618 Sofia, Bulgaria.
出版信息
Diabetol Metab Syndr. 2017 Nov 14;9:90. doi: 10.1186/s13098-017-0290-5. eCollection 2017.
BACKGROUND
Type 2 diabetes mellitus (T2DM) is one of the most common diseases worldwide and insulin insufficiency and insulin resistance are two main metabolic issues connected with it. The dyslipidemia associated with insulin resistance and T2DM is characterized by higher triglycerides (TGs), higher very-low-density lipoprotein cholesterol and lower apo A1. Pioglitazone, a member of the thiazolidinedione class, with a proven antihyperglycemic effect, is known to positively influence insulin sensitivity and β-cell function and to have the potential to alter the lipid profile.
METHODS
The aim of our meta-analysis is to summarize and determine the influence of pioglitazone on the glycemic profile and lipoprotein metabolism as well as on weight and BMI in order to highlight the benefit of pioglitazone therapy in patients with T2DM. A comprehensive literature search was conducted through the electronic databases PubMed, MEDLINE, Scopus, PsyInfo, eLIBRARY.ru (from 2000 until February 2016) to identify studies that investigate the effect of pioglitazone on the glycemic and lipid profile and on the weight and BMI. We chose the random-effects method as the primary analysis. Forest plots depict estimated results from the studies included in the analysis and funnel plots are used to evaluate publication bias. Sensitivity analyses were performed in order to evaluate the degree of influence of the consequent elimination of each individual study on the final result.
RESULTS
Of the 1536 identified sources only 15 randomised trials were included in the meta-analysis. Pioglitazone treatment was associated with improvement in the glycemic profile. It reduced FPG levels by a mean of 1.1-2 mmol/l and HbA1c by a mean of 0.9-1.3%. Our results reaffirmed the hypothesis that pioglitazone has a positive influence on the lipid profile of T2DM patients with increase in TC and HDL, no significant changes in LDL and notable decrease in TGs. Results also showed that pioglitazone therapy led to increase in both weight and BMI (WMD 1.755, 95% CI 0.674 to 2.837 and 1.145, 95% CI 0.389 to 1.901 respectively).
CONCLUSION
Our results prove that the PPAR γ agonist pioglitazone has the potential to be beneficial to patients with T2DM.
背景
2型糖尿病（T2DM）是全球最常见的疾病之一，胰岛素分泌不足和胰岛素抵抗是与之相关的两个主要代谢问题。与胰岛素抵抗和T2DM相关的血脂异常表现为甘油三酯（TG）升高、极低密度脂蛋白胆固醇升高和载脂蛋白A1降低。吡格列酮是噻唑烷二酮类药物的一种，具有已证实的降糖作用，已知可对胰岛素敏感性和β细胞功能产生积极影响，并有可能改变血脂谱。
方法
我们的荟萃分析旨在总结并确定吡格列酮对血糖谱、脂蛋白代谢以及体重和体重指数的影响，以突出吡格列酮治疗对T2DM患者的益处。通过电子数据库PubMed、MEDLINE、Scopus、PsyInfo、eLIBRARY.ru（从2000年至2016年2月）进行全面的文献检索，以识别研究吡格列酮对血糖和血脂谱以及体重和体重指数影响的研究。我们选择随机效应方法作为主要分析方法。森林图描绘了分析中纳入研究的估计结果，漏斗图用于评估发表偏倚。进行敏感性分析以评估逐个排除每项研究对最终结果的影响程度。
结果
在1536个识别出的来源中，只有15项随机试验纳入了荟萃分析。吡格列酮治疗与血糖谱改善相关。它使空腹血糖（FPG）水平平均降低1.1 - 2 mmol/L，糖化血红蛋白（HbA1c）平均降低0.9 - 1.3%。我们的结果再次证实了这一假设，即吡格列酮对T2DM患者的血脂谱有积极影响，总胆固醇（TC）和高密度脂蛋白（HDL）升高，低密度脂蛋白（LDL）无显著变化，TG显著降低。结果还表明，吡格列酮治疗导致体重和体重指数均增加（加权均数差分别为1.755，95%置信区间为0.674至2.837；以及1.145，95%置信区间为0.389至1.901）。
结论
我们的结果证明，过氧化物酶体增殖物激活受体γ（PPARγ）激动剂吡格列酮有可能对T2DM患者有益。
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