口服降糖药在逆转糖尿病前期中的作用

背景 糖耐量减低、空腹血糖受损和糖化血红蛋白轻度升高是正常与显性糖尿病之间的中间阶段,被称为糖尿病前期.糖尿病前期与发生心血管疾病的风险增加有关,这是独立于糖尿病进程的.据数据显示,有各种口服降糖药物可以帮助人们从糖尿病前期回复到正常血糖.目的 评估口服降糖药物逆转糖尿病前期的疗效.方法 在MEDLINE(1950～2011年11月)、EMBASE(1990年～2011年11月)和Cochrane Central Register of Controlled Trials(索引至2011年9月)上进行检索,并手动搜索了相关的临床试验研究和综述,以找出额外的相关研究报道.包括了随访12周或更长时间来评估口服降糖药逆转糖尿病前期到正常血糖的随机对照试验.随机效应模型被用来计算95％可信区间(CI)的比值比(OR).结果 十三项研究(n=11,600人)包括在荟萃分析中.结果显示:与对照组相比,糖尿病前期患者使用口服降糖药物使血糖恢复正常的可能性增加一倍(OR 2.03. 95％CI 1.54～2.67).在评估各类口服降糖药物时,噻唑烷二酮类(OR 2.33,95％Cl 1.93～2.81)和α-葡萄糖苷酶抑制剂(OR 2.02,95％CI 1.26～3.24)有显著地统计学意义;然而,双胍类(OR 2.04)和磺脲类药物(OR 1.84)未能达到统计学意义(P值分别为0 06和0.39).结论 在糖尿病前期患者的治疗中,口服降糖药与安慰剂相比,血糖恢复正常的可能性增加:只有噻唑烷二酮类和α-葡萄糖苷酶抑制剂在统计学上显著增加了使血糖恢复正常的可能.

OBJECTIVE: This study assessed the efficacy and tolerability of repetitive transcranial magnetic stimulation for treatment of auditory hal ucination of patients with schizophrenia spectrum disorders.
DATA SOURCES: Online literature retrieval was conducted using PubMed, ISI Web of Science, EMBASE, Medline and Cochrane Central Register of Control ed Trials databases from January 1985 to May 2012. Key words were “transcranial magnetic stimulation”, “TMS”, “repetitive transcranial magnetic stimulation”, and “hal ucination”.
STUDY SELECTION: Selected studies were randomized control ed trials assessing therapeutic ef-ficacy of repetitive transcranial magnetic stimulation for hal ucination in patients with schizophrenia spectrum disorders. Experimental intervention was low-frequency repetitive transcranial magnetic stimulation in left temporoparietal cortex for treatment of auditory hal ucination in schizophrenia spectrum disorders. Control groups received sham stimulation.
MAIN OUTCOME MEASURES: The primary outcome was total scores of Auditory Hal ucinations Rating Scale, Auditory Hal ucination Subscale of Psychotic Symptom Rating Scale, Positive and Negative Symptom Scale-Auditory Hal ucination item, and Hal ucination Change Scale. Secondary outcomes included response rate, global mental state, adverse effects and cognitive function.
RESULTS: Seventeen studies addressing repetitive transcranial magnetic stimulation for treatment of schizophrenia spectrum disorders were screened, with controls receiving sham stimulation. Al data were completely effective, involving 398 patients. Overal mean weighted effect size for repeti-tive transcranial magnetic stimulation versus sham stimulation was statistical y significant (MD =-0.42, 95%CI: -0.64 to -0.20, P = 0.000 2). Patients receiving repetitive transcranial magnetic stimulation responded more frequently than sham stimulation (OR = 2.94, 95%CI: 1.39 to 6.24, P =0.005). No significant differences were found between active repetitive transcranial magnetic stimulation and sham stimulation for positive or negative symptoms. Compared with sham stimulation, active repeti-tive transcranial magnetic stimulation had equivocal outcome in cognitive function and commonly caused headache and facial muscle twitching.
CONCLUSION: Repetitive transcranial magnetic stimulation is a safe and effective treatment for auditory hal ucination in schizophrenia spectrum disorders.