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胰高血糖素样肽1受体激动剂类降糖药致2型糖尿病患者头疼和眩晕的网状Meta分析

Impact of Glucagon like Peptide 1 Receptor Agonists on Headache and Dizziness among Type 2 Diabetes: A Network Meta analysis

DOI：

中文关键词: 胰高血糖素样肽1受体激动剂 2型糖尿病头疼眩晕网状Meta分析

英文关键词:Glucagon like peptide 1 receptor agonists Type 2 diabetes mellitus Headache Dizziness Network Meta analysis

基金项目:国家自然科学基金项目（编号：71673003）

作者	单位
高乐¹ 李志霞¹ 杨俊¹ 武珊珊² 王巍巍³ 杨智荣⁴ 詹思延¹ 孙凤¹	1.北京大学公共卫生学院流行病与卫生统计学系,北京 100191； 2.首都医科大学附属北京友谊医院国家消化系统疾病临床研究中心； 3.首都医科大学附属北京安定医院国家精神心理疾病临床医学研究中心；4.剑桥大学初级医疗中心

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中文摘要:

摘要目的：使用网状Meta分析系统评价胰高血糖素样肽1受体激动剂（GLP-1 RAs）类降糖药对2型糖尿病（T2DM）患者头疼和眩晕的影响。方法：系统检索Medline、Embase、Clinical trials和Cochrane数据库中（截止2017年6月23日）比较GLP-1 RAs与传统降糖药或安慰剂对头疼和眩晕发生风险影响的随机对照试验（RCT），采用贝叶斯网状Meta分析对纳入的研究进行分析。结果：共纳入100项RCTs，包括15种干预措施：8种GLP-1 RAs类降糖药（艾塞那肽、艾塞那肽缓释剂、利拉鲁肽、利西拉来、他司鲁肽、阿必鲁肽、杜拉鲁肽、索玛鲁肽）、安慰剂、2种二肽基肽酶-4（DPP-4）抑制剂（西格列汀和维格列汀）和4种传统降糖药（胰岛素、二甲双胍、磺脲类、噻唑烷二酮类）。网状Meta分析结果显示：与胰岛素相比，艾塞那肽（OR=1.35，95%CI：1.13~1.60）、利拉鲁肽（OR=1.35，95%CI：1.12~1.62）、利西拉来（OR=1.59，95%CI：1.22~2.06）和他司鲁肽（OR=1.78，95%CI：1.33~2.37）致T2DM患者发生头疼的风险增加；与安慰剂、胰岛素及噻唑烷二酮相比，艾塞那肽和利拉鲁肽显著增加了眩晕发生的风险（OR的取值范围为1.56~2.56）。此外，后验概率显示，致T2DM患者发生头疼风险最高的前三位为艾塞那肽缓释剂、二甲双胍、他司鲁肽；致T2DM患者发生眩晕风险最高的前三位为利拉鲁肽、利西拉来和艾塞那肽。结论：艾塞那肽缓释剂和他司鲁肽显著增加了头疼的发生风险，利拉鲁肽显著增加了眩晕的发生风险，但仍建议开展相应的大型前瞻性研究加以验证。

英文摘要:

ABSTRACT Objective:To systematically review the effects of Glucagon like peptide 1 receptor agonists (GLP-1 RAs) on headache and dizziness among type 2 diabetes (T2DM) patients. Methods:Medline, Embase, Clinical trials and Cochrane library were searched from inception through June 23, 2017 to identify randomized clinical trials (RCTs) assessing safety of GLP-1 RAs versus placebo or other anti diabetic drugs in T2DM. Network Meta analysis within a Bayesian framework was performed to calculate odds ratios for the incidence of headache and dizziness.Results:In the study, 100 RCTs were included, including 15 treatments: 8 GLP-1 RAs ( exenatide, exenatide long release agent, liraglutide, lixisenatide, taspoglutide, albiglutide, dulaglutide and semaglutide), placebo, 2 dipeptidyl peptidase 4 inhibitors (sitagliptin and vildagliptin) and 4 traditional anti diabetic drugs (insulin, metformin, sulfonylureas and thiazolidinediones ketones (TZD)). Compared with insulin, exenatide, liraglutide, lixisenatide and taspoglutide significantly increased the incidence of headache, with OR of 1.35 (95%CI: 1.13 1.60), 1.35(95%CI: 1.12 1.62), 1.59 (95%CI: 1.22 2.06) and 1.78(95%CI: 1.33 2.37), respectively. Significant lowering effects on dizziness were found when liraglutide and exenatide versus placebo, insulin, TZD (range of ORs: 1.56 2.56). The result from the network Meta analysis based on Bayesian theory could be used to rank all the treatments included, which showed that taspoglutide ranked third with maximum risk on headache, liraglutide ranked first with maximum risk on dizziness.Conclusion:Exenatide long release agent and taspoglutide were associated with significantly increasing effect on headache, liraglutide was associated with significantly increasing effect on dizziness.

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