二肽基肽酶-4 抑制剂在胰岛素治疗的 2 型糖尿病患者中的心血管结局。
Cardiovascular outcomes of dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes on insulin therapy.
机构信息
Dr. Yen's Clinic, No. 15, Shanying Rd., Gueishan Dist., Taoyuan City 33354, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
出版信息
Diabetes Res Clin Pract. 2018 Jun;140:279-287. doi: 10.1016/j.diabres.2018.04.012. Epub 2018 Apr 12.
AIMS
To compare the hazard of cardiovascular diseases between DPP-4 inhibitor users and non-users who were on insulin therapy.
METHODS
We conducted a population-based cohort study. 2652 patients with type 2 diabetes mellitus (T2DM) under insulin therapy were enrolled during 1997-2010. The incidence rates per 1000 person-years (PYs) of stroke, coronary heart disease (CAD) and heart failure were compared between 1326 DPP-4 inhibitor users and 1326 propensity score matched non-users. Multivariable Cox proportional hazards model was used to evaluate excess risk of the DPP-4 inhibitor non-users.
RESULTS
After adjustment of age, gender, comorbidities, drugs used and diabetes duration; the incidence rate per 1000 PYs were 21.70 and 9.88 in DPP-4 inhibitor non-users and users; DPP-4 inhibitor users had lower hazard ratio (HR) of stroke (adjusted HR: 0.59, 95% CI: 0.42-0.83, p value: 0.002) compared with non-users. The incidence rates per 1000 PYs of CAD and heart failure of control versus users were 19.85 versus 13.54 and 5.56 versus 4.78; the adjusted HRs of CAD and heart failure were 0.86 and 1.11. Both were non-significant.
CONCLUSION
This nationwide study demonstrated that insulin plus DPP-4 inhibitor users had significantly lower risk of stroke as compared with non-users.
目的
比较接受二肽基肽酶-4 抑制剂（DPP-4i）治疗和接受胰岛素治疗但未使用 DPP-4i 的患者发生心血管疾病的风险。
方法
我们开展了一项基于人群的队列研究。1997 年至 2010 年期间共纳入 2652 名接受胰岛素治疗的 2 型糖尿病（T2DM）患者。每 1000 人年（PY）的卒中、冠心病（CAD）和心力衰竭发生率在 1326 例 DPP-4i 使用者和 1326 例倾向评分匹配的非使用者之间进行了比较。多变量 Cox 比例风险模型用于评估 DPP-4i 非使用者的超额风险。
结果
校正年龄、性别、合并症、使用的药物和糖尿病病程后，DPP-4i 非使用者和使用者的 1000 PY 发生率分别为 21.70 和 9.88；与非使用者相比，DPP-4i 使用者发生卒中的风险比（HR）更低（校正 HR：0.59，95%CI：0.42-0.83，p 值：0.002）。对照组与使用者的 CAD 和心力衰竭的 1000 PY 发生率分别为 19.85 比 13.54 和 5.56 比 4.78；CAD 和心力衰竭的校正 HR 分别为 0.86 和 1.11，均无统计学意义。
结论
这项全国性研究表明，与非使用者相比，胰岛素加 DPP-4i 使用者发生卒中的风险显著降低。
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