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目的系统评价再评价二肽基肽酶-4(DPP-4)抑制剂和胰高糖素样肽-1(GLP-1)受体激动剂的安全性。方法计算机检索Cochrane Library、Pub Med、中国知网(CNKI)、维普数据库(VIP)、中国生物医学文献数据库(CBM)及万方数据库,并进行手工检索,筛选有关DPP-4抑制剂和GLP-1受体激动剂治疗糖尿病安全性的系统评价,检索时间截至2016年10月。用多系统评价评估问卷(AMSTAR)量表评价文献质量,用Rev Man5.3软件进行Meta分析。结果最终纳入46篇文献,AMSTAR评分均为5分以上。结果显示,DPP-4抑制剂与安慰剂相比,不增加低血糖、胃肠道、鼻咽炎、头痛、感染及心血管不良事件风险;而与其他降糖药相比,低血糖发生率低,同时心血管不良事件发生率低。GLP-1受体激动剂与安慰剂相比,低血糖和胃肠道不良反应发生率高,不增加鼻咽炎、头痛及心血管不良事件风险,不增加体重;而与其他降糖药物相比,低血糖发生率低,胃肠道反应发生率高,同时降低体重。DPP-4抑制剂和GLP-1受体激动剂均不增加胰腺炎风险。结论 DPP-4抑制剂安全性较高,而GLP-1受体激动剂会增加胃肠道不良反应和低血糖风险。
Objective To evaluate the safety of dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. Methods The Cochrane Library, Pub Med, CNKI, VIP, CBM and Wanfang databases were searched by computer. The data of DPP-4 inhibitor and GLP- 1 receptor agonist for the safety of diabetic patients, the search time as of October 2016. The quality of the literature was evaluated using the Multi-Systematic Review Rating Scale (AMSTAR), and Meta-analysis was performed using Rev Man 5.3 software. The results eventually included 46 articles, AMSTAR scores were more than 5 points. The results showed that compared with placebo, DPP-4 inhibitors did not increase the risk of hypoglycemia, gastrointestinal tract, nasopharyngitis, headache, infection and cardiovascular adverse events. Compared with other hypoglycemic agents, the incidence of hypoglycemia was lower , While the incidence of cardiovascular adverse events is low. Compared with placebo, GLP-1 receptor agonists have a high incidence of adverse reactions of hypoglycemia and gastrointestinal tract without increasing the risk of nasopharyngitis, headache and cardiovascular events without increasing body weight. Compared with other hypoglycemic agents , Low incidence of hypoglycemia, high incidence of gastrointestinal reactions, while reducing body weight. Neither DPP-4 inhibitor nor GLP-1 receptor agonist increased the risk of pancreatitis. Conclusions DPP-4 inhibitors are safe, whereas GLP-1 receptor agonists increase the risk of gastrointestinal adverse reactions and hypoglycaemia.