二甲双胍治疗非酒精性脂肪性肝病合并2型糖尿病的系统评价

目的:系统评价二甲双胍治疗非酒精性脂肪性肝病合并2型糖尿病的风险和效益,对二甲双胍干预非酒精性脂肪性肝病合并2型糖尿病的有效性和安全性提供循证证据。方法:采用Cochrane系统评价方法,检索筛选对二甲双胍治疗非酒精性脂肪性肝病合并2型糖尿病的随机对照试验二甲双胍组干预措施为使用二甲双胍治疗,伴或不伴生活方式干预;对照组干预措施为使用安慰剂或空白对照(未用药组)或其他药物治疗(其他药物组),伴或不伴生活方式干预;给药方式、剂量及疗程不限],提取资料并进行方法学质量评价后,采用RevMan 5.2软件进行荟萃分析(Meta分析)。结果:共纳入15篇文献,涉及1306例患者,纳入研究质量参差不齐,未对药物干预后的远期总体病死率、肝移植需求情况及肝细胞癌发生率等进行研究和报告。Meta分析结果显示,治疗后,二甲双胍患者的体重指数明显低于未用药组,差异有统计学意义(MD=-2.07,95%CI=-2.54^-1.60,P<0.001);安全性方面,二甲双胍组患者不良反应发生率明显高于未用药组(OR=14.09,95%CI=3.27~60.72,P<0.001)、其他药物组(OR=3.64,95%CI=1.54~8.61,P<0.001),差异均有统计学意义,但用药期间无严重不良反应发生,多数不良反应患者可以耐受。结论:尚不能确定二甲双胍是否能延缓非酒精性脂肪性肝病合并2型糖尿病患者的疾病进展,其在降低体重指数方面的效果可能对患者有益。

Systematic Review on Metformin in Treatment of Non-Alcoholic Fatty Liver Disease Complicated with Type 2 Diabetes

OBJECTIVE:To systematically review the risks and benefits of metformin in treatment of non-alcoholic fatty liver disease(NAFLD)complicated with type 2 diabetes,so as to provide evidence-based evidence for the effectiveness and safety of metformin in treatment of NAFLD complicated with type 2 diabetes.METHODS:Cochrane systematic review was adopted to retrieve and screen the randomized controlled trialsthe intervening measure of metformin group was given metformin for treatment,with or without lifestyle intervention;the intervening measure of control intervention group was given placebo or blank control(untreated group)or other drugs(other drug group),with or without lifestyle intervention;the administration route,dosage and treatment course were not limited]for metformin in treatment of NAFLD complicated with type 2 diabetes.RevMan 5.2 was adopted to conduct Meta analysis after data extraction and methodological quality evaluation.RESULTS:A total of 15 studies were involved,including 1306 patients;the quality of involved studies was uneven,the long-term overall mortality rate,the need for liver trans-plantation and the incidence of hepatocellular carcinoma after drug intervention were not studied and reported.Results of Meta analysis indicated the BMI of metformin group was significantly lower than that of the untreated group,with statistically significant difference(MD=-2.07,95%CI=-2.54--1.60,P<0.001);as for the safety,the incidence of adverse drug reactions of metformin group was significantly higher than that of the untreated group(OR=14.09,95%CI=3.27-60.72,P<0.001)and other drug group(OR=3.64,95%CI=1.54-8.61,P<0.001),with statistically significant differences.However,no severe adverse drug reactions occurred during the treatment,and most of adverse drug reactions were tolerable for patients.CONCLUSIONS:It remains uncertain whether metformin can delay the progression of NAFLD complicated with type 2 diabetes,while its effect in reducing body mass index may be beneficial to patients.