在不同 eGFR 和白蛋白尿分类的 2 型糖尿病患者中，钠-葡萄糖共转运蛋白 2 抑制剂与骨折风险的关系：一项来自中国香港的基于人群的研究。
Fracture risks associated with sodium-glucose cotransporter-2 inhibitors in type 2 diabetes patients across eGFR and albuminuria categories: A population-based study in Hong Kong.
机构信息
Division of Endocrinology and Metabolism, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
出版信息
Diabetes Res Clin Pract. 2023 Mar;197:110576. doi: 10.1016/j.diabres.2023.110576. Epub 2023 Feb 11.
AIMS
To evaluate major osteoporotic fracture (MOF) risk among type 2 diabetes patients treated with sodium-glucose cotransporter-2 inhibitors (SGLT2i) across eGFR and albuminuria categories.
METHODS
A population-based cohort of type 2 diabetes patients started on SGLT2i or dipeptidyl peptidase-4 inhibitors (DPP4i) during 2007-2020 was identified from Hong Kong Hospital Authority database. One-to-one propensity score matching was applied to match each SGLT2i user with one DPP4i user. The primary outcomes were 180- and 365-day risks of MOF. Cox proportional hazard regression models were used to estimate hazard ratios (HR).
RESULTS
A total of 28,696 patients (14,348 in each group) were included. Over 180-day follow-up, MOF occurred in 25 (0.17 %) SGLT2i users and 24 (0.17 %) DPP4i users (incidence of 4.07 and 3.63/1,000 person-years, respectively). At 365 days, MOF occurred in 43 (0.30 %) SGLT2i users and 44 (0.31 %) DPP4i users (incidence of 4.16 and 3.64/1,000 person-years, respectively). Risks of MOF were comparable between two groups at both 180 days (HR = 1.13, 95 %CI 0.65-1.98, P = 0.67) and 365 days (HR = 1.15, 95 %CI 0.75-1.75, P = 0.52). Subgroup analyses were consistent across age, sex, eGFR, albuminuria, or KDIGO categories.
CONCLUSIONS
Our study did not reveal a statistically significant increase in fracture risk with SGLT2i use compared with DPP4i among type 2 diabetes patients, across eGFR and albuminuria categories.
目的
评估 2 型糖尿病患者在不同肾小球滤过率（eGFR）和白蛋白尿类别下使用钠-葡萄糖协同转运蛋白 2 抑制剂（SGLT2i）治疗时发生主要骨质疏松性骨折（MOF）的风险。
方法
从香港医院管理局数据库中确定了 2007 年至 2020 年间开始使用 SGLT2i 或二肽基肽酶-4 抑制剂（DPP4i）的 2 型糖尿病患者的人群队列。采用 1:1 倾向评分匹配，将每位 SGLT2i 用户与一位 DPP4i 用户相匹配。主要结局为 MOF 的 180 天和 365 天风险。使用 Cox 比例风险回归模型估计风险比（HR）。
结果
共纳入 28696 名患者（每组 14348 名）。在 180 天的随访期间，25 名（0.17%）SGLT2i 用户和 24 名（0.17%）DPP4i 用户发生 MOF（发生率分别为 4.07 和 3.63/1000 人年）。在 365 天时，43 名（0.30%）SGLT2i 用户和 44 名（0.31%）DPP4i 用户发生 MOF（发生率分别为 4.16 和 3.64/1000 人年）。在这两个组中，MOF 的风险在 180 天（HR=1.13，95%CI 0.65-1.98，P=0.67）和 365 天（HR=1.15，95%CI 0.75-1.75，P=0.52）时相当。亚组分析在年龄、性别、eGFR、白蛋白尿或 KDIGO 类别中均一致。
结论
在不同 eGFR 和白蛋白尿类别中，与 DPP4i 相比，2 型糖尿病患者使用 SGLT2i 治疗并未显示出骨折风险有统计学意义的增加。
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