目的 基于循证药学方法制定老年患者个体化用药目录,以助力临床合理用药决策.方法 首先,充分利用循证药学信息,筛选出有风险基因信息的药物;其次,统计药物在不同数据来源的收录情况,选取3个及以上数据来源收录的药物,结合项目组专家委员会讨论确定的药物,纳入目录;再次,选取2个数据来源收录的药物,设计问卷对药物相关基因检测的必要性展开调查,根据专家问卷调查的评分结果,按得分高低纳入药物.数据来源包括真实世界数据(医院高频用药清单、老年患者门诊和住院医保高频用药清单、用药差错高频药物清单等)和循证药学证据(临床药物基因组学实施联盟、荷兰药物遗传学工作组、美国食品药品监督管理局网站等).结果 本研究首先获得3个数据来源收录并有风险基因信息的药物68种,结合项目组专家委员会讨论确定的23种药物,去重后形成74种药物清单.其次,对于2个数据来源收录并有风险基因信息的37种药物,研究通过专家问卷调查形成26种药物清单,最终形成包含100种药物的老年患者个体化用药目录.目录中包括中枢神经系统药物43种、心血管系统药物15种、抗肿瘤药12种等.有12种药物被6个及以上数据来源收录,其中消化系统药物最多,均为质子泵抑制剂.结论 本研究通过循证药学方法遴选出100种需个体化给药的老年患者常用药物.目录将随着证据的变化更新,可为老年患者合理用药提供指导.

目的 分析2023年WHO发布的2023版《世界卫生组织基本药物示范清单》(简称《示范清单》)与2021版相比的变化情况,为我国基本药物政策与管理提供参考.方法 将2023版与2021版《示范清单》进行对比,总结剔除和新增药品特点.结果 2023版《示范清单》共列出502种药品,较2021版的479种剔除4种、新增27种、明确细化1种药品.新增的27种药品中,抗感染类药物5种、固定剂量复方制剂5种.新增治疗酒精使用障碍的药物阿坎酸钙、纳曲酮和特定营养成分的食品作为新的一类药品;剔除了达沙布韦、奥必他韦+帕利他韦+利托那韦、聚乙二醇干扰素α和氯丙嗪;抗结核药物对氨基水杨酸在2023版《示范清单》中明确指出为对氨基水杨酸钠.结论 抗感染类药物、固定剂量复方制剂仍然是《示范清单》新增药品的重点和趋势.2023版《示范清单》适应当前全球人类健康现状对药品分类进行调整与补充,为我国基本药物目录的更新和国家药品管理提供了有益指导.

目的 通过Meta分析,探讨吡格列酮对2型糖尿病患者血浆脂联素的作用.方法 系统检索万方数据、中国知网、PubMed、the Cochrane Library与Embase数据库(建库至2021年4月30日)吡格列酮治疗2型糖尿病调节脂联素的随机对照试验,依据PRISMA标准(Meta分析报告标准)进行文献筛选与数据提取,采用Cochrane标准进行质量评估,使用RevMan 5.3和Stata 14.0软件进行数据统计与分析.结果 纳入10项随机对照临床试验,分析结果显示,与安慰剂相比,给予吡格列酮治疗能够显著升高血浆脂联素含量(8.65μg·mL-1,95％CI,7.18～10.12μg·mL-1).与其他类降糖药物相比,吡格列酮治疗升高脂联素作用可能更为明显(4.92μg·mL-1,95％CI,3.27～6.58μg·mL-1).结论 与安慰剂或其他类降糖药物相比,吡格列酮能够升高2型糖尿病患者的血浆脂联素含量.

