评价二肽基肽酶-4 抑制剂对接受胰岛素治疗的 2 型糖尿病患者冠状动脉疾病进展的影响：基于计算机断层扫描的研究。
Effect of dipeptidyl peptidase-4 inhibitor on the progression of coronary artery disease evaluated by computed tomography in patients receiving insulin therapy for type 2 diabetes mellitus.
机构信息
Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
出版信息
J Diabetes. 2023 Nov;15(11):944-954. doi: 10.1111/1753-0407.13449. Epub 2023 Aug 1.
BACKGROUND
We evaluated the effect of a dipeptidyl peptidase-4 inhibitor (DPP-4i) on the progression of obstructive coronary artery disease (OCAD) in patients with type 2 diabetes mellitus (T2DM) receiving insulin therapy.
METHODS
Using a multicenter clinical data warehouse, we analyzed the patients receiving insulin therapy for T2DM who underwent coronary computed tomography angiography (CCTA) for ≥2 times. The patients were divided into two groups according to the presence of DPP-4i prescription between the two CCTA examinations. The prevalence of OCAD (>50% stenosis on CCTA), new revascularization rates, and changes in the coronary calcium score (CCS) were analyzed.
RESULTS
A total of 623 patients were included, and a DPP-4i was prescribed to 380 (60.9%) patients. The median time difference between the two CCTAs was 39.0 (17.0-61.4) months. Newly developed OCAD at the follow-up CCTA was detected in 62 (16.3%) patients in the DPP-4i group and 76 (31.3%) patients in the no DPP-4i group (p < 0.001). The risk of new OCAD or new revascularization was lower in the DPP-4i group (19.7% vs. 38.7%; p < 0.001). After propensity score matching, the prevalence of new OCAD (15.9% vs. 29.5%; p = 0.001) and the composite rate of new OCAD or new revascularization (18.7% vs. 37.3%; p < 0.001) were lower in the DPP-4i group. The change in CCS per year did not differ significantly between the two groups (9.1 [0.1-56.8] vs. 13.5 [0.0-78.6]; p = 0.715).
CONCLUSIONS
Add-on DPP-4i therapy would be beneficial in preventing coronary artery disease progression in patients with T2DM receiving insulin therapy.
背景
我们评估了二肽基肽酶-4 抑制剂（DPP-4i）对接受胰岛素治疗的 2 型糖尿病（T2DM）患者阻塞性冠状动脉疾病（OCAD）进展的影响。
方法
使用多中心临床数据仓库，我们分析了接受胰岛素治疗的 T2DM 患者，这些患者进行了至少 2 次冠状动脉计算机断层扫描血管造影（CCTA）检查。根据两次 CCTA 检查之间是否有 DPP-4i 处方，将患者分为两组。分析 OCAD 的患病率（CCTA 上有≥50%狭窄）、新血管重建率和冠状动脉钙评分（CCS）的变化。
结果
共纳入 623 例患者，其中 380 例（60.9%）患者处方了 DPP-4i。两次 CCTA 之间的中位时间间隔为 39.0（17.0-61.4）个月。在随访 CCTA 中，DPP-4i 组有 62 例（16.3%）患者和无 DPP-4i 组有 76 例（31.3%）患者新发生 OCAD（p<0.001）。DPP-4i 组新 OCAD 或新血管重建的风险较低（19.7%比 38.7%；p<0.001）。经过倾向评分匹配后，DPP-4i 组新 OCAD 的患病率（15.9%比 29.5%；p=0.001）和新 OCAD 或新血管重建的复合率（18.7%比 37.3%；p<0.001）均较低。两组间每年 CCS 的变化差异无统计学意义（9.1[0.1-56.8]比 13.5[0.0-78.6]；p=0.715）。
结论
在接受胰岛素治疗的 T2DM 患者中，添加 DPP-4i 治疗有助于预防冠状动脉疾病进展。
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