Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Cardiovascular Research Centre (UnIC), Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Diabetes Metab Res Rev. 2021 Sep;37(6):e3413. doi: 10.1002/dmrr.3413. Epub 2020 Oct 12.
Non-alcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in Western countries and a common comorbidity with type 2 diabetes (T2D). It lacks effective pharmacotherapy. We aimed to summarize the evidence on the effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on liver structure and function.
Meta-analysis of randomized clinical trials in PubMed, Web of Science and ClinicalTrials.gov from their inception to April 2019. Trials evaluating liver function and/or structure and comparing SGLT2 inhibitors with placebo or other oral antidiabetic drugs in patients with T2D were included. Twenty studies (from 3033) were included. A total of 1950 patients with T2D, with or without NAFLD, were treated with SGLT2 inhibitors for at least 8 weeks, and 1900 patients were used as controls. Independent extraction was carried out by two observers. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis.
SGLT2 inhibitors induced a significant decrease in serum alanine (-7.43U/L, [95%CI -12.14, -2.71], p < 0.01), in aspartate aminotransferases (-2.83U/L, [-4.71, -0.95], p < 0.01), as well as in gamma glutamyl transferase (-8.21U/L, [-9.52, -6.91], p < 0.01), and an increase in total plasma bilirubin (8.19% [0.79, 15.59], p < 0.01), comparing with placebo or other oral antidiabetic drugs. SGLT2 inhibitors treatment was associated with a decrease in liver steatosis (-3.39% [-6.01, -0.77], p < 0.0.1).
Treatment with SGLT2 inhibitors improves liver structure and function in patients with T2D. This meta-analysis suggests that SGLT2 inhibitors are a promising pharmacological approach for treatment of NAFLD.
非酒精性脂肪性肝病（NAFLD）是西方国家最常见的慢性肝病形式，也是 2 型糖尿病（T2D）的常见合并症。它缺乏有效的药物治疗。我们旨在总结钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂对肝脏结构和功能影响的证据。
在 PubMed、Web of Science 和 ClinicalTrials.gov 上对从成立到 2019 年 4 月的随机临床试验进行荟萃分析。纳入评估肝功能和/或结构并比较 SGLT2 抑制剂与安慰剂或其他口服降糖药物在 T2D 患者中的试验。共纳入 20 项研究（来自 3033 项）。共 1950 例 T2D 患者，无论是否存在 NAFLD，接受 SGLT2 抑制剂治疗至少 8 周，1900 例患者作为对照。由两名观察者独立进行提取。本研究按照系统评价和荟萃分析的首选报告项目进行。
SGLT2 抑制剂可显著降低血清丙氨酸（-7.43U/L，[-12.14，-2.71]，p <0.01）、天门冬氨酸氨基转移酶（-2.83U/L，[-4.71，-0.95]，p <0.01）、γ-谷氨酰转移酶（-8.21U/L，[-9.52，-6.91]，p <0.01），并增加总血浆胆红素（8.19% [0.79，15.59]，p <0.01），与安慰剂或其他口服降糖药物相比。SGLT2 抑制剂治疗与肝脂肪变性减少相关（-3.39% [-6.01，-0.77]，p <0.01）。
SGLT2 抑制剂治疗可改善 T2D 患者的肝脏结构和功能。本荟萃分析表明，SGLT2 抑制剂是治疗 NAFLD 的一种有前途的药物治疗方法。
