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钠-葡萄糖协同转运蛋白2抑制剂对2型糖尿病患者肾脏及安全性的影响:一项全国性观察性队列研究

Renal and Safety Outcomes of SGLT2 Inhibitors in Patients with Type 2 Diabetes: A Nationwide Observational Cohort Study.

作者信息

Chang Junhyuk, Kim Chungsoo, Choi Heejung, Park Rae Woong, Lee Sukhyang

机构信息

Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea.

Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.

出版信息

J Clin Med. 2025 May 12;14(10):3349. doi: 10.3390/jcm14103349.

Abstract

: Evidence on the renal benefits and safety of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the Asia region is still lacking. This study aimed to evaluate the renal and safety outcomes of SGLT2is compared with dipeptidyl peptidase-4 inhibitors (DPP4i) using real-world data. : A retrospective cohort study was conducted using the nationwide claims data in Republic of Korea. We evaluated kidney outcomes (any new-onset kidney events, acute kidney injury (AKI), chronic kidney disease (CKD), and kidney failure) as primary outcomes and safety outcomes (infection, hemodynamic adverse events, and fracture). Propensity score matching was used to adjust confounders, and the hazard ratios were calculated using the Cox proportional hazards model. : The study included 13,649 patients in the SGLT2i group and 35,043 in the DPP4i group after the matching. The SGLT2i group had a lower risk of kidney diseases, AKI, and CKD (HR 0.88 [0.61-0.74]) than the DPP4i group. For secondary outcomes, the risk of genital infection was higher (HR 2.38 [2.12-2.68]), and the risk of hyperkalemia was lower in the SGLT2i group than in the DPP4i group (HRs 0.49 [0.36-0.67]). : The SGLT2 inhibitors had a lower risk of new-onset kidney outcomes and CKD than the DPP4 inhibitors. A high incidence of genital infection and a low incidence of hyperkalemia were shown in the SGLT2 inhibitor.

摘要

亚洲地区关于钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)肾脏获益及安全性的证据仍然不足。本研究旨在利用真实世界数据评估SGLT2i与二肽基肽酶-4抑制剂(DPP4i)相比的肾脏结局及安全性。

一项回顾性队列研究利用韩国全国性医保理赔数据开展。我们将肾脏结局(任何新发肾脏事件、急性肾损伤(AKI)、慢性肾脏病(CKD)及肾衰竭)作为主要结局,将安全性结局(感染、血流动力学不良事件及骨折)作为次要结局进行评估。采用倾向评分匹配法调整混杂因素,并使用Cox比例风险模型计算风险比。

匹配后,研究纳入SGLT2i组13649例患者和DPP4i组35043例患者。SGLT2i组发生肾脏疾病、AKI及CKD的风险低于DPP4i组(风险比0.88 [0.61 - 0.74])。对于次要结局,SGLT2i组生殖器感染风险较高(风险比2.38 [2.12 - 2.68]),高钾血症风险低于DPP4i组(风险比0.49 [0.36 - 0.67])。

SGLT2抑制剂相比DPP4抑制剂有更低的新发肾脏结局及CKD风险。SGLT2抑制剂表现出较高的生殖器感染发生率和较低的高钾血症发生率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a077/12112461/5539ba65b3d1/jcm-14-03349-g001.jpg

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