GLP-1受体激动剂和双重激动剂在肥胖个体中的减重异质性及中介因素：一项Meta分析
Weight Reduction Heterogenicity and Mediators of GLP-1RAs and Dual Agonists for Individuals With Obesity: A Meta-Analysis.
文献信息
| PMID | 42733128 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Difei Lu |
| 作者单位 | Department of Endocrinology, Peking University First Hospital, Beijing, China. |
| 期刊 | Clinical obesity |
| SCI 分区 | Q3 |
| IF | 2.6 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
胰高血糖素样肽-1受体激动剂（GLP-1RAs）和双重激动剂已成为肥胖治疗的关键选择，但显著的减重异质性仍知之甚少。本Meta回归分析旨在识别影响这种异质性的因素。我们检索了Medline、Embase、Cochrane图书馆和Web of Science，截止日期为2026年2月1日，遵循PRISMA指南，纳入了32项符合条件的试验（40,408名参与者）。使用R软件进行Meta回归和亚组分析。汇总分析显示，GLP-1RAs和双重激动剂实现了加权平均减重9.36%（95% CI 7.92%-10.80%），研究间异质性高（I2=99.6%，p<0.001）。亚组分析显示，GLP-1/GIP双重激动剂（替尔泊肽）和更长的治疗持续时间（≥72周）产生了更优的减重效果。Meta回归表明，基线焦虑/抑郁与减重疗效呈正相关（β=2.44，p<0.001，R2=81.34%）。合并2型糖尿病（T2DM）、阻塞性睡眠呼吸暂停（OSA）和代谢功能障碍相关脂肪性肝病（MAFLD）与治疗反应呈负相关（均p<0.05）。情绪状态和代谢合并症包括T2DM、OSA和MAFLD是GLP-1RAs和双重激动剂减重疗效个体间差异的重要影响因素，为个性化肥胖管理提供了证据。
英文摘要
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual agonists have become pivotal options for obesity, but marked weight loss heterogeneity remains poorly understood. This meta-regression analysis aimed to identify factors influencing this heterogeneity. We searched Medline, Embase, The Cochrane Library, and Web of Science up to February 1, 2026, enrolling 32 eligible trials (40 408 participants) following PRISMA guidelines. Meta-regression and subgroup analyses were performed using R software. Pooled analysis showed that GLP-1RAs and dual agonists achieved a weighted mean weight reduction of 9.36% (95% CI 7.92%-10.80%), with high interstudy heterogeneity (I2 = 99.6%, p < 0.001). Subgroup analyses revealed that GLP-1/GIP dual agonists (tirzepatide) and longer treatment duration (≥ 72 weeks) yielded superior weight-lowering effects. Meta-regression demonstrated that baseline anxiety/depression was positively associated with weight loss efficacy (β = 2.44, p < 0.001, R2 = 81.34%). Comorbid Type 2 diabetes mellitus (T2DM), obstructive sleep apnea (OSA) and metabolic dysfunction-associated fatty liver disease (MAFLD) were negatively correlated with treatment response (all p < 0.05). Emotional state and metabolic comorbidities including T2DM, OSA and MAFLD are important influencing factors of the interindividual differences of weight loss efficacy of GLP-1RAs and dual agonists, providing evidence for personalized obesity management.