摘要
目的系统评价强化血糖控制对2型糖尿病的疗效及安全性。方法电子检索数据库MEDLINE、EMBASE、Cochrane图书馆、维普数据库、中国期刊全文数据库、中国生物医学文献数据库、万方数据库等,文献检索起至时间均从建库至2009年6月。检索纳入文献的参考文献,纳入强化血糖控制研究2型糖尿病患者大血管或微血管并发症的所有随机对照试验,评价纳入研究方法学质量,并提取有效数据,用RevMan5.0软件进行Meta分析。结果共纳入8个随机对照试验,37004例2型糖尿病患者。Meta分析结果显示:强化血糖控制可使心血管事件发生率降低9%[OR=0.91,95%CI(0.85,0.98),P=0.007];使微血管事件发生率降低26%[OR=0.74,95%CI(0.60,0.91),P=0.005];对周围血管事件,两组结果差异无统计学意义[OR=0.94,95%CI(0.83,1.07),P=0.35]。在所有原因导致的死亡[OR=1.00,95%CI(0.92,1.08),P=0.98]及心血管事件导致的死亡[OR=1.03,95%C(I0.83,1.28),P=0.77]中,两组结果差异均无统计学意义。强化血糖控制能使低血糖事件发生率增加超过1.1倍[OR=2.12,95%CI(1.24,3.60),P=0.006]。结论强化血糖控制较标准治疗能显著降低心血管,及微血管事件发生的危险性,但会增加低血糖事件发生的危险性。在死亡事件方面,两者并无明显差异。
Objectives To systemically review and investigate the efficacy of intensive glucose control in Type 2 diabetes mellitus. Methods Database searches of MEDLINE, EMBASE, Cochrane Controlled Trials Register, VIP Database, CNKI, and CBM disc （from the date of establishment of the databases to June 2009） were conducted. Additional studies were retrieved via references of articles and direct contact with the authors to retrieve relevant data. Prospective, randomized controlled trials of intensive glucose control compared with standard therapy in diabetic patients were selected. We accessed the quality of included trials and extracted the relevant data. Statistical analysis was performed using The Cochrane Collaboration＇s software RevMan 5.0. Results Eight trials with a total of 37 004 participants were included. The Meta-analysis showed： intensive glucose therapy was associated with a significant 9% reduction in the odds of cardiovascular events [OR=0.91, 95%CI （0.85, 0.98）, P=0.007], and a 26% reduction in the microvascular events [OR=0.74, 95%CI （0.60, 0.91）, P=0.005]. For the peripheral vascular events, no statistical difference was found between intensive therapy and standard therapy [OR=0.94, 95%CI （0.83, 1.07）, P=0.35]. No statistical difference could be found in total mortality [OR=I.00, 95%CI （0.92, 1.08）, P=0.98] and cardiovascular mortality [OR=l.03, 95%CI （0.83, 1.28）, P=0.77]. Intensive therapy could increase more than 1.1-fold odds of hypoglycemia compared with standardtherapy [OR=2.12, 95%CI （1.24, 3.60）, P=0.006]. Conclusions Findings from this meta-analysis suggest that intensive glucose control significantly reduces the risk of cardiovascular events and microvascular events, and increases the risk of hypoglycemia, while no prominent difference is found in mortality.
出处
《中国循证医学杂志》
CSCD
2009年第7期774-782,共9页
Chinese Journal of Evidence-based Medicine
关键词
2型糖尿病
强化血糖控制
系统评价
Type 2 diabetes mellitus
Intensive glucose control
Systematic review
