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首页> 外文期刊>The journal of clinical psychiatry >The effect of metformin on anthropometrics and insulin resistance in patients receiving atypical antipsychotic agents: a meta-analysis.
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The effect of metformin on anthropometrics and insulin resistance in patients receiving atypical antipsychotic agents: a meta-analysis.

机译：二甲双胍对接受非典型抗精神病药的患者的人体测量学和胰岛素抵抗的影响：一项荟萃分析。

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CONTEXT: In the Clinical Antipsychotic Trials of Intervention Effectiveness, atypical antipsychotics (AAPs) were found to be associated with weight gain and impairment of glucose metabolism. While metformin has been shown to attenuate weight gain and insulin resistance, not all studies have shown a benefit in the reduction of antipsychotic-induced weight gain and insulin resistance. OBJECTIVE: To characterize metformin's impact on anthropometrics and insulin resistance in patients taking AAPs. DATA SOURCES: A systematic literature search of MEDLINE, EMBASE, and Cochrane CENTRAL was conducted from the earliest possible date through December 31, 2008. The search was performed using the following Medical Subject Headings and text keywords: metformin, biguanide(s), in combination with neuroleptic(s), neuroleptic drug(s), antipsychotic(s), dopamine antagonist(s), atypical antipsychotic(s), psychotropic(s), risperidone, olanzapine, quetiapine, ziprasidone, sulpiride, clozapine, iloperidone, aripiprazole, paliperidone, melperone, bifeprunox, amisulpride, zotepine, and sertindole. STUDY SELECTION: Six of 62 identified studies (N = 336 participants) met our inclusion criteria: randomized, placebo-controlled trials of metformin in patients taking AAPs with data on weight, body mass index (BMI), waist circumference, insulin resistance (determined using the homeostasis model assessment of insulin resistance [HOMA-IR]), and/or a diagnosis of diabetes. DATA EXTRACTION: Data were independently abstracted by 2 investigators; disagreements were resolved through discussion or by a third investigator using a standardized data abstraction tool. For continuous endpoints, the weighted mean difference (WMD) of the change from baseline with 95% CI was calculated as the difference between the mean in the metformin and placebo groups. For categorical endpoints, the pooled relative risk (RR) with 95% CI was calculated. A random-effects model was used for all analyses. DATA SYNTHESIS: Compared to placebo, the metformin group had significantly reduced weight (WMD, 3.16 kg; P = .0002), BMI (WMD, 1.21 kg/m(2); P = .0001), waist circumference (WMD, 1.99 cm; P = .005), and HOMA-IR (WMD, 1.71; P = .004). The reduction in risk of diabetes was not statistically significant (RR, 0.30; P = .13). CONCLUSIONS: This analysis suggests that using metformin in patients treated with AAPs may reduce metabolic risks. Additional randomized controlled trials are needed, but available data support consideration of this intervention in clinical practice.
机译：语境：在干预效果的临床抗精神病药物试验中，发现非典型抗精神病药物（AAP）与体重增加和葡萄糖代谢受损有关。尽管已证明二甲双胍可减轻体重增加和胰岛素抵抗，但并非所有研究都显示出减少抗精神病药物引起的体重增加和胰岛素抵抗的益处。目的：研究二甲双胍对服用AAP的患者的人体测量学和胰岛素抵抗的影响。数据来源：从最早的日期到2008年12月31日，对MEDLINE，EMBASE和Cochrane CENTRAL进行了系统的文献检索。检索使用以下医学主题词和文字关键字：metformin，biguanide（s），与抗精神病药，抗精神病药，抗精神病药，多巴胺拮抗剂，非典型抗精神病药，精神药物，利培酮，奥氮平，喹硫平，齐拉西酮，舒必利，氯氮平，伊潘立酮，阿立哌唑，帕潘立酮，美拉酮，bifeprunox，氨磺必利，唑替平和sertindole。研究选择：62项确定的研究中有6项（N = 336名参与者）符合我们的纳入标准：二甲双胍在接受AAP的患者中进行的随机，安慰剂对照试验，数据涉及体重，体重指数（BMI），腰围，胰岛素抵抗性（确定使用稳态模型评估胰岛素抵抗（HOMA-IR）和/或诊断糖尿病。数据提取：数据由2位调查人员独立提取;通过讨论或由第三名调查人员使用标准化数据抽象工具解决了分歧。对于连续终点，计算从基线开始具有95％CI的变化的加权平均差（WMD），作为二甲双胍和安慰剂组的平均值之差。对于分类终点，计算出具有95％CI的合并相对风险（RR）。所有分析均使用随机效应模型。数据合成：与安慰剂相比，二甲双胍组的体重（WMD，3.16 kg; P = .0002），BMI（WMD，1.21 kg / m（2）; P = .0001），腰围（WMD，1.99）显着降低cm; P = .005）和HOMA-IR（WMD，1.71; P = .004）。糖尿病风险的降低没有统计学意义（RR，0.30; P = .13）。结论：该分析表明，在接受AAP治疗的患者中使用二甲双胍可以降低代谢风险。还需要其他随机对照试验，但可用数据支持在临床实践中考虑这种干预措施。

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