胰高血糖素样肽-1受体激动剂与二肽基肽酶-4抑制剂及基础胰岛素治疗2型糖尿病的心血管和肾脏结局：一项系统评价和荟萃分析
Cardiovascular and renal outcomes of GLP-1 receptor agonists vs. DPP-4 inhibitors and basal insulin in type 2 diabetes mellitus: A systematic review and meta-analysis.
作者信息
Evans Marc, Kuodi Paul, Akunna Chisom Joyqueenet, McCreedy Nicole, Donsmark Morten, Ren Hongye, Nnaji Chukwudi A
机构信息
Department of Diabetes and Endocrinology, University Hospital Llandough, Penarth, UK.
Department of Public Health, Faculty of Health Sciences, Lira University, Lira, Uganda.
出版信息
Diab Vasc Dis Res. 2023 Nov-Dec;20(6):14791641231221740. doi: 10.1177/14791641231221740.
OBJECTIVE
To compare the cardiovascular and renal outcomes of GLP-1 RA versus DPP4i and basal insulin in the management of T2DM.
METHODS
Data from 22 studies involving over 200,000 participants were pooled using the inverse variance method and random-effects meta-analysis. The review was reported in accordance with PRISMA.
RESULTS
Compared with DPP4i, treatment with GLP-1 RA was associated with a greater benefit on composite cardiovascular outcomes (HR:0.77, 95% CI:0.69-0.87), myocardial infarction (HR:0.82, 95% CI:0.69-0.97), stroke (HR:0.83, 95% CI: 0.74-0.93), cardiovascular mortality (HR:0.76, 95% CI:0.68-0.85) and all-cause mortality (HR:0.65, 95% CI:0.48-0.90). There was no difference in effect on heart failure (HR:0.97, 95% CI:0.82-1.15). Compared with basal insulin, GLP-1 RA was associated with better effects on composite cardiovascular outcomes (HR:0.62, 95% CI:0.48-0.79), heart failure (HR:0.57, 95% CI:0.35-0.92), myocardial infarction (HR:0.70, 95% CI:0.58-0.85), stroke (HR:0.50, 95% CI:0.40-0.63) and all-cause mortality (HR:0.31, 95% CI:0.20-0.48). Evidence from a small number of studies suggests that GLP-1 RA had better effects on composite and individual renal outcomes, such as eGFR, compared with either DPP4i and basal insulin.
CONCLUSION
Available evidence suggests that treating T2DM with GLP-1 RA can yield better benefits on composite and specific cardiorenal outcomes than with DPP4i and basal insulin.
PROSPERO REGISTRATION NUMBER
CRD42022335504.
目的
比较胰高血糖素样肽-1受体激动剂（GLP-1 RA）、二肽基肽酶4抑制剂（DPP4i）和基础胰岛素在2型糖尿病（T2DM）管理中的心血管和肾脏结局。
方法
采用逆方差法和随机效应荟萃分析，汇总了22项研究的数据，涉及超过200,000名参与者。本综述按照系统评价和荟萃分析的首选报告项目（PRISMA）进行报告。
结果
与DPP4i相比，GLP-1 RA治疗在复合心血管结局（风险比[HR]：0.77，95%置信区间[CI]：0.69 - 0.87）、心肌梗死（HR：0.82，95% CI：0.69 - 0.97）、中风（HR：0.83，95% CI：0.74 - 0.93）、心血管死亡率（HR：0.76，95% CI：0.68 - 0.85）和全因死亡率（HR：0.65，95% CI：0.48 - 0.90）方面具有更大益处。在心力衰竭方面的效果无差异（HR：0.97，95% CI：0.82 - 1.15）。与基础胰岛素相比，GLP-1 RA在复合心血管结局（HR：0.62，95% CI：0.48 - 0.79）、心力衰竭（HR：0.57，95% CI：0.35 - 0.92）、心肌梗死（HR：0.70，95% CI：0.58 - 0.85）、中风（HR：0.50，95% CI：0.40 - 0.63）和全因死亡率（HR：0.31，95% CI：0.20 - 0.48）方面具有更好的效果。少数研究的证据表明，与DPP4i和基础胰岛素相比，GLP-1 RA在复合和个体肾脏结局（如估算肾小球滤过率[eGFR]）方面具有更好的效果。
结论
现有证据表明，与DPP4i和基础胰岛素相比，用GLP-1 RA治疗T2DM在复合和特定的心肾结局方面可产生更好的益处。
国际前瞻性系统评价注册库（PROSPERO）注册号：CRD42022335504。
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