替尔泊肽对比司美格鲁肽治疗超重或肥胖人群有效性与安全性的Meta分析

doi:10.3877/cma.j.issn.2095-9605.2025.02.006

目的

通过Meta分析对比替尔泊肽（Tirzepatide）与司美格鲁肽（Semaglutide）治疗超重或肥胖人群的有效性与安全性。

方法

检索Medline、Pubmed、Embase、Web of science、Cochrane中心注册数据库、知网、万方和维普等数据库中关于替尔泊肽与司美格鲁肽在超重或肥胖患者中应用的对比研究。文献质量评价采用Minors条目，使用Stata 14.0软件进行统计分析。

结果

共纳入3项研究，结果显示：替尔泊肽治疗后的总体重下降百分比与司美格鲁肽相比无统计学差异（MD=-4.26%, 95%CI：-8.63%~0.10%）；体重减轻≥5%、≥10%和≥15%人群比例高于司美格鲁肽组（92% vs. 72% ，64% vs. 45%，45% vs. 23%，差异有统计学意义）；两个药物的总不良反应发生率差异无统计学意义（RR 1.00，95%CI: 0.89~1.13）。

结论

替尔泊肽的整体减重效果要优于司美格鲁肽，可以显著降低超重或肥胖患者的体重，且不良反应发生率低，可成为肥胖药物治疗的一种新选择方案。

关键词: 替尔泊肽, 司美格鲁肽, 超重, 肥胖, Meta分析

Objective

Evaluating the efficacy and safety of tirzepatide compared with semaglutide in patients with overweight or obesity by a meta-analysis.

Methods

Medline, Pubmed, Embase, Web of Science, Cochrane Libarary, CNKI, Wanfang and CMJD were searched for studies comparing tirzepatide with semaglutide in patients with overweight or obesity. The quality of including studies was assessed by methodological index for non-randomized studies (MINORS). Stata 14.0 was used for meta-analysis.

Results

3 studies (18611 individuals) were analysed. No statistical difference was found between the two groups in total weight reduction (%) (MD=-4.26%, 95%CI: -8.63%~0.10%). Patients receiving tirzepatide had a significantly higher proportion of weight loss ≥5%, ≥10% and ≥15% compared with semaglutide (92% vs. 72%, 64% vs. 45%, 45% vs. 23%). There was no statistical difference between the two medications in the occurrence of total adverse events (RR 1.00, 95%CI: 0.89~1.13).

Conclusions

Our results suggest the use of tirzepatide is better than that of semaglutide in patients with overweight or obesity which lead a significant weight reduction with a low occurrence of adverse reactions and can be a new option for the treatment of obesity.

Key words: Tirzepatide, Semaglutide, Overweight, Obesity, Meta-analysis

图1 文献筛选流程图

表1 纳入文献的基线特征

作者	年份	研究类型	总例数	平均年龄（年）	替尔泊肽组年龄（年）	司美格鲁肽组年龄（年）	替尔泊肽组性别比（男:女）	司美格鲁肽组性别比（男:女）	替尔泊肽组体重（kg）	司美格鲁肽组体重（kg）	替尔泊肽组BMI（kg/m²）	司美格鲁肽组BMI（kg/m²）	糖尿病（%）	用药剂量	结局指标	干预时间（月）
Rodriguez等^[12]	2024	回顾性研究	18385	52.0±12.9	51.9±12.7	52.0±13.2	2709: 6484	2707: 6486	110±25.7	110±25.8	39.0±8.08	39.1±8.09	52.0	替尔泊肽5 mg 司美格鲁肽0.5 mg	体重变化、药物不良反应	12个月
Zakaria等^[13]	2024	回顾性研究	111	43.1±9.9	未详细分组		44: 67（总性别比，未详细分组）		95.44±20.92（总基线体重，未详细分组）		<30，31；>30,80（未详细分组）		22.9	替尔泊肽5/7.5/10 mg 司美格鲁肽1.0 mg	体重变化、代谢疾病改善情况	3个月
Jamal等^[14]	2024	回顾性研究	115	38.1±10.4	40.2±10.5	38.1±10.3	8: 37	14: 56	100.2±28.5	90.1±19.4	36.9±7.1	33.9±6.0	1.7	替尔泊肽<10 mg,>10 mg 司美格鲁肽<1.0 mg,>1.0 mg	体重变化、药物不良反应	6个月

表1 纳入文献的基线特征

作者	年份	研究类型	总例数	平均年龄（年）	替尔泊肽组年龄（年）	司美格鲁肽组年龄（年）	替尔泊肽组性别比（男:女）	司美格鲁肽组性别比（男:女）	替尔泊肽组体重（kg）	司美格鲁肽组体重（kg）	替尔泊肽组BMI（kg/m²）	司美格鲁肽组BMI（kg/m²）	糖尿病（%）	用药剂量	结局指标	干预时间（月）
Rodriguez等^[12]	2024	回顾性研究	18385	52.0±12.9	51.9±12.7	52.0±13.2	2709: 6484	2707: 6486	110±25.7	110±25.8	39.0±8.08	39.1±8.09	52.0	替尔泊肽5 mg 司美格鲁肽0.5 mg	体重变化、药物不良反应	12个月
Zakaria等^[13]	2024	回顾性研究	111	43.1±9.9	未详细分组		44: 67（总性别比，未详细分组）		95.44±20.92（总基线体重，未详细分组）		<30，31；>30,80（未详细分组）		22.9	替尔泊肽5/7.5/10 mg 司美格鲁肽1.0 mg	体重变化、代谢疾病改善情况	3个月
Jamal等^[14]	2024	回顾性研究	115	38.1±10.4	40.2±10.5	38.1±10.3	8: 37	14: 56	100.2±28.5	90.1±19.4	36.9±7.1	33.9±6.0	1.7	替尔泊肽<10 mg,>10 mg 司美格鲁肽<1.0 mg,>1.0 mg	体重变化、药物不良反应	6个月

表2 文献质量评级（MINORS条目）

文献	研究目的明确	纳入对象连贯	计划数据收集	终点结局能否反应研究目的	终点结局评价的客观性	随访时间是否充足	失访率低于5%	总分
Rodriguez等^[12]	2	2	2	2	2	2	2	14
Zakaria等^[13]	2	2	2	2	2	2	2	14
Jamal等^[14]	2	2	2	2	2	2	1	13

表2 文献质量评级（MINORS条目）

文献	研究目的明确	纳入对象连贯	计划数据收集	终点结局能否反应研究目的	终点结局评价的客观性	随访时间是否充足	失访率低于5%	总分
Rodriguez等^[12]	2	2	2	2	2	2	2	14
Zakaria等^[13]	2	2	2	2	2	2	2	14
Jamal等^[14]	2	2	2	2	2	2	1	13

图2 替尔泊肽（Tirzepatide）与司美格鲁肽（Semaglutide）治疗后比较。A为体重下降百分比对比情况；B为BMI下降对比情况

图4 替尔泊肽与司美格鲁肽药物不良反应比较

图3 药物治疗后体重减轻≥5%、≥10%、≥15%的患者比例。A为替尔泊肽治疗组；B为司美格鲁肽治疗组

图5 体重下降百分比发表偏倚分析

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Comparing the efficacy and safety of Tirzepatide with Semaglutide in patients with overweight or obesity: a Meta-analysis

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Comparing the efficacy and safety of Tirzepatide with Semaglutide in patients with overweight or obesity: a Meta-analysis