摘要目的 对沙格列汀(SAXA)与磺脲类(SUs)联合二甲双胍(MET)治疗2型糖尿病的有效性、安全性和经济性进行系统分析,为临床决策和药品招标采购提供询证参考.方法 通过CNKI、维普、中国生物医学文献服务系统、万方、Pubmed、Web of Science、The Cochrane LibraryEmbase等数据库,搜集SAXA联合MET与SUs联合MET治疗2型糖尿病的随机对照试验.在对用药疗效和不良反应进行Meta分析的基础上,评价其经济性.结果 共纳入8个RCT研究,1724例患者.Meta分析结果显示,HbA1c(WMD合并=0.01,P=0.76)、FPG(WMD合并=1.61,P=0.42)和HOMA-β(WMD合并=3.07,P=0.08)差异均无统计学意义.SAXA联合MET不良反应率低于SUs联合MET(RR合并=0.57,P=0.02).通过药物经济学分析,SAXA组平均每病例日药物成本为11.6元,SUs组平均每病例日药物成本为4.1元.结论 与SAXA联合MET相比,SUs联合MET在血糖控制和胰岛素功能恢复上效果相似,不良反应控制较弱,同时在“4+7”带量采购政策下,SUs联合MET具有更好的经济性,有利于减轻患者和医保负担,并为政策的推进提供依据.

abstractsObjective Systematic analysis was made on the efficacy,safety and economy of sagliptin and sulfonylurea combined with metformin for type 2 diabetes mellitus to provide references for clinical decisionmaking and drug bidding.Methods CNKI,VIP,China Biomedical Literature Service System,Wanfang,Pubmed,Web of Science,The Cochrane Library Embase,and other databases were used to collect the randomized controlled trials (RCTs) on the treatment of type 2 diabetes mellitus with sargliptin combined with metformin and sulfonylureas.Based on the meta-analysis of drug efficacy and adverse reactions,its economy was evaluated.Results Eight RCTs studies involving 1 724 patients were included.Meta-analysis showed that there were no statiatical differences in HbAlc (WMD=0.01,P=-0.76),FPG (WMD=1.61,P=0.42),and HOMA-beta (WMD=3.07,P=0.08).The adverse reactions rate of the sagliptin group was lower than that of the sulfonylureas group (RR=0.57,P=0.02).Through pharmacoeconomic analysis,the average daily cost of drugs per patient in the shagliting group was 11.6 yuan,and that in the sulfonylureas group was 4.1 yuan.Conclusion Compared with shaglitin and metformin,sulfonylureas combined with metformin has similar effects on blood sugar control and insulin function recovery but worse adverse reactions control.Under the "4+7" purchasing policy,sulfonylureas combined with metformin has better economy,which is conducive to alleviating the patients' burden and medical insurance and provides the basis for policy promotion.