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胰高血糖素样肽-1 受体激动剂可能有益于 COPD 患者的心肺结局。

Glucagon-like peptide-1 receptor agonists may benefit cardiopulmonary outcomes in patients with COPD.

机构信息

Dr Yen's Clinic, Taoyuan, Taiwan.

Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.

出版信息

Thorax. 2024 Oct 16;79(11):1017-1023. doi: 10.1136/thorax-2023-221040.

Abstract

BACKGROUND

Clinical studies have shown that glucagon-like peptide-1 receptor agonists (GLP-1 RA) can have beneficial effects on cardiopulmonary function. We conducted this longitudinal cohort study to compare the risk of cardiopulmonary outcomes and mortality between GLP-1 RA use and no use in patients with type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD).

METHODS

The study identified 8060 matched GLP-1 RA users and non-users from Taiwan's National Health Insurance Research Database from 1 January 2008 to 31 December 2019. Cox proportional hazards models were used to determine the risk of cardiopulmonary outcomes between GLP-1 RA users and non-users.

RESULTS

The mean follow-up time was 2.51 and 2.46 years for GLP-1 RA users and non-users, respectively. In the matched cohorts, GLP-1 RA users had a significantly lower risk of mortality (adjusted HR (aHR) 0.46, 95% CI 0.38 to 0.56), cardiovascular events (aHR 0.73, 95% CI 0.65 to 0.82), non-invasive positive pressure ventilation (aHR 0.66, 95% CI 0.47 to 0.93), invasive mechanical ventilation (aHR 0.64, 95% CI 0.51 to 0.8) and bacterial pneumonia (aHR 0.76, 95% CI 0.65 to 0.88) than GLP-1 RA non-users. The subsequent analyses for various subgroup and medication duration also showed that GLP-1 RA was associated with a significantly lower risk of mortality, cardiovascular events, ventilation support and bacterial pneumonia than non-GLP-1 RA.

CONCLUSION

This nationwide cohort study showed that GLP-1 RA had a lower risk of cardiopulmonary outcomes and all-cause mortality than non-GLP-1 RA in patients with T2D and COPD. GLP-1 RA may help manage diabetes in people with COPD.

摘要

背景

临床研究表明,胰高血糖素样肽-1 受体激动剂(GLP-1 RA)对心肺功能有有益影响。我们进行了这项纵向队列研究,比较了 2 型糖尿病(T2D)和慢性阻塞性肺疾病(COPD)患者使用 GLP-1 RA 与不使用 GLP-1 RA 的心肺结局和死亡率的风险。

方法

本研究从台湾全民健康保险研究数据库中确定了 2008 年 1 月 1 日至 2019 年 12 月 31 日 8060 对匹配的 GLP-1 RA 使用和未使用的患者。使用 Cox 比例风险模型确定 GLP-1 RA 使用者和未使用者之间心肺结局的风险。

结果

GLP-1 RA 使用者和未使用者的平均随访时间分别为 2.51 年和 2.46 年。在匹配队列中,GLP-1 RA 使用者的死亡率(调整后的 HR(aHR)0.46,95%CI 0.38 至 0.56)、心血管事件(aHR 0.73,95%CI 0.65 至 0.82)、无创正压通气(aHR 0.66,95%CI 0.47 至 0.93)、有创机械通气(aHR 0.64,95%CI 0.51 至 0.8)和细菌性肺炎(aHR 0.76,95%CI 0.65 至 0.88)的风险明显低于 GLP-1 RA 未使用者。随后对各种亚组和药物持续时间的分析也表明,GLP-1 RA 与死亡率、心血管事件、通气支持和细菌性肺炎的风险明显低于非 GLP-1 RA 相关。

结论

这项全国性队列研究表明,与非 GLP-1 RA 相比,T2D 和 COPD 患者使用 GLP-1 RA 心肺结局和全因死亡率较低。GLP-1 RA 可能有助于管理 COPD 患者的糖尿病。

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