中国骨质疏松杂志

GLP-1受体激动剂对2型糖尿病患者骨折风险影响的Meta分析

A meta-analysis of GLP-1 receptor agonists for the fracture risk in patients with type 2 diabetes mellitus

DOI：10.3969/j.issn.1006.7108.2018.07.002

英文关键词:GLP-1 receptor agonists Type 2 diabetes mellitus Fractures Meta-analysis

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作者	单位
张岩松1 王可可1,2 刘力嘉3 赵春阳1,2 姜明燕1,2*	1. 中国医科大学附属第一医院药学部,辽宁沈阳 110001 2. 中国医科大学药学院,辽宁沈阳 110122 3. 沈阳药科大学,辽宁沈阳 110016

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中文摘要:

目的系统评价GLP-1受体激动剂（GLP-1RAs）对2型糖尿病患者骨折风险的影响。方法系统检索PubMed、Medline、Embase、Cochrane 图书馆、Web of science、CNKI及万方数据库。根据纳入排除标准筛选使用GLP-1RAs治疗2型糖尿病的随机对照试验（RCT）。利用RevMan 5.0 及 Stata 12.0 软件进行分析。结果最终纳入符合标准的RCT36篇，Meta分析结果显示：利拉鲁肽治疗2型糖尿病患者骨折风险低于对照组，差异有统计学意义 [OR = 0.47，95% CI（0.24，0.91），P = 0.024]，而与对照组相比，GLP-1 RAs [OR = 0.94，95% CI（0.64，1.37），P = 0.735]、艾塞那肽 [OR = 1.81，95% CI（0.83，3.95），P = 0.139]、度拉鲁肽 [OR = 1.21，95% CI（0.57，2.58），P = 0.616]、利西那肽 [OR = 1.27，95% CI（0.50，3.24），P = 0.617]及阿必鲁肽 [OR = 0.70，95% CI（0.25，2.20），P = 0.515]，在骨折风险方面差异均无统计学意义。与对照组相比，GLP-1 RAs治疗对2型糖尿病患者骨折骨密度 [OR = 0.16，95% CI（–0.10，0.42），P = 0.223]及血清钙 [SMD = 0.17，95% CI（–0.20，0.55），P = 0.358]水平差异均无统计学意义。结论应用利拉鲁肽治疗2型糖尿病可降低患者骨折发生风险，而艾塞那肽等其他GLP-1 RAs及GLP-1 RAs总体骨折风险程度与对照组相似，且GLP-1 RAs对2型糖尿病患者骨密度及血清钙作用与对照组程度相似。

英文摘要:

Objective To evaluate the effect of GLP-1 receptor agonists on the fracture risk in patients with type 2 diabetes mellitus. Methods PUBMED, MEDLINE, the Cochrane Library, EMBASE, Web of Science, CNKI, and Wanfang data base were searched. The randomized controlled trials (RCT) of GLP-1 receptor agonists for the treatment of type 2 diabetes mellitus were collected according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.0 software and Stata 12.0 software. Results Thirty-six RCTs were included. The results of meta-analysis showed that the incidence of fracture in liraglutide group was significantly lower than that in the control group, and the difference was statistically significant (OR = 0.47, 95% CI 0.24, 0.91, P = 0.024). No significant difference was shown in the incidence of fracture between control group and GLP-1 receptor agonists group (OR = 0.94, 95% CI 0.64, 1.37, P = 0.735), exenatide (OR = 1.81, 95% CI 0.83, 3.95, P = 0.139), dulaglutide (OR = 1.21, 95% CI 0.57, 2.58, P = 0.616), lixisenatide (OR = 1.27, 95% CI 0.50, 3.24, P = 0.617), and albiglutide (OR = 0.70, 95% CI 0.25, 2.20, P = 0.515), respectively. In the aspects of the risk factors of fracture, bone mineral density and serum calcium, there were no significant differences between GLP-1 receptor agonists group and the control groups (OR = 0.16, 95% CI -0.10, 0.42, P = 0.223 and SMD = 0.17, 95% CI -0.20, 0.55, P = 0.358, respectively). Conclusion The use of liraglutide reduces fracture risk in patients with type 2 diabetes mellitus. However, the use of other antidiabetic drugs or other GLP-1 receptor agonists has similar fracture risk compared with the control group. In addition, the effect of GLP-1 receptor agonists on bone mineral density and serum calcium is similar to that of the control group.

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