目的 评价降钙素治疗绝经后骨质疏松症(PMOP)的有效性、安全性和经济性,为临床用药决策提供循证医学证据.方法 计算机检索the Cochrane Library、PubMed、Embase、中国知网、万方数据库、中国生物医学文献服务系统和卫生技术评估(HTA)机构官方网站,收集降钙素治疗PMOP的系统评价(SR)/Meta分析、药物经济学研究和HTA报告,检索时限均为建库至2022年9月30日.由2位研究者独立进行文献筛选、数据提取及质量评价,并对数据结果进行描述性分析.结果 共纳入18项研究,包括12项SR/Meta分析和6项药物经济学研究,未检索到HTA报告.在有效性方面,所纳入的研究结果基本一致:降钙素在降低椎体骨折发生率方面除对比单独使用钙剂和拉索昔芬可能有一定优势外,相比其他阳性药物均未体现出临床优势;在降低非椎体骨折发生率方面,降钙素除对比单独使用钙剂和雷洛昔芬可能有一定优势外,相比其他阳性药物均未体现出临床优势;在提高椎体骨密度(BMD)方面,仅有2项研究表明降钙素相比钙剂有一定优势,和其他阳性药物相比未见临床优势;在提高非椎体BMD方面,仅有1项研究表明降钙素与钙剂合用相比单独使用钙剂对提高股骨BMD有一定优势,和其他阳性药物相比未见临床优势;在降低骨痛评分方面,所纳入的2项研究均表明鼻用降钙素对减轻椎骨骨折患者的急性疼痛具有短期益处,对慢性疼痛患者无效.在安全性方面,所纳入的3项研究均表明降钙素相比其他阳性药物的不良反应更轻微,但长期使用有增加恶性肿瘤的风险.在经济性方面,只有1项研究表明使用鼻用降钙素治疗PMOP相比不治疗或使用依替膦酸盐治疗更具有经济学优势.结论 降钙素对减轻PMOP椎体骨折患者的急性疼痛有一定作用,安全性有待进一步考察,未见明显经济学优势.

目的 对比德谷胰岛素与其他长效基础胰岛素类似物在治疗1型糖尿病(T1DM)中的疗效与安全性,为临床提供证据参考.方法 检索PubMed、Cochrane图书馆、Clinical Trails.gov、中国知网、万方数据、中文科技期刊数据库、药物临床试验登记与信息公示平台等建库至2021年3月31日,关于德谷胰岛素治疗T1DM的随机对照试验(RCT),对符合纳入标准的研究用Rev Man 5.4.1软件进行Meta分析.结果 Meta分析共纳入5项RCT,合计2256例患者.Meta分析结果显示,对于成人T1DM患者,与其他长效基础胰岛素类似物相比,德谷胰岛素在降低糖化血红蛋白(HbA1c)方面无明显统计学差异[MD=0.01,95％CI(-0.05,0.08),P=0.69],降低空腹血糖(FPG)方面更优[MD=-0.85,95％CI(-1.15,-0.56),P<0.00001],使用德谷胰岛素比使用地特胰岛素体重增加更多[MD=1.07,95％CI(0.47,1.67),P<0.00001];总低血糖[RR=0.95,95％CI(0.92,0.97),P=0.0003]、严重低血糖发生率[RR=0.78,95％CI(0.66,0.93),P=0.005]、夜间低血糖发生率[RR=0.70,95％CI(0.61,0.80),P<0.00001]更低.文献综述显示德谷胰岛素也适用于T1DM的儿童和青少年;降低血糖波动及低血糖发生率的特点可能使其具有更好的成本效益.结论 对于成年T1DM患者,与其他长效基础胰岛素类似物相比,德谷胰岛素降低HbA1c的效果及安全性相当,在减少FPG、减少低血糖发生率,尤其是夜间低血糖发生率方面更具有优势,这些优势可能带来更优的成本效益.德谷胰岛素可以作为FPG相对较高或具有低血糖高风险的T1DM患者治疗的一种选择.

