Yoo Hyunju, Park Inwhee, Kim Dae Jung, Lee Sukhyang
Division of Clinical Pharmacy, College of Pharmacy, Ajou University, 206 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of Korea.
Department of Nephrology, College of Medicine, Ajou University, Suwon, Republic of Korea.
Int J Clin Pharm. 2019 Apr;41(2):563-573. doi: 10.1007/s11096-019-00794-7. Epub 2019 Mar 12.
Background Diabetes is a major cause of microvascular complications. Renin-angiotensin-aldosterone blockers have been known to have the benefits of delaying onset and progression of diabetic complications including nephropathy. Objective To evaluate the effect of sarpogrelate, an antiplatelet agent, on the new onset diabetic complications in patients with type 2 diabetes mellitus. Setting A 1108-bed tertiary university hospital in Korea. Methods A retrospective cohort study was conducted using electronic medical records between 2010 and 2015 in Korea. The study cohort of the propensity score matched patients with or without sarpogrelate was evaluated for the diabetic complications identified with the diagnosis codes in T2DM patients on the metformin based antidiabetic therapy. Nephropathy was further evaluated for progression of kidney function. Main outcome measure The incidence of composite microvascular complications included nephropathy, neuropathy, and retinopathy. Results The 1:2 propensity score matched 478 out of 14,440 patients were included in the final analysis with or without sarpogrelate (162 vs. 316 patients). The incidence of nephropathy, neuropathy, and retinopathy was 1.23% versus 5.38% (HR 0.21, 95% CI 0.05-0.92), 1.23% versus 4.43% (HR 0.26, 95% CI 0.06-1.14), and 6.17% versus 6.33% (HR 0.93, 95% CI 0.43-1.97) with sarpogrelate and without sarpogrelate, respectively. Changes in the estimated glomerular filtration rate and urine albumin creatinine ratio were not significantly different between the groups. Conclusion In Korean patients, sarpogrelate, an antiplatelet agent, was associated with reducing the incidence and progression of nephropathyin type 2 diabetes, but not associated with the composite endpoints including neuropathy and retinopathy.
糖尿病是微血管并发症的主要原因。已知肾素 - 血管紧张素 - 醛固酮阻滞剂具有延缓包括肾病在内的糖尿病并发症的发生和进展的益处。目的：评估抗血小板药物沙格雷酯对2型糖尿病患者新发糖尿病并发症的影响。地点：韩国一家拥有1108张床位的三级大学医院。方法：利用2010年至2015年韩国的电子病历进行回顾性队列研究。对倾向评分匹配的使用或未使用沙格雷酯的患者队列，评估接受基于二甲双胍的抗糖尿病治疗的2型糖尿病患者中通过诊断代码确定的糖尿病并发症。进一步评估肾病患者的肾功能进展情况。主要结局指标：包括肾病、神经病变和视网膜病变的复合微血管并发症的发生率。结果：1:2倾向评分匹配后，14440例患者中的478例（使用或未使用沙格雷酯，分别为162例和316例）纳入最终分析。肾病、神经病变和视网膜病变的发生率分别为1.23% 对5.38%（HR 0.21，95%CI 0.05 - 0.92）、1.23% 对4.43%（HR 0.26，95%CI 0.06 - 1.14）以及6.17% 对6.33%（HR 0.93，95%CI 0.43 - 1.97），分别为使用沙格雷酯组和未使用沙格雷酯组。两组间估计肾小球滤过率和尿白蛋白肌酐比值的变化无显著差异。结论：在韩国患者中，抗血小板药物沙格雷酯与降低2型糖尿病肾病的发生率和进展相关，但与包括神经病变和视网膜病变在内的复合终点无关。
