钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂在急性心力衰竭患者中的疗效和安全性：一项系统评价和荟萃分析
Efficacy and safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with acute heart failure: a systematic review and meta-analysis.
作者信息
Hou Jingjin, Ren Li, Hou Qingbin, Jia Xiaodong, Mei Zhu, Xu Jiaxin, Yang Zheming, Li Yiming, Yan Chenghui
机构信息
State Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.
出版信息
Front Cardiovasc Med. 2024 Sep 11;11:1388337. doi: 10.3389/fcvm.2024.1388337. eCollection 2024.
BACKGROUND
The effectiveness and safety of a novel class of hypoglycemic medications known as sodium-glucose cotransporter 2 (SGLT2) inhibitors have not been completely established in relation to acute heart failure (AHF). Consequently, we sought to compare the prognostic and safety outcomes of patients administered SGLT2 inhibitors for the treatment of AHF.
METHODS
An extensive search of the Web of Science, PubMed, and EMBASE was conducted for randomized controlled trials and observational studies that have evaluated the use of SGLT2 inhibitors in AHF from the inception of these drugs to the present. We compiled data related to cardiovascular safety and prognosis. Aggregated risk ratios (RR), mean differences (MD), or standardized mean differences (SMD) were generated for all outcomes, with 95% confidence intervals (CIs), to evaluate the predictive significance of SGLT2 inhibitors in patients with AHF.
RESULTS
We identified 4,053 patients from 13 studies. Patients experienced a substantial reduction in all-cause mortality (RR = 0.82, 95% CI: 0.70-0.96, = 0.01), readmission rates (RR = 0.85, 95% CI: 0.74-0.98, = 0.02), the number of heart failure exacerbation events (RR = 0.69, 95% CI: 0.50-0.95, = 0.02), and the number of rehospitalization events due to heart failure (RR = 0.71, 95% CI: 0.58-0.86, < 0.05) in the SGLT2 inhibitors-treatment group compared to a placebo or standard care (control group). SGLT2 inhibitors improved patient quality of life (SMD = -0.24, 95% CI: -0.40 to -0.09, = 0.002). SGLT2 inhibitors were associated with enhanced diuresis in patients with AHF (MD = 2.83, 95% CI: 1.36-4.29, < 0.05). Overall, treatment with SGLT2 inhibitors significantly reduced the level of serum NT-proBNP (MD = -497.62, 95% CI: -762.02 to -233.21, < 0.05) and did not increase the incidence of adverse events (RR = 0.91, 95% CI: 0.82-1.01, = 0.06).
CONCLUSIONS
This meta-analysis suggests that treatment with SGLT2 inhibitors is associated with a better prognosis in patients with AHF than in patients not treated with SGLT2 inhibitors. It is safe and effective to initiate SGLT2 inhibitors in patients with AHF.
SYSTEMATIC REVIEW REGISTRATION
https://www.doi.org/10.37766/inplasy2024.9.0015, identifier (INPLASY202490015).
背景
一类新型降糖药物——钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂在急性心力衰竭（AHF）中的有效性和安全性尚未完全明确。因此，我们试图比较接受SGLT2抑制剂治疗AHF患者的预后和安全性结果。
方法
对科学网、PubMed和EMBASE进行广泛检索，以查找自这些药物问世以来评估SGLT2抑制剂在AHF中应用的随机对照试验和观察性研究。我们汇总了与心血管安全性和预后相关的数据。针对所有结果生成汇总风险比（RR）、平均差（MD）或标准化平均差（SMD），并给出95%置信区间（CI），以评估SGLT2抑制剂对AHF患者的预测意义。
结果
我们从13项研究中确定了4053例患者。与安慰剂或标准治疗（对照组）相比，SGLT2抑制剂治疗组患者的全因死亡率（RR = 0.82，95% CI：0.70 - 0.96，P = 0.01）、再入院率（RR = 0.85，95% CI：0.74 - 0.98，P = 0.02）、心力衰竭加重事件数（RR = 0.69，95% CI：0.50 - 0.95，P = 0.02）以及因心力衰竭再次住院事件数（RR = 0.71，95% CI：0.58 - 0.86，P < 0.05）均显著降低。SGLT2抑制剂改善了患者的生活质量（SMD = -0.24，95% CI：-0.40至-0.09，P = 0.002）。SGLT2抑制剂与AHF患者利尿增强有关（MD = 2.83，95% CI：1.36 - 4.29，P < 0.05）。总体而言，SGLT2抑制剂治疗显著降低了血清NT-proBNP水平（MD = -497.62，95% CI：-762.02至-233.21，P < 0.05），且未增加不良事件发生率（RR = 0.91，95% CI：0.82 - 1.01，P = 0.06）。
结论
这项荟萃分析表明，与未接受SGLT2抑制剂治疗的患者相比，SGLT2抑制剂治疗的AHF患者预后更好。对AHF患者启动SGLT2抑制剂治疗是安全有效的。
系统评价注册
https://www.doi.org/10.37766/inplasy2024.9.0015，标识符（INPLASY202490015）。
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