Zou Cai-Yan, Sun Yan, Liang Jun
Medical College, Soochow University, Suzhou, Jiangsu 215123, China; Department of Endocrinology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, China.
Department of Endocrinology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, China.
Clin Res Hepatol Gastroenterol. 2023 Jan;47(1):102053. doi: 10.1016/j.clinre.2022.102053. Epub 2022 Nov 17.
OBJECTIVES: This network meta-analysis (NMA) aimed to evaluate the relative rank-order of existing diabetes medications in patients with nonalcoholic fatty liver disease (NAFLD) with or without type 2 diabetes mellitus (T2DM). METHODS: A systematic literature search was conducted using the Medline, Embase and Cochrane databases. Clinical trials comparing the efficacy of diabetes medications with other interventions, including lifestyle modification and placebo, in patients with NAFLD were included. The results from the NMA are presented as the weighted mean difference (WMD) of the continuous results and the corresponding 95% confidence intervals (95% CIs). RESULTS: The articles presented the results of 49 trials involving 3,836 subjects published between 2013 and 2021. According to our results, thiazolidinedione (TZD) was ranked as the best diabetes medication in the reduction of alanine aminotransferase (ALT) (WMD = -10.10, 95% CI: -15.18, -5.01), followed by dipeptidyl peptidase-4 inhibitor (DPP4i) (WMD = -8.90, 95% CI: -14.41, -3.40). DPP4i also resulted in the greatest reduction in aspartate aminotransferase (AST) (WMD = -6.89, 95% CI: -11.72, -2.07). γ-Glutamyl transferase (γ-GT) reduction was highest in patients treated with glucagon-like peptide 1 receptor agonists (GLP1RAs) (WMD = -15.48, 95% CI: -30.93, -0.02). Ultimately, SGLT2is and GLP1RAs were superior to other diabetes medications or placebo in reducing liver fat fraction (LFF) (WMD = -6.09, 95% CI: -10.50, -1.68; WMD = -5.55, 95% CI: -10.40, -0.69, respectively). CONCLUSION: Diabetes medications, including TZD, DPP4i and GLP1RAs, were found to be suitable alternatives for liver enzyme reduction in the treatment of NAFLD patients. SGLT2is are considered the most effective therapies for lipid modulation in these patients.
目的：本网络荟萃分析（NMA）旨在评估现有糖尿病药物在伴有或不伴有2型糖尿病（T2DM）的非酒精性脂肪性肝病（NAFLD）患者中的相对排名顺序。 方法：使用Medline、Embase和Cochrane数据库进行系统文献检索。纳入比较糖尿病药物与其他干预措施（包括生活方式改变和安慰剂）在NAFLD患者中疗效的临床试验。NMA的结果以连续结果的加权平均差（WMD）和相应的95%置信区间（95%CI）表示。 结果：这些文章呈现了2013年至2021年间发表的49项试验的结果，涉及3836名受试者。根据我们的结果，噻唑烷二酮（TZD）在降低丙氨酸氨基转移酶（ALT）方面被列为最佳糖尿病药物（WMD = -10.10，95%CI：-15.18，-5.01），其次是二肽基肽酶-4抑制剂（DPP4i）（WMD = -8.90，95%CI：-14.41，-3.40）。DPP4i在降低天冬氨酸氨基转移酶（AST）方面也有最大降幅（WMD = -6.89，95%CI：-11.72，-2.07）。在接受胰高血糖素样肽1受体激动剂（GLP1RAs）治疗的患者中，γ-谷氨酰转移酶（γ-GT）降低幅度最大（WMD = -15.48，95%CI：-30.93，-0.02）。最终，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2is）和GLP1RAs在降低肝脏脂肪分数（LFF）方面优于其他糖尿病药物或安慰剂（WMD分别为-6.09，95%CI：-10.50，-1.68；WMD = -5.55，95%CI：-10.40，-0.69）。 结论：发现糖尿病药物，包括TZD、DPP4i和GLP1RAs，是治疗NAFLD患者时降低肝酶的合适替代药物。SGLT2is被认为是这些患者脂质调节最有效的疗法。
Clin Res Hepatol Gastroenterol. 2022-4
Cochrane Database Syst Rev. 2017-12-22
Cochrane Database Syst Rev. 2021-4-19
Cochrane Database Syst Rev. 2020-10-19
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