Liang Chung-Yu, Chen Dong-Yi, Mao Chun-Tai, Hsieh I-Chang, Hung Ming-Jui, Wang Chao-Hung, Wen Ming-Shien, Cherng Wen-Jin, Chen Tien-Hsing
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung.
Chang Gung University College of Medicine, Taoyuan.
Medicine (Baltimore). 2018 Dec;97(52):e13844. doi: 10.1097/MD.0000000000013844.
Limited data are available about the cardiovascular (CV) safety and efficacy of sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, in ischemic stroke patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Ischemic stroke patients with T2DM and CKD were selected from the Taiwan National Health Insurance Research Database (NHIRD) from March 1, 2009 to December 31, 2011. A total of 1375 patients were divided into 2 age- and gender-matched groups: patients who received sitagliptin (n = 275; 20%) and those who did not (n = 1,100). Primary major adverse cardiac and cerebrovascular events (MACCE), including ischemic stroke, hemorrhagic stroke, myocardial infarction (MI), or CV death, were evaluated. During a mean 1.07-year follow-up period, 45 patients (16.4%) in the sitagliptin group and 165 patients (15.0%) in the comparison group developed MACCEs (Hazard ratio [HR] 1.05; 95% confidence interval [CI], 0.75-1.45). Compared to the non-sitagliptin group, the sitagliptin group had a similar risk of ischemic stroke (HR 0.82; 95% CI, 0.51-1.32.), hemorrhagic stroke (HR 1.50; 95% CI, 0.58-3.82), MI (HR 1.14; 95% CI, 0.49-2.65), and CV mortality (HR 1.06; 95% CI, 0.61-1.85). The use of sitagliptin in recent ischemic stroke patients with T2DM and CKD was not associated with increased or decreased risk of adverse CV events.
关于二肽基肽酶-4（DPP-4）抑制剂西他列汀在患有2型糖尿病（T2DM）和慢性肾脏病（CKD）的缺血性中风患者中的心血管（CV）安全性和疗效，可用数据有限。从2009年3月1日至2011年12月31日的台湾国民健康保险研究数据库（NHIRD）中选取患有T2DM和CKD的缺血性中风患者。总共1375名患者被分为两个年龄和性别匹配的组：接受西他列汀治疗的患者（n = 275；20%）和未接受治疗的患者（n = 1100）。评估主要的重大不良心脑血管事件（MACCE），包括缺血性中风、出血性中风、心肌梗死（MI）或心血管死亡。在平均1.07年的随访期内，西他列汀组有45名患者（16.4%）发生MACCE，对照组有165名患者（15.0%）发生MACCE（风险比[HR] 1.05；95%置信区间[CI]，0.75 - 1.45）。与非西他列汀组相比，西他列汀组发生缺血性中风的风险相似（HR 0.82；95% CI，0.51 - 1.32），出血性中风（HR 1.50；95% CI，0.58 - 3.82），MI（HR 1.14；95% CI，0.49 - 2.65）和心血管死亡率（HR 1.06；95% CI，0.61 - 1.85）。在近期患有T2DM和CKD的缺血性中风患者中使用西他列汀与不良心血管事件风险的增加或降低无关。
