2型糖尿病和脏疾病患者的甲福明:系统性审查
Silvio E Inzucchi1, Kasia J Lipska1, Helen Mayo2
1Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut.
JAMA
|December 24, 2014
概括
在轻度至中度慢性病中使用甲福明通常是安全的,乳酸症的发病率与一般糖尿病人群相似. 通过剂量调整和监测,谨慎扩大甲福明的处方得到支持.
科学领域:
- 内分泌学 在内分泌学.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 药理学 药理学是指药理学的学科.
背景情况:
- 甲胺是2型糖尿病的第一线治疗方法.
- 由于对乳酸性化症的担忧,在功能受损的患者中限制使用甲福林.
研究的目的:
- 评估使用甲福明的乳酸性酸症在患有功能障碍的患者中的风险.
- 评估在不同程度功能障碍的患者中甲福明的安全性和疗效.
主要方法:
- 从1950年至2014年对英语文章进行系统审查,搜索MEDLINE和Cochrane数据库.
- 包括药理动力学/代谢学研究,大型病例系列,回顾性研究,元分析和临床试验.
- 不包括评论,信件,社论,案例报告和小型案例系列.
主要成果:
- 在轻度至中度慢性脏疾病 (eGFR 30-60 mL/min/1.73 m2) 中使用甲福明并不会显著增加乳酸水平.
- 甲福明使用者的乳酸性酸发病率较低 (每10万人/年3-10人),与糖尿病患者的背景发病率相当.
- 有限的数据显示,CKD患者的乳酸酸风险增加;对于显著功能障碍,没有RCT存在.
- 人口研究表明,甲福明通常是违反指导方针的,没有增加乳酸性酸症的比率.
- 观察性研究表明,即使有脏禁忌,甲福明也可能对大血管有好处.
结论:
- 证据支持在患有轻度至中度慢性病的患者中谨慎扩大甲福明的使用.
- 适当的剂量减少和仔细的功能监测是必不可少的.
- 需要进一步的研究,以确定功能明显受损的患者的安全性.
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