2型糖尿病中钠-葡萄糖协同转运蛋白2抑制剂与二肽基肽酶4抑制剂的心脏保护作用：比较安全性和疗效的荟萃分析
Cardioprotective effects of sodium glucose cotransporter 2 inhibitor versus dipeptidyl peptidase 4 inhibitor in type 2 diabetes: A meta-analysis of comparative safety and efficacy.
作者信息
Shrestha Abhigan Babu, Halder Anupam, Rajak Kripa, Jha Saroj Kumar, Lamichhane Ramesh, Oishee Arefin Naher, Chowdary Nayanika Tummala, Pokharel Pashupati, Shrestha Sajina, Adhikari Lukash, Adhikari Bikash, Rajak Aman, Haider Khan Jalal, Mainali Nischal
机构信息
Department of Internal Medicine, M Abdur Rahim Medical College, Dinajpur, Bangladesh.
Department of Internal Medicine, University of Pittsburgh Medical Centre, Harrisburg, PA, USA.
出版信息
SAGE Open Med. 2024 Jul 27;12:20503121241261204. doi: 10.1177/20503121241261204. eCollection 2024.
BACKGROUND
Sodium glucose cotransporter 2 inhibitors are recommended for the treatment of heart failure due to their cardioprotective effects, despite primarily being used as antidiabetic medications. However, the comparative profile of two antidiabetic drugs, sodium glucose cotransporter 2 inhibitors with dipeptidyl peptidase 4 inhibitor remains unclear.
STUDY HYPOTHESIS
This study aims to compare the safety and efficacy profiles of sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase 4 inhibitor drugs.
METHODS
A comprehensive search was conducted in PubMed, Scopus, Web of Science, Google Scholar, and ClinicalTrials.gov using appropriate Medical Subject Headings terms from inception until February 23, 2023. The outcomes were pooled using a random-effects model for hazard ratio with a 95% confidence interval. A -value of <0.05 was considered statistically significant.
RESULTS
Twelve studies were included after systematic screening, with a sample size of 745,688 for sodium glucose cotransporter 2 inhibitors and 769,386 for dipeptidyl peptidase 4 inhibitor. The mean age in each group was 61.1 (8.52) and 61.28 (9.25) years, respectively. Upon pooling the included articles with sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase 4 inhibitor, the primary outcome of all-cause death demonstrated an hazard ratio of 0.64 (0.57, 0.70), : 65.54%, < 0.001, and major adverse cardiovascular events yielded an hazard ratio of 0.76 (0.65, 0.86), : 87.83%, < 0.001. The secondary outcomes included myocardial infarction with an hazard ratio of 0.84 (0.78, 0.90), : 47.64%, < 0.001, stroke with an hazard ratio of 0.81 (0.75, 0.87), : 36.78%, < 0.001, and hospitalization with an hazard ratio of 0.62 (0.53, 0.70), : 83.32%, < 0.001.
CONCLUSION
Our findings suggest that compared to dipeptidyl peptidase 4 inhibitor, initiating treatment with sodium glucose cotransporter 2 inhibitors provides cardiovascular disease protection and may be considered in patients with type 2 diabetes.
背景
钠-葡萄糖协同转运蛋白2抑制剂尽管主要用作抗糖尿病药物，但因其心脏保护作用而被推荐用于治疗心力衰竭。然而，两种抗糖尿病药物，即钠-葡萄糖协同转运蛋白2抑制剂与二肽基肽酶4抑制剂的对比情况仍不清楚。
研究假设
本研究旨在比较钠-葡萄糖协同转运蛋白2抑制剂与二肽基肽酶4抑制剂药物的安全性和有效性。
方法
从创刊至2023年2月23日，使用适当的医学主题词在PubMed、Scopus、科学网、谷歌学术和ClinicalTrials.gov上进行全面检索。使用随机效应模型合并风险比的结果，并给出95%置信区间。P值<0.05被认为具有统计学意义。
结果
经过系统筛选，纳入了12项研究，钠-葡萄糖协同转运蛋白2抑制剂组的样本量为745,688，二肽基肽酶4抑制剂组的样本量为769,386。每组的平均年龄分别为61.1（8.52）岁和61.28（9.25）岁。将纳入的钠-葡萄糖协同转运蛋白2抑制剂与二肽基肽酶4抑制剂的文章合并后，全因死亡的主要结局显示风险比为0.64（0.57，0.70），I²：65.54%，P<0.001，主要不良心血管事件的风险比为0.76（0.65，0.86），I²：87.83%，P<0.001。次要结局包括心肌梗死，风险比为0.84（0.78，0.90），I²：47.64%，P<0.001；中风，风险比为0.81（0.75，0.87），I²：36.78%，P<0.001；以及住院，风险比为0.62（0.53，0.70），I²：83.32%，P<0.001。
结论
我们的研究结果表明，与二肽基肽酶4抑制剂相比，起始使用钠-葡萄糖协同转运蛋白2抑制剂进行治疗可提供心血管疾病保护，2型糖尿病患者可考虑使用。
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