Efficacy and safety of dipeptidyl peptidase-4 inhibitors in the treatment of type 2 diabetes mellitus patients with moderate to severe renal impairment: a meta-analysis.

OBJECTIVE: Dipeptidyl peptidase-4 (DPP-4) inhibitors are a new class of oral antidiabetic agents for type 2 diabetes mellitus (T2DM) patients. However, the effects and safety of DPP-4 inhibitors in T2DM patients with renal impairment (RI) remain controversial. Therefore, we conducted this meta-analysis to assess the efficacy and safety of DPP-4 inhibitors in T2DM patients with moderate to severe RI. MATERIALS AND METHODS: The PubMed, Embase, and Web of Science database were searched for published randomized controlled trials (RCTs), which compared DPP-4 inhibitors with placebo or a control regimen. A fixed-model effect or random-effect model was used to assess the effects of DPP-4 inhibitors on T2DM patients with RI. Subgroup analysis or meta-regression analysis were performed to explore the potential sources of heterogeneity among the included studies. RESULTS: 13 RCTs with a total of 2,940 patients were included in this meta-analysis. Compared with other treatments, DPP-4 inhibitors were associated with a greater change in HbA1c level (weight mean difference (WMD)=-0.50, 95%CI: -0.61, -0.39; p<0.001), and a higher response rate of patients achieving the HbA1c goal of <7% (risk ratio (RR)=1.38, 95%CI: 1.12, 1.70; p=0.002). Subgroup analysis suggested that the reduced HbA1c was observed in all types of DPP-4 inhibitors, and in patients with moderate or severe RI, but not in those with end-stage renal disease. DPP-4 inhibitors did not significantly lower the FPG level (WMD=-0.36, 95%CI: -0.92, 0.20; p=0.204), and this was seen in all types of DPP-4 inhibitors except gemigliptin, which showed a significant reduction in FPG level. The prevalence of adverse events (RR=0.98, 95%CI: 0.94, 1.02; p=0.256) in the two groups was not significantly different, and DPP-4 inhibitors did not induce a higher rate of hypoglycemia (RR=1.31, 95%CI: 0.97, 1.77; p=0.075). CONCLUSIONS: DPP-4 inhibitors significantly lowered HbA1c levels in T2DM patients with moderate to severe RI. And the treatment of DPP-4 inhibitors did not increase the risk of hypoglycemia and adverse events. Considering the potential limitations in this meta-analysis, more large-scale, well-conducted RCTs are needed to identify our findings.

A preliminary study on the molecular evolution of the two routes of intrauterine transmission of HBV.

Intrauterine transmission of hepatitis B virus (HBV) is one of the main reasons for the failure of vaccination and plays an important role in areas with high HBV prevalence. In the present study, the quasispecies isolated from eight pairs of HBsAg-positive mothers and their neonates, who were infected with HBV by intrauterine transmission, were selected as study subjects. Phylogenetic trees of the HBV strains of each pair of mother and neonate were constructed, the topological structures were compared, and the distance between and within the quasispecies was calculated. The eight phylogenetic trees included four types. In the first type, the maternal and neonatal sequences clustered into one clade. In the second type, the sequences of the mothers and neonates formed separate monophyletic clusters, and the two clades were sister groups. In the third type, the strains of mother were the ancestors of the neonatal strains. In the fourth type, the strains of the mothers clustered with only some of the sequences of the neonate, and the other strains of the neonate formed another monophyletic group. Combined with the genetic distance, possible transmission routes of the eight cases are proposed.

[A follow-up study on correlated factors for intrauterine infection of hepatitis B virus].

One hundred and twenty-two pregnant women with positive serum hepatitis B surface antigen (HBsAg) and their infants were followed-up to study the risk factors related to intrauterine infection of hepatitis B virus (HBV). Infants were immunized with three doses of hepatitis B vaccine within 24 hours after birth, one month and six months of age, respectively, and hepatitis B immunoglobulin (HBIG) was injected simultaneously with the first dose. Markers of HBV infection in pregnant women and infants were detected by enzyme linked immunosorbent assay (ELISA). Results showed that 13 infants were detected positive for HBsAg in their sera, eight of them were positive at their birth and the other five converted positive during follow-up. Simple and multiple logistic regression analyses showed that positivity of hepatitis Be antigen (HBeAg) in mothers and their threatened abortion related to intrauterine infection, with relative risks of 31.27 and 10.87, respectively.

[The preliminary study on the hepatitis B virus infection rate of peripheral blood mononuclear cell in both HBsAg and HBeAg-positive pregnant women and its role in intrauterine transmission].

OBJECTIVE: To study the hepatitis B virus (HBV) infection rate of peripheral blood mononuclear cells (PBMC) and the role of infected PBMC in the intrauterine transmission. METHODS: Polymerase chain reaction (PCR) was using for detection of HBV-DNA in PBMC of 52 both HBsAg and HBeAg positive pregnant women just before onset of labour, and HBsAg were detected in sera of their neonates by enzyme linked immunoabsorbent assay (ELISA) within 24 hours after birth. RESULTS: HBV infection rate of PBMC in these women was 46.2% (24/52). There was positive correlation between infection rate of PBMC and HBsAg titre of pregnant women (chi 2 = 4.59, P < 0.05), but no relationship between PBMC infection rate and neonatal HBV infection. CONCLUSION: The possibility of intrauterine transmission of HBV by infected PBMC through transplacental passage was small.