GLP-1 受体激动剂对 2 型糖尿病患者心律失常及其亚型的影响：系统评价和荟萃分析。
Effects of GLP-1 receptor agonists on arrhythmias and its subtypes in patients with type 2 diabetes: A systematic review and meta-analysis.
机构信息
Department of Endocrinology and Metabolism, First Affiliated Hospital of Jinan University, Guangzhou, China.
Department Clinical Experimental Center, First Affiliated Hospital of Jinan University, Guangzhou, China.
出版信息
Front Endocrinol (Lausanne). 2022 Aug 11;13:910256. doi: 10.3389/fendo.2022.910256. eCollection 2022.
PURPOSE
An update of a systematic review and meta-analysis of the risk of arrhythmias and their subtypes in type 2 diabetic patients receiving glucagon-like peptide 1 receptor agonist (GLP-1RA) medication according to data from the Cardiovascular Outcome Trial(CVOT).
METHODS
Randomized controlled trials (RCT) on GLP-1RA therapy and cardiovascular outcomes in type 2 diabetes mellitus patients published in full-text journal databases such as MEDLINE (via PubMed), Embase, Clinical Trials.gov, and the Cochrane Library from establishment to March 1, 2022 were searched. We assessed the quality of individual studies by the Cochrane risk-of-bias algorithm. RevMan 5.4.1 software was use for calculating meta-analysis.
RESULTS
A total of 60,081 randomized participants were included in the data of these 8 GLP-1RA cardiovascular outcomes trials. Pooled analysis reported no significant effect on total arrhythmia [RR=0.96, 95% CI (0.96, 1.05), =0.36], and its subtypes such as atrial fibrillation [RR=0.96, 95% CI (0.86, 1.07), =0.43], atrial flutter [RR= 0.82, 95% CI (0.57, 1.19), =0.30], atrial tachycardia [RR=0.64, 95% CI (0.20, 2.01), =0.44)], sinoatrial node dysfunction [RR=0.74, 95% CI (0.44, 1.25), =0.26], ventricular preterm systole [RR=1.42, 95% CI (0.62, 3.26), =0.41], second degree AV block [RR=0.96, 95% CI (0.53, 1.72), =0.88], complete AV block [RR=0.75, 95% CI (0.49, 1.17), =0.21], ventricular fibrillation [RR=1.00, 95% CI (0.50, 2.02), =1.00], ventricular tachycardia [RR=1.37, 95% CI (0.91, 2.08), =0.13] from treatment with GLP-1RA versus placebo. However, the risk of hypoglycemia was reduced by about 30% [RR=0.70, 95% CI (0.57, 0.87), =0.001] and the risk of pneumonia by about 25% [RR=0.85, 95% CI (0.75, 0.97), =0.01], both statistically significant differences.
CONCLUSION
In type 2 diabetic patients, treatment with GLP-1RA has no significant effect on the risk of major arrhythmias but significantly reduces the risk of hypoglycemia and pneumonia.
目的
根据心血管结局试验（CVOT）的数据，对接受胰高血糖素样肽 1 受体激动剂（GLP-1RA）药物治疗的 2 型糖尿病患者心律失常及其亚型风险进行系统评价和荟萃分析更新。
方法
检索 MEDLINE（通过 PubMed）、Embase、ClinicalTrials.gov 和 Cochrane 图书馆等全文期刊数据库中 2022 年 3 月 1 日之前发表的关于 GLP-1RA 治疗和 2 型糖尿病患者心血管结局的随机对照试验（RCT）。我们使用 Cochrane 偏倚风险算法评估个别研究的质量。RevMan 5.4.1 软件用于计算荟萃分析。
结果
共有 60081 名随机参与者纳入了这 8 项 GLP-1RA 心血管结局试验的数据中。汇总分析报告总心律失常无显著影响[RR=0.96，95%CI（0.96，1.05），=0.36]，其亚型如心房颤动[RR=0.96，95%CI（0.86，1.07），=0.43]、心房扑动[RR=0.82，95%CI（0.57，1.19），=0.30]、房性心动过速[RR=0.64，95%CI（0.20，2.01），=0.44]、窦房结功能障碍[RR=0.74，95%CI（0.44，1.25），=0.26]、室性期前收缩[RR=1.42，95%CI（0.62，3.26），=0.41]、二度房室传导阻滞[RR=0.96，95%CI（0.53，1.72），=0.88]、完全性房室传导阻滞[RR=0.75，95%CI（0.49，1.17），=0.21]、心室颤动[RR=1.00，95%CI（0.50，2.02），=1.00]、室性心动过速[RR=1.37，95%CI（0.91，2.08），=0.13]与安慰剂相比，GLP-1RA 治疗无显著差异。然而，低血糖风险降低了约 30%[RR=0.70，95%CI（0.57，0.87），=0.001]，肺炎风险降低了约 25%[RR=0.85，95%CI（0.75，0.97），=0.01]，差异均有统计学意义。
结论
在 2 型糖尿病患者中，GLP-1RA 治疗对主要心律失常风险无显著影响，但显著降低低血糖和肺炎风险。
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