Objective:To understand the status quo and problems of insulin application at home in patients with diabetes mellitus.Methods:Pharmacists in many hospitals across the country were organized to conduct a questionnaire survey on status quo of insulin application in patients with diabetic mellitus, so as to understand their insulin use, insulin injection behavior, insulin treatment adherence, glucose monitoring adherence, insulin preservation behavior, rate of up to target blood glucose, and the incidence of adverse reactions such as hypoglycemia. The questionnaire contained 50 questions, the accuracy rate of 21 questions related to insulin application norms was calculated, and the effect of insulin application behavior of patients on the efficacy and safety of insulin therapy was investigated.Results:Clinical pharmacists from 31 hospitals across the country participated in the questionnaire distribution and survey, and 240 valid questionnaires were returned. Among the 240 patients, 106 (44.2%) were male and 134 (55.8%) were female, aged (58±15) years; 210 (87.5%) had type 2 diabetes mellitus, 25 (10.4%) had type 1 diabetes mellitus, and 5 (2.1%) had other types; 151 (62.9%) patients were treated with one kind of insulin, 89 (37.1%) were treated with 2 kinds of insulin, and a total of 13 kinds of insulin were involved; 97.9% (235/240) of the patients had at least one wrong or irregular insulin use behavior, 75.0% (180/240) had at least one problem related to insulin treatment adherence, 70.4% (169/240) had poor glucose monitoring adherence, and 68.8% (165/240) had at least one irregular insulin preservation behavior. The rate of up to target blood glucose was only 13.8% (33/240), and the incidence of hypoglycemia was 55.8% (134/240). The total correct rates of answers to insulin use behavior and treatment adherence in patients with up to target blood glucose were significantly higher than those in patients without up to target blood glucose [71.4% (57.1%, 81.0%) vs. 61.9% (52.4%, 71.4%), P=0.045; 77.8% (55.6%, 88.9%) vs. 66.7% (55.6%, 77.8%), P=0.023], and differences in the correct rate of answers to insulin use behavior and each behavior between the patients with and without hypoglycemia were not statistically significant (all P>0.05). Conclusions:Insulin has a wide variety and similar drug names, which are easily confused, leading to medication errors. The incidence of irregular insulin injection behavior, treatment adherence, and insulin preservation behavior in patients is high, which may affect the rate of up to target blood glucose.

目的 提高医务人员对达格列净片导致正常血糖酮症的警惕,为安全使用达格列净片提供参考.方法 分析2例由达格列净片导致正常血糖酮症患者的诊疗经过,结合国内外文献分析,探讨达格列净片导致正常血糖酮症的发生情况以及危险因素.结果 2例有糖尿病酮症病史的患者分别在使用达格列净片52 d和18 d后出现正常血糖酮症,立即停用达格列净片并予胰岛素治疗,患者酮体转阴.结论 应重视达格列净片导致正常血糖酮症的风险,特别是在既往有糖尿病酮症病史患者中的使用风险.

目的:基于快速卫生技术评估方法,评价吡格列酮二甲双胍复方制剂治疗2型糖尿病的有效性、安全性和经济性.方法:检索PubMed、Embase、the Cochrane Library、Web of Science、中国知网、万方等数据库,同时检索相关快速卫生技术评估(HTA)网站及数据库.根据纳入与排除标准独立筛选文献、评价质量和提取数据后,对其有效性、安全性和经济性结果进行定性分析.结果:共纳入0篇HTA报告、11篇系统评价/Meta分析、8篇经济学研究.结果 显示,吡格列酮联合二甲双胍能有效降低2型糖尿病患者糖化血红蛋白水平,不良反应发生率无显著增加,低血糖发生风险较低;二者的复方制剂与两药联用相比,可提高患者用药依从性;在经济性方面,吡格列酮联合二甲双胍可延长患者的质量调整生命年(QALYs),具有较好的成本效果,复方制剂与之相比未增加费用.结论:吡格列酮联合二甲双胍治疗2型糖尿病具有较好的安全性、有效性和经济性.

