Table 2_The role of GLP-1 receptor agonists in IBD-related surgery and IBD-related complications of inflammatory bowel disease among patients with metabolic comorbidities: a systematic review and meta-analysis.docx

BackgroundGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for type 2 diabetes and obesity, and emerging evidence suggests potential immunomodulatory effects. However, few studies have evaluated their role in inflammatory bowel disease (IBD), and no comprehensive clinical trials exist. This meta-analysis aimed to assess the association between GLP-1RA use and IBD-related surgeries and complications.
MethodsA systematic literature search was conducted in PubMed, Embase, and Web of Science from inception to March 2025. Cohort studies comparing IBD patients treated with GLP-1RAs versus non-users were included. Two reviewers independently performed study selection and data extraction. Random-effects meta-analyses were performed using log-transformed effect sizes. Heterogeneity was assessed using I2 and τ2. Publication bias was evaluated through funnel plots, and certainty of evidence was graded using the GRADE framework.
ResultsSix studies were included, providing eight effect estimates (two studies contributed two cohorts each). Three of the six included studies (50%) were non–peer-reviewed conference abstracts, which may affect interpretability. For IBD-related surgery (4 effect estimates), GLP-1RA use was significantly associated with lower risk (pooled estimate: 0.45; 95% CI: 0.35–0.59; I2 = 38.1%). For IBD-related complications (4 estimates), GLP-1RA use showed a non-significant trend toward benefit (estimate: 0.39; 95% CI: 0.15–1.03), with high heterogeneity (I2 = 98.9%). Sensitivity analysis supported robustness for surgery but revealed instability in complication outcomes. Funnel plots showed no publication bias for surgery, but asymmetry was noted for complications.
ConclusionGLP-1RA use may reduce the risk of IBD-related surgery among IBD patients with metabolic comorbidities. Findings for IBD-related complications should be interpreted with caution due to substantial heterogeneity and the inclusion of abstract-only studies. Further prospective research is warranted.
Systematic review registrationThis systematic review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), under registration ID CRD420251015882. The full protocol is publicly accessible through the PROSPERO database at https://www.crd.york.ac.uk/prospero/. No amendments were made to the original protocol. Any changes arising during the peer-review process will be transparently documented in the final publication.

研究背景：胰高血糖素样肽-1受体激动剂（Glucagon-like peptide-1 receptor agonists，GLP-1RAs）目前广泛应用于2型糖尿病与肥胖的临床治疗，越来越多的研究证据表明其具备潜在的免疫调节作用。但目前鲜有研究探讨其在炎症性肠病（inflammatory bowel disease，IBD）中的作用，且尚无相关大规模综合性临床试验。本项meta分析旨在评估GLP-1RA使用与炎症性肠病相关手术及并发症的关联。
研究方法：本研究于2025年3月前，系统检索PubMed、Embase及Web of Science数据库自建库以来的所有相关文献。纳入对比接受GLP-1RA治疗与未接受该类药物治疗的炎症性肠病患者的队列研究。由2名评价者独立完成文献筛选与数据提取工作。采用对数转换后的效应量进行随机效应模型meta分析，通过I²和τ²指标评估研究间异质性；采用漏斗图评估发表偏倚，并通过GRADE分级框架对证据质量进行评级。
研究结果：本研究共纳入6项相关研究，共计8份效应量（其中2项研究各提供2个队列数据）。纳入的6项研究中，3项（占比50%）为未经过同行评议的会议摘要，这可能会对研究结果的解读产生影响。针对炎症性肠病相关手术（共4份效应量）的分析显示，使用GLP-1RA与手术风险降低显著相关（合并效应量：0.45；95%置信区间：0.35~0.59；I²=38.1%）。针对炎症性肠病相关并发症（共4份效应量）的分析显示，使用GLP-1RA呈现出获益趋势，但该趋势未达到统计学显著性（效应量：0.39；95%置信区间：0.15~1.03），且研究间存在高度异质性（I²=98.9%）。敏感性分析结果显示，手术相关分析结果稳健，但并发症相关分析结果存在不稳定性。漏斗图分析显示，手术相关研究无明显发表偏倚，但并发症相关研究存在漏斗图不对称现象。
研究结论：对于合并代谢共病的炎症性肠病患者，使用GLP-1RA或许可降低其炎症性肠病相关手术的风险。由于研究间存在显著异质性且纳入了仅以会议摘要形式发表的研究，对于炎症性肠病相关并发症的分析结果应谨慎解读。未来仍需开展更多前瞻性研究以验证本结论。
系统评价注册信息：本系统评价已预先在国际系统评价前瞻性注册平台（International Prospective Register of Systematic Reviews，PROSPERO）完成注册，注册编号为CRD420251015882。完整的研究方案可通过PROSPERO数据库（https://www.crd.york.ac.uk/prospero/）公开获取，研究初始方案未进行任何修订。同行评议过程中产生的任何方案调整，均会在最终发表的论文中进行透明化说明。