Department of Cardiology, Copenhagen University Hospital, Gentofte, Hellerup, Denmark.
Diabetes Res Clin Pract. 2011 Oct;94(1):119-25. doi: 10.1016/j.diabres.2011.07.011. Epub 2011 Aug 9.
The aim was to investigate the outcomes of individual sulfonylureas in patients with heart failure (HF).
All patients hospitalized with HF for the first time in 1997-2006, alive 30 days after discharge, and who received anti-diabetic monotherapy with glimepiride (n=1097), glibenclamide (glyburide) (n=1031), glipizide (n=557), gliclazide (n=251), or tolbutamide (n=541) were identified from nationwide registers. Risk of all-cause mortality was assessed by multivariable Cox regression models.
Over the median observational time of 744 (Inter Quartile Range 268-1451) days, 2242 patients (64%) died. The analysis demonstrated similar hazard ratio (HR) for mortality for treatment with glimepiride (1.10 [95% confidence interval 0.92-1.33]), glibenclamide (1.12 [0.93-1.34]), glipizide (1.14 [0.93-1.38]), tolbutamide (1.04 [0.85-1.26]), and gliclazide (reference). Grouped according to pancreatic specificity, i.e., with tolbutamide, glipizide, and gliclazide as specific, and glibenclamide, and glimepiride as non-specific agents, no differential prognosis was found between the two groups (HR 1.04 [0.96-1.14], for non-specific, compared to pancreas specific agents). The prognosis was not dependent on prior acute myocardial infarction or ischemic heart disease (p for interactions >0.3).
In current clinical practice, it is unlikely that there are considerable differences in risk of mortality associated with individual sulfonylureas in patients with heart failure.
旨在研究心力衰竭（HF）患者中个体磺酰脲类药物的治疗结局。
从全国性登记处确定了 1997-2006 年首次因 HF 住院且出院后 30 天存活，且接受格列美脲（n=1097）、格列本脲（glyburide）（n=1031）、格列吡嗪（n=557）、格列齐特（n=251）或甲苯磺丁脲（n=541）单药抗糖尿病治疗的所有患者。通过多变量 Cox 回归模型评估全因死亡率的风险。
在中位观察时间 744（四分位距 268-1451）天内，2242 例患者（64%）死亡。分析表明，格列美脲（1.10[95%置信区间 0.92-1.33]）、格列本脲（1.12[0.93-1.34]）、格列吡嗪（1.14[0.93-1.38]）、甲苯磺丁脲（1.04[0.85-1.26]）和格列齐特（参照）治疗的死亡率的危险比（HR）相似。根据胰腺特异性分组，即甲苯磺丁脲、格列吡嗪和格列齐特为特异性，格列本脲和格列美脲为非特异性药物，未发现两组之间的预后存在差异（HR 1.04[0.96-1.14]，非特异性药物与胰腺特异性药物相比）。预后与既往急性心肌梗死或缺血性心脏病无关（交互作用的 p 值>0.3）。
在当前的临床实践中，心力衰竭患者中使用个体磺酰脲类药物与死亡率相关的风险不太可能存在显著差异。
