胰高血糖素样肽-1 受体激动剂在 2 型糖尿病患者中的作用：一项荟萃分析。
Effect of glucagon-like peptide-1 receptor agonists in subjects with type 2 diabetes mellitus: A meta-analysis.
机构信息
Department of General practice, The Third Affiliated Hospital of Soochow University, Changzhou, China.
Department of Endocrinology, Wu Jin's Hospital of JiangSu University, Changzhou, China.
出版信息
J Clin Pharm Ther. 2021 Dec;46(6):1650-1658. doi: 10.1111/jcpt.13502. Epub 2021 Aug 5.
WHAT IS KNOWN AND OBJECTIVE
We performed a meta-analysis to evaluate the effects of glucagon-like peptide-1 receptor agonists compared to placebo on cardiovascular, kidney-related, and eye-related disease outcomes or on mortality in subjects with type 2 diabetes mellitus.
METHODS
A systematic literature search up to April 2021 was performed, and 8 studies included 61,661 subjects with type 2 diabetes mellitus at the start of the study, 29,034 of them were using glucagon-like peptide-1 receptor agonists and 32,627 were given a placebo. They reported on relationships between the effects of glucagon-like peptide-1 receptor agonists compared to placebo on mortality rates, cardiovascular, renal and ophthalmic outcomes in subjects with type 2 diabetes mellitus. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the effects of glucagon-like peptide-1 receptor agonists compared to placebo on the listed outcomes on subjects with type 2 diabetes mellitus, using the dichotomous method with a random or fixed-effect model.
RESULTS
The use of glucagon-like peptide-1 receptor agonists was associated with significantly lowered all-cause mortality (OR, 0.76; 95% CI, 0.65-0.89, p < 0.001), cardiovascular deaths (OR, 0.87; 95% CI, 0.81-0.94, p < 0.001), myocardial infarctions (OR, 0.92; 95% CI, 0.85-0.98, p = 0.01), strokes (OR, 0.81; 95% CI, 0.74--0.90, p < 0.001), hospital admissions owing to heart failure (OR, 0.91; 95% CI, 0.83-1.00, p = 0.04) and renal events (OR, 0.83; 95% CI, 0.77-0.89, p < 0.001) compared to placebo in subjects with type 2 diabetes mellitus. However, glucagon-like peptide-1 receptor agonists had significantly higher ophthalmic events (OR, 1.15; 95% CI, 1.04-1.29, p = 0.009) compared to placebo in subjects with type 2 diabetes mellitus.
WHAT IS NEW AND CONCLUSION
Glucagon-like peptide-1 receptor agonists may have a lower risk of all-cause mortality, cardiovascular death, myocardial infarction, stroke, hospital admission owing to heart failure and renal events compared to placebo in subjects with type 2 diabetes mellitus. However, they have significantly higher ophthalmic events compared to placebo in subjects with type 2 diabetes mellitus. Further studies are required to validate these findings.
已知和目的
我们进行了一项荟萃分析，以评估胰高血糖素样肽-1 受体激动剂与安慰剂相比，在 2 型糖尿病患者的心血管、肾脏相关和眼部相关疾病结局或死亡率方面的效果。
方法
对截至 2021 年 4 月的文献进行系统检索，共纳入 8 项研究，纳入了 61661 例 2 型糖尿病患者，其中 29034 例患者使用胰高血糖素样肽-1 受体激动剂，32627 例患者给予安慰剂。这些研究报告了胰高血糖素样肽-1 受体激动剂与安慰剂相比，在 2 型糖尿病患者死亡率、心血管、肾脏和眼部结局方面的关系。我们使用二项分类法，随机或固定效应模型，计算比值比（OR）及其 95%置信区间（CI），以评估胰高血糖素样肽-1 受体激动剂与安慰剂相比，在 2 型糖尿病患者中上述结局的效果。
结果
与安慰剂相比，使用胰高血糖素样肽-1 受体激动剂可显著降低全因死亡率（OR，0.76；95%CI，0.65-0.89，p < 0.001）、心血管死亡（OR，0.87；95%CI，0.81-0.94，p < 0.001）、心肌梗死（OR，0.92；95%CI，0.85-0.98，p = 0.01）、中风（OR，0.81；95%CI，0.74-0.90，p < 0.001）、因心力衰竭住院（OR，0.91；95%CI，0.83-1.00，p = 0.04）和肾脏事件（OR，0.83；95%CI，0.77-0.89，p < 0.001）。然而，与安慰剂相比，胰高血糖素样肽-1 受体激动剂会显著增加 2 型糖尿病患者的眼部事件（OR，1.15；95%CI，1.04-1.29，p = 0.009）。
新发现和结论
与安慰剂相比，胰高血糖素样肽-1 受体激动剂可能使 2 型糖尿病患者的全因死亡率、心血管死亡、心肌梗死、中风、因心力衰竭住院和肾脏事件的风险降低。然而，它们会使 2 型糖尿病患者的眼部事件风险显著增加。需要进一步的研究来验证这些发现。
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