Sinha Binayak, Datta Debasis, Ghosal Samit
Department of Endocrinology, AMRI Hospitals Kolkata India.
Department of Hepatology, Fortis Hospital Kolkata India.
JGH Open. 2020 Dec 7;5(2):219-227. doi: 10.1002/jgh3.12473. eCollection 2021 Feb.
Sodium glucose cotransporter 2 inhibitors (SGLT-2i), by way of their unique mode of action, present an attractive strategy for the treatment of type 2 diabetes and non-alcoholic fatty liver disease (NAFLD), which often coexist and may lead to severe complications. However, the evidence for treatment with SGLT-2i is limited to small heterogeneous studies. Therefore, this meta-analysis was conducted to deduce the effects of SGLT-2i in NAFLD with type 2 diabetes (T2D).
A web-based search identified nine randomized controlled trials from the Cochrane Library, Embase, and PubMed for this meta-analysis. The Comprehensive Meta-Analysis Software version 3 was used to calculate the effect size.
The outcomes of interest were analyzed from a pooled population of 11 369 patients-7281 on SGLT-2i and 4088 in the control arm. SGLT-2i therapy produced a statistically significant improvement in alanine aminotransferase [standardised mean difference (SDM), -0.21, 95% confidence interval (CI), -0.32 to -0.10, < 0.01], aspartate aminotransferase (Standardised mean difference (SDM), -0.15, 95% CI, -0.24 to -0.07, < 0.01), and liver fat as measured by proton density fat fraction (SDM, -0.98, 95% CI, -1.53 to -0.44, < 0.01) in comparison to standard of care or placebo. In addition, there was a significant reduction in glycosylated hemoglobin (SDM, -0.37, 95% CI, -0.60 to -0.14, < 0.01) and weight (SDM, -0.58, 95% CI, -0.93 to -0.23, < 0.01) in the SGLT-2i arm.
This meta-analysis provides a convincing signal that SGLT-2i have a salutary effect on NAFLD in type 2 diabetes (T2D), probably driven by an improvement of glycemia and body weight, which in turn attenuates hepatic inflammation and hepatic fat accumulation.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）通过其独特的作用方式，为2型糖尿病和非酒精性脂肪性肝病（NAFLD）的治疗提供了一种有吸引力的策略，这两种疾病常同时存在并可能导致严重并发症。然而，SGLT-2i治疗的证据仅限于小型异质性研究。因此，进行了这项荟萃分析以推断SGLT-2i对2型糖尿病（T2D）合并NAFLD的影响。
通过基于网络的检索，从Cochrane图书馆、Embase和PubMed中确定了9项随机对照试验用于该荟萃分析。使用综合荟萃分析软件版本3计算效应量。
对11369名患者的汇总人群进行了感兴趣结局的分析，其中7281名患者接受SGLT-2i治疗，4088名患者在对照组。与标准治疗或安慰剂相比，SGLT-2i治疗使丙氨酸氨基转移酶[标准化均数差（SDM），-0.21，95%置信区间（CI），-0.32至-0.10，<0.01]、天冬氨酸氨基转移酶（标准化均数差（SDM），-0.15，95%CI，-0.24至-0.07，<0.01）以及通过质子密度脂肪分数测量的肝脏脂肪（SDM，-0.98，95%CI，-1.53至-0.44，<0.01）有统计学显著改善。此外，SGLT-2i治疗组糖化血红蛋白（SDM，-0.37，95%CI，-0.60至-0.14，<0.01）和体重（SDM，-0.58，95%CI，-0.93至-0.23，<0.01）显著降低。
这项荟萃分析提供了一个有说服力的信号，即SGLT-2i对2型糖尿病（T2D）合并的NAFLD有有益作用，这可能是由血糖和体重的改善驱动的，进而减轻肝脏炎症和肝脏脂肪堆积。