Sodium-glucose transporter 2 inhibitors (SGLT2i) are novel oral hypoglycemic agents, which reduces blood glucose by inhibiting the reabsorption of glucose in the proximal convoluted tubule of the kidney and increasing the excretion of glucose to the urine. SGLT2i is effective in the treatment for diabetes mellitus, but there are also some safety problems. Diabetic ketoacidosis (DKA) is a serious adverse reaction of SGLT2i. SGLT2i could cause at least a 7-fold increase in developing DKA, approximately 70% of which are euglycemic DKA (euDKA). The risk factors for euDKA include insufficient insulin secretion cell reserve, type 1 diabetes mellitus, insulin reduction or discontinuation, hypovolemia, perioperative period, weight loss, and restricted feeding, etc. Because the increase of blood glucose in patients with euDKA is not obvious, the diagnosis is often delayed, so close attention should be paid to it. Safety medication training for SGLT2i should be strengthened to improve clinicians′ understanding of SGLT2i-related euDKA, so that they can strictly grasp the indications of medication and avoid the inducement of euDKA. Once euDKA occurs, clinicians can make early diagnosis and treatment. Pharmacists should be involved in the safety management of patients using SGLT2i to improve the safety in treatment.

目的 探讨钠-葡萄糖协同转运蛋白-2(SGLT-2)抑制剂在临床使用中药品不良反应发生的规律及特点,以提高临床用药安全.方法 检索中国知网、万方数据、维普网、PubMed、Embase、Medline数据库,对建库以来至2019年11月28日国内外公开发表的有关SGLT-2抑制剂致药品不良反应病例文献报道进行回顾性分析.结果 共收集40例SGLT-2抑制剂致药品不良反应,共13种,前3位分别为糖尿病酮症酸中毒(55.0％)、急性胰腺炎(10.0％)、范科尼综合征(7.5％).结论 SGLT-2抑制剂致药品不良反应表现多样,警惕其新的药品不良反应如范科尼综合征、Sweet综合征等,临床使用中应严格把控用药指征并加强用药监护.

目的:研究我国《国家基本药物目录》(以下简称:《目录》)中仿制药参比制剂设立情况,为仿制药参比制剂的遴选提供科学依据.方法:将国家药品监督管理局发布的仿制药参比制剂与《国家基本药物目录》中药品进行匹配,对匹配情况及匹配后特征进行分析.采用描述性分析、卡方检验等方法进行统计学分析.结果:2018年版《目录》中化学药品和生物制品共计417种,其中有112种(27％)无任何对应剂型和规格的参比制剂.在发布的4509种参比制剂中,59％的参比制剂不是基本药物.国内未上市参比制剂具有的剂型和规格数量要多于国内上市的参比制剂(Z=-6.86,p＜0.01).国内上市的682种原研进口参比制剂中,基本药物的比例为13％;国内未上市的3646种原研进口参比制剂中,基本药物的比例为20％.两者差异有统计学意义(x2=97.7,p＜0.01).结论:参比制剂不断增多,但针对基本药物的参比制剂缺失比例仍较大.参比制剂剂型规格复杂多样,但大部分并未被《目录》囊括.这些特点使基本药物参比制剂的选择和使用面临更大的挑战.

目的:探讨不同种类餐时胰岛素联合基础胰岛素治疗2型糖尿病的有效性和经济性.方法:采用回顾性研究方法,选择2016年1月至2019年1月天津医科大学朱宪彝纪念医院收治的216例确诊为2型糖尿病的患者资料,根据治疗方案不同分为A组(56例)、B组(53例)、C组(54例)及D组(53例).A组患者采用赖脯胰岛素+甘精胰岛素治疗,B组患者采用赖脯胰岛素+地特胰岛素治疗,C组患者采用门冬胰岛素+地特胰岛素治疗,D组患者采用门冬胰岛素+甘精胰岛素治疗.四组患者的疗程均为2周.比较四组患者治疗前后的血糖水平和临床疗效,并采用成本-效果分析法进行经济学评价.结果:A、B、C及D组患者的总有效率分别为91.07％(51/56)、84.91％(45/53)、87.04％ (47/54)及86.79％(46/53),差异无统计学意义(P＞0.05).A、B、C及D组方案的成本分别为320.24、327.06、331.16及324.31元;成本-效果比分别为3.52、3.85、3.80及3.74,A组最低;B、C及D组方案的增量成本-效果比为-1.11、-2.71及-0.95,A组方案更具有成本-效果优势.敏感度分析结果支持成本-效果分析结果.结论:从短期疗效上分析,赖脯胰岛素联合甘精胰岛素治疗2型糖尿病的方案更优.

