Ren Qiao, Tan Yao, Zhang Guixiang, Dai Yuzhao, Yang Lidan, Wu Yunmo, He He, Chen Jie
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China.
J Evid Based Med. 2025 Jun;18(2):e70021. doi: 10.1111/jebm.70021.
Metabolic dysfunction associated steatotic liver disease (MASLD) is a universal hepatic disease, and many recent randomized clinical trials (RCTs) have explored whether hypoglycemic agents may be beneficial for its treatment. This study aimed to assess the relative effectiveness of each hypoglycemic agent for MASLD.
China National Knowledge Infrastructure（CNKI）, WanFang, Weipu, PubMed, Embase, The Cochrane Library, and Web of Science Core Collection were searched for RCTs on the efficacy of hypoglycemic agents in MASLD published up to December 31, 2024. All statistical analyses were performed using R version 4.3.3. The network meta-analysis was conducted using Bayesian statistical methods.
A total of 26 hypoglycemic agents for treating MASLD in 37 studies with 2406 participants were included. Empagliflozin was most effective in improving liver stiffness measurement (LSM), whereas liraglutide showed significant benefits in body weight, body mass index (BMI), and waist circumference. Both sodium-glucose co-transporter 2 (SGLT-2) inhibitors (e.g., empagliflozin) and glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., liraglutide) improved liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], gamma-glutamyltransferase [GGT]), glucose metabolism (fasting plasma glucose [FPG], and homeostasis model assessment of insulin resistance [HOMA-IR]), and lipid profiles. Pioglitazone had limited benefits in these outcomes. Secondary outcomes such as inflammatory markers and fibrosis showed minimal changes.
Several hypoglycemic agents can improve laboratory and imaging indicators in adult patients with MASLD. Liraglutide is more effective than other agents, whereas empagliflozin emerged as the most effective for reducing LSM. However, different agents have different effects on the indicators; therefore, the relevant agents must be selected according to the specific patient condition.
代谢功能障碍相关脂肪性肝病（MASLD）是一种常见的肝脏疾病，近期许多随机临床试验（RCT）探讨了降糖药物对其治疗是否有益。本研究旨在评估每种降糖药物治疗MASLD的相对有效性。
检索中国知网（CNKI）、万方、维普、PubMed、Embase、考克兰图书馆和科学网核心合集，查找截至2024年12月31日发表的关于降糖药物治疗MASLD疗效的RCT。所有统计分析均使用R 4.3.3版本进行。采用贝叶斯统计方法进行网络荟萃分析。
共纳入37项研究中的26种治疗MASLD的降糖药物，涉及2406名参与者。恩格列净在改善肝脏硬度测量（LSM）方面最有效，而利拉鲁肽在体重、体重指数（BMI）和腰围方面显示出显著益处。钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂（如恩格列净）和胰高血糖素样肽-1（GLP-1）受体激动剂（如利拉鲁肽）均可改善肝酶（丙氨酸氨基转移酶[ALT]、天冬氨酸氨基转移酶[AST]、γ-谷氨酰转移酶[GGT]）、糖代谢（空腹血糖[FPG]和胰岛素抵抗稳态模型评估[HOMA-IR]）及血脂谱。吡格列酮在这些指标上益处有限。炎症标志物和纤维化等次要结局变化极小。
几种降糖药物可改善成年MASLD患者的实验室和影像学指标。利拉鲁肽比其他药物更有效，而恩格列净在降低LSM方面最为有效。然而，不同药物对指标的影响不同；因此，必须根据患者具体情况选择相关药物。
