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目的综合评价利尿剂、β受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体阻滞剂(ARB)和钙通道阻滞剂(CCB)5类降压药物对新发糖尿病(NOD)的影响。方法检索有关降压药物和NOD的临床试验,在WinBUGS 1.4.3软件中构建随机效应贝叶斯模型,估计这5类药物以及安慰剂之间的OR值及其优劣顺序。结果共纳入28项临床试验,将安慰剂作为被比较者,OR值分别为:ARB 1.23(95%CI:1.087～1.399),ACEI 1.204(95%CI:1.033～1.424),CCB 0.928 9(95%CI:0.779 3～1.095),β受体阻滞剂0.738 4(95%CI:0.604 7～0.890 6),利尿剂0.789 4(95%CI:0.654～0.928 3)。其中,ARB引发NOD的概率最低,其后依次为ACEI、安慰剂、CCB、利尿剂和β受体阻滞剂。结论 ARB、ACEI会减少NOD发生的风险,而CCB、利尿剂和β受体阻滞剂会增加NOD发生的风险。
Objective To evaluate the effects of diuretics, β-blockers, angiotensin converting enzyme inhibitors (ACEIs), angiotensin Ⅱ receptor blockers (ARBs) and calcium channel blockers (CCBs) Effect on New-onset Diabetes Mellitus (NOD). Methods The clinical trials of antihypertensive drugs and NOD were searched and the random effects Bayesian model was constructed in WinBUGS 1.4.3 software to estimate the OR values and the order of advantages and disadvantages of these 5 drugs and placebo. Results A total of 28 clinical trials were enrolled in the study. The ORs for placebo were as follows: ARB 1.23 (95% CI 1.087-1.399), ACEI 1.204 (95% CI 1.033-1.424), CCB 0.928 9 % CI: 0.779 3- 1.095), β blockers 0.738 4 (95% CI: 0.604 7-0.890 6), and diuretics 0.789 4 (95% CI 0.654-0.928 3). Among them, ARB caused the lowest probability of NOD, followed by ACEI, placebo, CCB, diuretics and β-blockers. Conclusions ARB and ACEI can reduce the risk of NOD. CCB, diuretics and β-blockers increase the risk of NOD.