依据目前已完成的胰高糖素样肽-1受体激动剂（GLP-1RA）相关基础和临床研究，从血糖控制、降低体重、改善血脂代谢、改善内皮功能、降低血压、保护心血管方面总结了GLP-1RA的保护机制，并阐述GLP-1RA心血管保护作用的异同及可能机制。

1病例资料 患者,男,59岁,1月余前开始血糖控制不佳,偶有低血糖现象发生,曾间断使用过多种降糖方案,如精蛋白生物合成人胰岛素注射液(预混30R)、盐酸二甲双胍片、阿卡波糖片等,于2019年9月7日入院.入院诊断:2型糖尿病;冠状动脉粥样硬化性心脏病;高血压病2级;血脂异常.患者2006年外院行冠状动脉CT检查,自述狭窄＜50％,否认药物不良反应史,否认药物食物过敏史.现服用苯磺酸氨氯地平片5mg,po,qd降压,阿托伐他汀钙片20 mg,po,qn调脂,阿司匹林肠溶片0.1g,po,qd抗血小板聚集治疗.

全球2型糖尿病的患者数已达约4.25亿例,预计在2045年将会有将近7亿例罹患糖尿病,其中60％的2型糖尿病患者死于心血管疾病.2008年,FDA要求所有降糖新药申报其临床试验中的心血管事件.目前,除二甲双胍、利拉鲁肽和恩格列净外,大多数抗糖尿病药物对心血管表现出中性或负性的作用.越来越多的多中心随机对照试验和真实世界研究报道了新型降糖药钠-葡萄糖共转运蛋白2抑制剂对糖尿病患者的心血管保护作用.本文将对钠-葡萄糖共转运蛋白2抑制剂对糖尿病患者心血管系统作用的相关研究进行综述,并对其保护作用可能的机制进行总结.

