二甲双胍在年龄相关性黄斑变性中的潜在作用：一项系统评价和荟萃分析
Metformin, A Potential Role in Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis.
作者信息
Romdhoniyyah Dewi Fathin, Harding Simon P, Cheyne Christopher P, Beare Nicholas A V
机构信息
Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L7 8TX, UK.
St. Paul's Eye Unit, Liverpool University Hospitals NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK.
出版信息
Ophthalmol Ther. 2021 Jun;10(2):245-260. doi: 10.1007/s40123-021-00344-3. Epub 2021 Apr 12.
BACKGROUND
Currently, no generally approved medical treatment can delay the onset of age-related macular degeneration (AMD) or slow the progression of degenerative changes. Repurposing drugs with beneficial effects on AMD pathophysiology offers a route to new treatments which is faster, cost-effective, and safer for patients. Recent studies indicate a potential role for metformin in delaying AMD development and progression. In this context, we conducted a systematic review and meta-analysis to look for beneficial associations between metformin and AMD.
METHODS
We systematically searched Medline and Embase (via Ovid), Web of Science, and ClinicalTrials.gov databases for clinical studies in humans that examined the associations between metformin treatment and AMD published from inception to February 2021. We calculated pooled odds ratio (OR) with 95% confidence interval (CI) considering a random effect model in the meta-analysis.
RESULTS
Five retrospective studies met the inclusion criteria. There are no prospective studies that have reported the effect of metformin in AMD. The meta-analysis showed that people taking metformin were less likely to have AMD although statistical significance was not met (pooled adjusted OR = 0.80, 95% CI 0.54-1.05, I = 98.8%). Subgroup analysis of the association between metformin and early and late AMD could not be performed since the data was not available from the included studies.
CONCLUSIONS
Analysis of retrospective data suggests a signal that metformin may be associated with decreased risk of any AMD. It should be interpreted with caution because of the failure to meet statistical significance, the small number of studies, and the limitation of routine record data. However prospective studies are warranted in generalizable populations without diabetes, of varied ethnicities, and AMD stages. Clinical trials are needed to determine if metformin has efficacy in treating early and late-stage AMD.
背景
目前，尚无普遍认可的医学治疗方法能够延缓年龄相关性黄斑变性（AMD）的发病或减缓其退行性病变的进展。重新利用对AMD病理生理学具有有益作用的药物为开发新的治疗方法提供了一条途径，这对患者来说更快、更具成本效益且更安全。最近的研究表明二甲双胍在延缓AMD发展和进展方面可能发挥作用。在此背景下，我们进行了一项系统评价和荟萃分析，以寻找二甲双胍与AMD之间的有益关联。
方法
我们系统检索了Medline和Embase（通过Ovid）、Web of Science以及ClinicalTrials.gov数据库，以查找自数据库建立至2021年2月发表的关于人类临床研究中二甲双胍治疗与AMD之间关联的研究。在荟萃分析中，我们采用随机效应模型计算合并比值比（OR）及95%置信区间（CI）。
结果
五项回顾性研究符合纳入标准。尚无前瞻性研究报道二甲双胍对AMD的影响。荟萃分析表明，服用二甲双胍的人群患AMD的可能性较小，尽管未达到统计学显著性（合并调整后OR = 0.80，95%CI 0.54 - 1.05，I² = 98.8%）。由于纳入研究未提供相关数据，因此无法对二甲双胍与早期和晚期AMD之间的关联进行亚组分析。
结论
对回顾性数据的分析表明有迹象显示二甲双胍可能与降低任何类型AMD的风险相关。由于未达到统计学显著性、研究数量较少以及常规记录数据的局限性，对此应谨慎解读。然而，有必要在无糖尿病、不同种族和不同AMD阶段的可推广人群中开展前瞻性研究。需要进行临床试验以确定二甲双胍在治疗早期和晚期AMD方面是否具有疗效。
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