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GLP-1受体激动剂治疗2型糖尿病合并肥胖/超重患者效果的网状Meta分析
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| 篇名： | GLP-1受体激动剂治疗2型糖尿病合并肥胖/超重患者效果的网状Meta分析 |
| TITLE： | Network meta-analysis of the efficacy of GLP-1 receptor agonists in the treatment of type 2 diabetes mellitus complicated with obesity/overweight |
| 摘要： | 目的 系统评价6种胰高糖素样肽-1受体激动剂（GLP-1RA）治疗2型糖尿病（T2DM）合并超重/肥胖患者的疗效与安全性，为临床用药提供循证依据。方法计算机检索PubMed、Embase、WebofScience、theCochraneLibrary、中国知网、维普网、万方数据、中国生物医学文献数据库，检索时限从建库起至2025年12月1日。根据纳入与排除标准，严格筛选随机对照试验（RCT），从中提取资料并对纳入研究进行文献偏倚风险评价，采用Stata17.0软件进行网状Meta分析。结果共纳入29项符合标准的RCT，包括7404例患者，涉及6种GLP-1RA：司美格鲁肽、利拉鲁肽、艾塞那肽、度拉糖肽、聚乙二醇洛塞那肽、贝那鲁肽。在血糖控制方面，司美格鲁肽在降低糖化血红蛋白（HbA1c）、空腹血糖（FPG）水平排名第1位的概率最高，其次是聚乙二醇洛塞那肽；在控制体重方面，司美格鲁肽排名第1位的概率最高，其次是利拉鲁肽和艾塞那肽；在安全性方面，度拉糖肽在胃肠道反应发生率方面排名第1位的概率最高，各GLP-1RA类药物均未显著增加严重低血糖风险。亚组分析显示，利拉鲁肽1.8mg，qd和艾塞那肽微球2.0mg，qw在降低HbA1c与减轻体重方面相对同品种其他剂量/剂型疗效更佳。结论对于T2DM合并超重/肥胖患者，司美格鲁肽在降糖与减重方面获益最大，度拉糖肽的胃肠道耐受性表现更优。利拉鲁肽1.8mg，qd与艾塞那肽微球2.0mg，qw的降糖及减重综合疗效在同品种中相对更佳。 |
| ABSTRACT： | OBJECTIVE To systematically evaluate the efficacy and safety of 6 kinds of GLP-1RAs in the treatment of type 2 diabetes mellitus （T2DM） patients with overweight or obesity， and to provide evidence-based reference for clinical practice. METHODS A comprehensive search was conducted in PubMed， Embase， Web of Science， the Cochrane Library， CNKI， VIP， Wanfang Data， and CBM from the inception to December 1， 2025. Randomized controlled trials （RCTs） were screened according to inclusion and exclusion criteria. Data extraction and risk of bias assessment were performed on the included studies. Network meta-analysis was conducted using Stata 17.0 software. RESULTS A total of 29 eligible RCTs were included， involving 7 404 patients. Six GLP-1RAs were evaluated： semaglutide， liraglutide， exenatide， dulaglutide， polyethylene glycol loxenatide， and beinaglutide. In terms of glycemic control， semaglutide had the highest probability of ranking first in reducing glycated hemoglobin （HbA1c） and fasting plasma glucose levels， followed by polyethylene glycol loxenatide. In terms of weight management， semaglutide showed the highest probability of ranking first， followed by liraglutide and exenatide. Regarding safety， dulaglutide had the highest probability of ranking first in reducing the incidence of gastrointestinal adverse events； none of the GLP-1RAs significantly increased the risk of severe hypoglycemia. Subgroup analysis revealed that liraglutide 1.8 mg， qd and exenatide extend-release 2.0 mg， qw demonstrated superior efficacy in reducing HbA1c and body weight compared with other doses/dosage forms of the same agents. CONCLUSIONS For T2DM patients with overweight or obesity， semaglutide offers the greatest benefits in glycemic control and weight reduction， while dulaglutide demonstrates superior gastrointestinal tolerability. Liraglutide 1.8 mg， qd and exenatide extend-release 2.0 mg， qw show relatively better overall efficacy in glycemic control and weight reduction among the same agents. |
| 期刊： | 2026年第37卷第10期 |
| 作者： | 曾瑾；陈举亮；胡紫微；姚良然；詹亚坤 |
| AUTHORS： | ZENG Jin，CHEN Juliang，HU Ziwei，YAO Liangran，ZHAN Yakun |
| 关键字： | 胰高糖素样肽-1受体激动剂；司美格鲁肽；利拉鲁肽；艾塞那肽；2型糖尿病；肥胖；超重 |
| KEYWORDS： | GLP-1 receptor agonists； semaglutide； liraglutide； exenatide； type 2 diabetes mellitus； obesity； overweight |
| 阅读数： | 8 次 |
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