Metformin, one of the most widely used oral hypoglycemic agents in the world, plays an important role in treating type 2 diabetes for decades, and it has been recommended as a first-line drug in diabetes guidelines around the world because of the good efficacy and safety for monotherapy and combination therapy, evidence of health economic benefits, and definite clinical evidence in the prevention of cardiovascular complications. Metformin has been clinically applied for more than 30 years in China. However, some clinicians and patients still have misunderstandings about the use of metformin, which makes some patients, that could formally benefit from metformin therapy miss treatment opportunities. Therefore, the Chinese Expert Consensus Statement on Metformin in Clinical Practice was jointly formed by endocrinologists and pharmaceutical experts with the aim of guiding clinicians and patients to correctly understand and rationally use Metformin (Supplementary file, https://links.lww.com/CM9/A237). By using a question-and-answer format, this consensus addressed the clinical status and initial treatment opportunity, mechanism, drug dose and clinical efficacy, drug use in special diabetic populations, safety, effects on cardiovascular system, which included six modules and 17 main recommendations about combination medication of Metformin. Main recommendations are presented in Table 1.Table 1: Main recommendations of metformin therapy.Recommendations were formulated using the Class of Recommendation (COR) and Level of Evidence (LOE) system by the American College of Cardiology and American Heart Association.[1] This system provides a transparent mechanism to judge benefit relative to risk using a classification scheme (I, IIa, IIb, and III), supported by evidence quality and quantity using an LOE rating (A, B-Randomized, B-Non-randomized, C-Limited data, C-Expert opinion, all recommendations are listed with a COR and LOE rating. The Expert Group members: Yi-Ming Mu1, Li-Nong Ji2, Guang Ning3, Guang-Wei Li4, Zhong-Yan Shan5, Yan Li6, Zi-Lin Sun7, Yan-Bing Li8, Jia-Jun Zhao9, Wei-Qing Wang2, Da-Long Zhu10, Tian-Pei Hong11, Nan-Wei Tong12, Zhi-Guang Zhou13, Da-Jin Zou14, Chao Liu15, Qiang Li16, Li-Xin Guo17, Yong-De Peng18, Lu-Lu Chen19, Xin-Hua Xiao20, Xue-Feng Yu21, You-Min Wang22, Qiu-He Ji23, Qi-Fu Li24, Chun-Lin Li25, Quan-Min Li26, Li-Xin Shi27, Yi-Ming Li28, Yong-Quan Shi29, Suo-Di Zhai30, Zhi-Gang Zhao31, Wan-Hua Yang32, Li-Wei Ji33, Rong-Sheng Zhao30, Jiu-Hong Wu34 1Department of Endocrinology, People's Liberation Army General Hospital, Beijing 100853, China 2Department of Endocrinology, Peking University People's Hospital, Beijing 100044, China 3Department of Endocrinology and Metabolism, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China 4Department of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China 5Department of Endocrinology, the First Hospital of China Medical University, Shenyang, Liaoning 110001, China 6Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China 7Department of Endocrinology, Zhongda Hospital Southeast University, Nanjing, Jiangsu 210009, China 8Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510000, China 9Department of Endocrinology, Shandong Provincial Hospital, Jinan, Shandong 250021, China 10Department of Endocrinology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu 210008, China 11Department of Endocrinology, Peking University Third Hospital, Beijing 100191, China 12Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China 13Department of Endocrinology and Metabolism, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China 14Department of Endocrinology, Department of Endocrinology, Changhai Hospital, Shanghai 200433, China 15Department of Endocrinology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu 210028, China 16Department of Endocrinology, Shenzhen University General Hospital, Shenzhen, Guangdong 518055, China 17Department of Endocrinology, Beijing Hospital, Beijing 100730, China 18Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai 200080, China 19Department of Endocrinology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430022, China 20Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China 21Department of Endocrinology, Tongji Medical College, Huazhong University of Science &Technology, Wuhan, Hubei 430030, China 22Department of Endocrinology, the First Affiliated Hospital of Medical University of Anhui, Hefei, Anhui 230022, China 23Department of Endocrinology, Xijing Hospital, Xi'an, Shaanxi 710032, China 24Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 404000, China 25Department of Geriatric Endocrinology, People's Liberation Army General Hospital, Beijing 100853, China 26Department of Endocrinology, Rocket People's Liberation Army General Hospital, Beijing 100088, China 27Department of Endocrinology and Metabolism, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China 28Department of Endocrinology, Shanghai Huashan Hospital, Shanghai 200040, China 29Department of Endocrinology, Shanghai Changzheng Hospital, Shanghai 200433, China 30Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China 31Department of Pharmacy, Beijing Tiantan Hospital, Beijing 100050, China 32Department of Pharmacy, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China 33Department of Pharmacy, Beijing Hospital, Beijing 100730, China 34Department of Pharmacy, Special Medical Center of Strategic Support Forces, Beijing 100101, China. Conflicts of Interest None.

1例48岁和1例61岁男性患者,因血糖控制不佳入院,入院后诊断为代谢综合征,48岁患者合并高尿酸血症既往痛风多次发作,入院后予患者非布司他20 mg·d-1降尿酸,同时非诺贝特100 mg·d-1降甘油三酯,达格列净5–10 mg·d-1降糖治疗,一周后患者血尿酸由550μmol·L-1降至182μmol·L-1,调整非布司他为20 mg,一周两次.61岁患者既往高尿酸血症,2年前尿酸治疗达标后规律使用苯溴马隆25 mg·d-1维持降尿酸治疗,血尿酸一直维持在目标范围内,患者同时使用瑞舒伐他汀5 mg·d-1调脂治疗.临床药师在对患者的全程药学监护过程中,发现降尿酸药物超说明书用药,查阅相关文献,旨在找到合理的医学证据支持,但未发现高质量循证医学证据支持小剂量降尿酸药物的使用;治疗代谢综合征的药物如氯沙坦、非诺贝特、他汀类等可有效降低血尿酸,但尚无对于合并代谢综合征的患者血尿酸达标后能否用这些辅助降尿酸药物维持血尿酸在目标范围内的高质量循证医学证据.

