用于慢性病和糖尿病患者的 thiazolidinediones
Patrizia Natale1,2, Suetonia C Green3, David J Tunnicliffe1
1Sydney School of Public Health, The University of Sydney, Sydney, Australia.
The Cochrane database of systematic reviews
|November 13, 2025
概括
这次审查发现,在患有慢性病 (CKD) 的2型糖尿病患者中, thiazolidinediones可能不会显著改变心血管死亡风险. 由于研究的局限性,其他结局 (如严重低血糖症) 的证据仍然不确定.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内分泌学 在内分泌学.
- 心脏病学 心脏病学
背景情况:
- 2型糖尿病 (T2D) 是心血管疾病 (CVD) 和慢性病 (CKD) 的重要风险因素,影响患者的生活质量和医疗保健成本.
- 大约三分之一的T2D患者会患上CKD,需要仔细管理并存的疾病.
- 已知 thiazolidinediones (TZDs) 可以改善血糖控制,并可能减少病的进展,但它们在患有T2D的CKD患者的安全性和有效性需要进一步调查.
研究的目的:
- 系统地审查和评估在被诊断患有CKD和T2D的患者中使用 thiazolidinedione 的益处和危害.
- 评估关键结果,如心血管死亡和严重低血糖症,以及包括全因死亡率和主要心血管不良事件 (MACE) 在内的重要结果.
主要方法:
- 在Cochrane脏和移植研究登记册中进行了全面的搜索,直到2024年10月.
- 符合条件的研究包括随机对照试验,比较TZD与安慰剂,常规护理或其他降血糖剂在任何阶段的CKD (1-5),包括透析患者的个人中.
- 数据提取和偏差风险评估由三位作者独立使用偏差风险2工具进行,并使用随机效应模型进行聚合分析.
主要成果:
- 纳入了85项研究,共有3044名参与者,平均年龄为62岁,平均随访时间为24周.
- 与安慰剂或标准治疗相比,TZD对心血管死亡几乎没有影响 (低确定性证据),对严重低血糖的影响无法估计.
- 没有报告重大心血管不良事件 (MACE),非致命的心肌梗塞,非致命性中风或需要置换疗法 (KRT) 的功能衰竭的研究. 偏差的整体风险很高或不清楚,导致低至非常低的确定性证据.
结论:
- 目前的证据表明, thiazolidinediones 可能对患有CKD和T2D患者的心血管死亡风险的影响很小,但关于其他关键结果的数据不足以得出明确的结论.
- 偏见的高风险和证据的低确定性凸显了未来研究的必要性.
- 进一步进行高质量的研究是必不可少的,以澄清这种人群中TZDs的益处和危害,重点关注利益相关者优先考虑的结果,以指导临床决策.
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