胰高血糖素样肽-1受体激动剂疗法降低2型糖尿病患者膝骨关节炎风险及全膝关节置换风险：一项基于全国人群的队列研究
Glucagon-like peptide-1 receptor agonists therapy to attenuate the risk of knee osteoarthritis and total knee replacement in type 2 diabetes mellitus: A nation-wide population-based cohort study.
作者信息
Lin Chih-Ping, Chung Chi-Hsiang, Lu Chieh-Hua, Su Sheng-Chiang, Kuo Feng-Chih, Liu Jhih-Syuan, Li Peng-Fei, Huang Chia-Luen, Ho Li-Ju, Chen Kuan-Chan, Chang Chun-Yung, Lin Ming-Shiun, Liu Yi-Chen, Cheng An-Che, Lin Hong-Han, Kuo Shi-Wen, Lee Chien-Hsing, Hsieh Chang-Hsun, Hung Yi-Jen, Liu Hsin-Ya, Guo Lan-Yuen, Chien Wu-Chien
机构信息
Department of Internal Medicine, Division of Endocrinology and Metabolism, Zuoying Armed Forces General Hospital, Kaohsiung, Taiwan, ROC.
Department of Internal Medicine, Division of Endocrinology and Metabolism, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC.
出版信息
Medicine (Baltimore). 2025 Feb 7;104(6):e41243. doi: 10.1097/MD.0000000000041243.
Type 2 diabetes mellitus (T2DM) is an independent risk factor of knee osteoarthritis (KOA). This study was mainly based on data from the Taiwan National Health Insurance Database. Using big data analysis, we showed that glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment is helpful for patients with T2DM who have a lower risk of KOA or total knee replacement (TKR). A total of 35,762 patients with T2DM were included in this study. We divided these patients into 988 patients with T2DM without KOA and 372 patients with T2DM with KOA who received GLP-1RA treatment and those who did not receive GLP-1RA treatment. The patients were matched for sex, age, and inclusion date by 1:1 propensity score, which was included in the control group. Cox proportional hazards analyses were performed to compare KOA risk and TKR rate during a maximum follow-up period of 5 years. There were 1976/744 patients with T2DM without/with KOA who received and did not receive GLP-1RA treatment, including 1052/322 men (53.24/43.28%) and 924/422 women (46.76/56.72%). At the end of follow-up, there were 46/39 (4.66/10.48%) patients with T2DM without/with KOA who received GLP-1RA treatment and underwent KOA/TKR were lower than those without GLP-1RA treatment 87/70 (8.81/18.82%). Cox proportional hazard regression analysis showed a lower rate of KOA/TKR among patients with GLP-1RA treatment (adjusted hazard ratio [HR] = .852; 95% confidence interval [CI] = .784-.930, P < .001/ adjusted HR = .913; 95% CI = .885-.977, P = .015, respectively). Kaplan-Meier analysis showed that the cumulative risk of KOA/TKR in patient with/without GLP-1RA was significantly different (log-rank test, P < .001/P < .001, respectively). This study aimed to provide clinicians with the option of GLP-1RA as a treatment for patients with T2DM with or without KOA to reduce the risk of KOA or TKR among such patients.
2型糖尿病（T2DM）是膝关节骨关节炎（KOA）的独立危险因素。本研究主要基于台湾国民健康保险数据库的数据。通过大数据分析，我们发现胰高血糖素样肽-1受体激动剂（GLP-1RA）治疗对患KOA或全膝关节置换（TKR）风险较低的T2DM患者有益。本研究共纳入35762例T2DM患者。我们将这些患者分为988例未患KOA的T2DM患者和372例患KOA的T2DM患者，他们分别接受了GLP-1RA治疗和未接受GLP-1RA治疗。通过1:1倾向评分对患者的性别、年龄和纳入日期进行匹配，将其纳入对照组。进行Cox比例风险分析，以比较在最长5年的随访期内KOA风险和TKR发生率。有1976/744例未患/患KOA的T2DM患者接受和未接受GLP-1RA治疗，其中男性1052/322例（53.24/43.28%），女性924/422例（46.76/56.72%）。随访结束时，接受GLP-1RA治疗的未患/患KOA的T2DM患者中分别有46/39例（4.66/10.48%）发生KOA/TKR，低于未接受GLP-1RA治疗的患者87/70例（8.81/18.82%）。Cox比例风险回归分析显示，接受GLP-1RA治疗的患者中KOA/TKR发生率较低（调整后风险比[HR]=0.852；95%置信区间[CI]=0.784 - 0.930，P<0.001/调整后HR=0.913；95%CI=0.885 - 0.977，P=0.015）。Kaplan-Meier分析显示，接受/未接受GLP-1RA治疗的患者中KOA/TKR的累积风险有显著差异（对数秩检验，P<0.001/P<0.001）。本研究旨在为临床医生提供将GLP-1RA作为治疗患或未患KOA的T2DM患者的选择，以降低此类患者中KOA或TKR的风险。
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