我国成人糖尿病的患病率已达10.4％.有大量的糖尿病患者平时在医院接受药物治疗.目前,为了配合国家打赢新冠肺炎防疫战争,很多糖尿病患者都不得不“窝”在家里,去医院的机会明显减少了.面对家中所剩不多的降糖药,有的糖友觉得无所谓,没有药了,正好不用吃了.有的糖友则忧心忡忡,怕缺了降糖药不能坚持治疗,自己长期的努力白费了.我们都知道管理自己的血糖也是一场持久战.针对糖友提出的几个问题,药师提出以下建议,谨供参考.

目的 系统评价卡维地洛与美托洛尔对糖脂代谢的影响,为临床用药提供参考.方法 计算机检索The Cochrane Library、PubMed、Embase、CNKI、VIP、CBMdisc以及万方医学网,收集卡维地洛(试验组)对比美托洛尔(对照组)治疗心血管疾病时对糖脂代谢影响的随机对照研究,提取相关资料并按照改良Jadad评分量表评价纳入研究质量,采用RevMan 5.3软件进行Meta分析.结果 共纳入51项随机对照研究,合计4355例患者.Meta分析结果显示,治疗2、3和6月空腹血糖(FPG)分别为(MD=-0.44,95％CI:-0.61～-0.27,P<0.001)、(MD=-0.46,95％CI:-0.61～-0.30,P<0.001)和(MD=-0.37,95％CI:-0.46～-0.27,P<0.001),试验组均较对照组低,且差异均具有统计学意义;试验组2、3和6月FINS和3、6月ISI较对照度低,但2月FINS和6月ISI无显著统计学差异(P>0.05);试验组2、3及6月的总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)低于对照组,除2月TC不具有显著统计学差异(P=0.06),其余均有显著的统计学差异(P<0.05);试验组2、3及6月的高密度脂蛋白胆固醇(HDL-C)高于对照组,均有显著的统计学差异(P<0.05).亚组分析结果与全组分析基本一致,表明基线糖脂不影响两药对血糖和血脂代谢的影响.结论 长期使用(>2月)β受体阻滞剂会影响糖脂代谢,无论基线糖脂水平如何,与美托洛尔相比,卡维地洛显著改善FPG、空腹胰岛素(FINS)、胰岛素敏感指数(ISI)、TC、TG、LDL-C和HDL-C,对糖脂代谢产生有利影响.考虑到纳入部分研究质量较低,存在发表偏倚,期待更多高质量大样本的临床随机对照试验来支持本结论.

目的:通过对乙酰左卡尼汀预防和治疗糖尿病周围神经病变进行快速卫生技术评估,评价乙酰左卡尼汀的有效性、安全性和经济性,为临床用药决策提供循证医学证据.方法:通过系统检索PubMed、Embase、Cochrane library、CNKI、CBM和CRD web等数据库,由2位研究者独立地根据纳入排除标准进行文章筛选、质量评价及数据提取,并对数据结果进行分析.结果:共纳入0项卫生技术评估(health technology assessment,HTA)报告、5篇系统评价/Meta分析和0篇经济学研究.乙酰左卡尼汀在改善糖尿病周围神经病变患者的疼痛、神经传导速度和振幅响应,降低视觉模拟评分有较好效果,安全性好.结论:乙酰左卡尼汀预防和治疗糖尿病周围神经病变具有良好的有效性和安全性.