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1.广东省代谢病中西医结合研究中心,广州 510006
2.糖脂代谢病教育部重点实验室,国家中医药管理局高脂血症调肝降脂重点研究室,广州 510006
3.广东药科大学 附属第一医院,广州 510080
4.广东药科大学 医学信息与工程学院,广州 510006
Received:30 July 2021,
Published Online:16 August 2021,
Published:05 October 2021
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吴淼闻,黄晓强,詹会霞等.贞术调脂胶囊对2型糖尿病HbA1c疗效的真实世界研究[J].中国实验方剂学杂志,2021,27(19):110-117.
WU Miao-wen,HUANG Xiao-qiang,ZHAN Hui-xia,et al.Effect of Zhenzhu Tiaozhi Capsule on HbA1c in Patient with Type 2 Diabetes Mellitus: A Real-world Study[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(19):110-117.
吴淼闻,黄晓强,詹会霞等.贞术调脂胶囊对2型糖尿病HbA1c疗效的真实世界研究[J].中国实验方剂学杂志,2021,27(19):110-117. DOI: 10.13422/j.cnki.syfjx.20211991.
WU Miao-wen,HUANG Xiao-qiang,ZHAN Hui-xia,et al.Effect of Zhenzhu Tiaozhi Capsule on HbA1c in Patient with Type 2 Diabetes Mellitus: A Real-world Study[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(19):110-117. DOI: 10.13422/j.cnki.syfjx.20211991.
目的
2
基于真实世界数据探究贞术调脂胶囊(FTZ)对2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)的长期疗效特点。
方法
2
提取医院信息系统(HIS)中使用FTZ的T2DM患者(FTZ组)与使用常规降糖药物的T2DM患者(常规治疗组),运用倾向性评分匹配(PSM)法平衡组间混杂因素,以HbA1c为疗效评价指标,采用
t
检验,
χ
2
检验比较两组间疗效差异;对同一患者的重复测量数据,采用广义估计方程(GEE)比较两组间疗效差异并评估对HbA1c疗效的稳定性;采用多元线性回归分析可能影响FTZ降低HbA1c效力的因素,并对相关因素分层后进行亚组分析。
结果
2
研究共纳入FTZ组患者46例与常规治疗组患者1 208例,经PSM得到组间协变量均衡的样本42对,在1年的观察期内,①FTZ组治疗后的HbA1c为6.51%±1.09%,自身前后比较及与常规治疗组间比较差异均无统计学意义;同时FTZ组治疗后HbA1c
<
7.0%的达标率为73.8%,自身前后比较及与常规治疗组间比较差异均无统计学意义;②GEE结果显示,对于重复测量的治疗后HbA1c水平,两组之间差异无统计学意义,且随着治疗时间的增加,组间HbA1c水平保持平稳;③多元线性回归及亚组分析结果显示,FTZ对HbA1c基线更高[
β
=-0.530,95%置信区间(CI) -0.850~-0.209,
P
<
0.01]或合并高血压病(
β
=-0.918,95%CI -1.614~-0.222,
P
<
0.05)的患者降低HbA1c的效力更强。
结论
2
在真实世界中FTZ具有控制血糖的作用,其效果与常规降糖药物相近,并且可以在较长时间内保持患者的血糖稳定。
Objective
2
To explore the long-term effect of Zhenzhu Tiaozhi capsule(FTZ) on hemoglobin A1c(HbA1c)in patients with type 2 diabetes mellitus (T2DM) based on real-world data.
Method
2
T2DM patients who were provided with FTZ (FTZ group) and those receiving conventional hypoglycemic drugs (control group) were extracted from the hospital information system (HIS) of the First Affiliated Hospital of Guangdong Pharmaceutical University, followed by propensity score matching (PSM) for balancing the confounding factors between groups. With HbA1c as the efficacy evaluation index, the difference in efficacy between the two groups was compared using
t
-test and
χ
2
test. For repeated measurement data of the same patient, the difference in efficacy and the stability of FTZ against HbA1c were analyzed by generalized estimating equation (GEE). The factors that might affect the efficacy of FTZ against HbA1c were subjected to multivariate linear regression analysis (MLRA), and the subgroup analyses were then conducted after the stratification of relevant factors.
Result
2
There were 46 patients included in the FTZ group and 1 208 patients in the control group. PSM yielded 42 pairs of samples with balanced covariates between groups. As revealed by one-year observation, ① HbA1c in the FTZ group after treatment was 6.51%±1.09%. No significant difference was observed either in pre- and post-treatment comparison in the FTZ group or in its comparison with the control group. At the same time, the HbA1c compliance rate in the FTZ group was 73.8% after treatment. No significant difference was observed either in pre- and post-treatment comparison in the FTZ group or in its comparison with the control group. ② The GEE results showed that the post-treatment HbA1c levels in the two groups were not significantly different from each other. Moreover, the HbA1c level remained stable over treatment time. ③ MLRA and subgroup analyses results demonstrated that FTZ was more effective in patients with high baseline HbA1c [
β
=-0.530,95% confidence interval(CI) -0.850~-0.209,
P
<
0.01] or those who were complicated with hypertension (
β
=-0.918,95%CI -1.614~-0.222,
P
<
0.05).
Conclusion
2
In the real world, FTZ is able to control the blood sugar, and its effect is similar to those of conventional hypoglycemic drugs. Besides, it is capable of stabilizing the blood sugar for a long time.
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