钠-葡萄糖协同转运蛋白 2 抑制剂与静脉血栓栓塞风险：一项全国范围内基于人群的研究和荟萃分析。
Sodium-glucose co-transporter-2 inhibitors and the risk of venous thromboembolism: A nationwide population-based study and meta-analysis.
机构信息
Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Health Information Center, Tzu Chi University, Hualien, Taiwan.
出版信息
Diabetes Metab Res Rev. 2024 Feb;40(2):e3739. doi: 10.1002/dmrr.3739. Epub 2023 Oct 20.
AIMS
Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have off-target effects on haemoconcentration and anti-inflammation. The impact of SGLT-2i on the risk of venous thromboembolism (VTE) in patients with diabetes mellitus (DM) remains unclear. This study aimed to evaluate the risk of newly diagnosed VTE in patients with DM using SGLT-2i in comparison to dipeptidyl peptidase-4 inhibitors (DPP-4i) or glucagon-like peptide-1 receptor agonists (GLP-1RA).
MATERIALS AND METHODS
In this nationwide retrospective cohort study, we used data from Taiwan's National Health Insurance Research Database. Patients with diabetes aged 20 years or older who received SGLT-2i, DPP-4i, or GLP-1RA between 1 May 2016, and 31 December 2020, were included. The risks of VTE in SGLT-2i users were compared with those of DPP-4i and GLP-1RA users. A Cox regression model with stabilised inverse probability of treatment weighting was used to calculate hazard ratio (HR) for VTE risk. Additionally, a meta-analysis of relevant articles published before 23 May 2023, was conducted.
RESULTS
Data from 136,530 SGLT-2i, 598,280 DPP-4i, and 5760 GLP-1RA users were analysed. SGLT-2i use was associated with a lower risk of VTE than DPP-4i (HR, 0.70; 95% CI, 0.59-0.84; p < 0·001), but not with GLP-1RA (HR, 1.39; 95% CI, 0.32-5.94; p = 0.66). Our meta-analysis further supported these findings (SGLT-2i vs. DPP-4i: HR, 0.71; 95% CI, 0.62-0.82; p < 0·001; SGLT-2i vs. GLP-1RA: HR, 0.91; 95% CI, 0.73-1.15; p = 0.43), suggesting the robustness of our retrospective analysis.
CONCLUSIONS
In patients with DM, SGLT-2i was associated with a lower risk of VTE compared to DPP-4i, but not GLP-1RA.
目的
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）对血液浓缩和抗炎有非靶点作用。SGLT-2i 对糖尿病（DM）患者静脉血栓栓塞（VTE）风险的影响尚不清楚。本研究旨在评估与二肽基肽酶-4 抑制剂（DPP-4i）或胰高血糖素样肽-1 受体激动剂（GLP-1RA）相比，SGLT-2i 用于治疗糖尿病患者时新发 VTE 的风险。
材料和方法
在这项全国性回顾性队列研究中，我们使用了来自台湾全民健康保险研究数据库的数据。纳入 2016 年 5 月 1 日至 2020 年 12 月 31 日期间接受 SGLT-2i、DPP-4i 或 GLP-1RA 治疗的年龄在 20 岁及以上的糖尿病患者。比较 SGLT-2i 使用者与 DPP-4i 和 GLP-1RA 使用者的 VTE 风险。使用稳定逆概率治疗加权 Cox 回归模型计算 VTE 风险的风险比（HR）。此外，还对 2023 年 5 月 23 日前发表的相关文章进行了荟萃分析。
结果
分析了 136530 例 SGLT-2i、598280 例 DPP-4i 和 5760 例 GLP-1RA 使用者的数据。与 DPP-4i 相比，SGLT-2i 治疗与较低的 VTE 风险相关（HR，0.70；95%CI，0.59-0.84；p<0·001），但与 GLP-1RA 无关（HR，1.39；95%CI，0.32-5.94；p=0.66）。我们的荟萃分析进一步支持了这些发现（SGLT-2i 与 DPP-4i：HR，0.71；95%CI，0.62-0.82；p<0·001；SGLT-2i 与 GLP-1RA：HR，0.91；95%CI，0.73-1.15；p=0.43），表明我们的回顾性分析具有稳健性。
结论
在糖尿病患者中，与 DPP-4i 相比，SGLT-2i 与较低的 VTE 风险相关，但与 GLP-1RA 无关。
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