钠-葡萄糖协同转运蛋白2抑制剂对慢性肾脏病患者心房颤动和心房扑动的预防作用：一项荟萃分析

The preventive effect of sodium-glucose co-transporter-2 inhibitors on atrial fibrillation and atrial flutter in patients with chronic kidney disease: a meta-analysis.

作者信息

Yang Qian, Wang Chen, Wang Wenjing, Li Yanhong, Dang Yi

机构信息

Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China.

Department of Internal Medicine, Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China.

出版信息

Front Pharmacol. 2025 May 20;16:1585491. doi: 10.3389/fphar.2025.1585491. eCollection 2025.

DOI:10.3389/fphar.2025.1585491

PMID:40463899

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12129918/

Abstract

BACKGROUND

The presence of atrial fibrillation (AF) and atrial flutter (AFL) in patients with chronic kidney disease (CKD) can exacerbate renal dysfunction, which in turn increases the onset of AF or AFL. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been proven to have cardiac and renal protective effects. The meta-analysis was performed to investigate whether SGLT2i can reduce the risk of AF/AFL in patients with CKD.

METHODS

PubMed, Embase, Cochrane Library, and Clinical Trials.gov were searched up to December 2024. Randomized controlled trials (RCTs) comparing of SGLT2i and placebo on AF/AFL in patients with CKD were included. Risk ratio (RR) with 95% confidence interval (CI) were calculated in the overall population and selected subgroups.

RESULTS

10 RCTs involving 28,712 patients were included. SGLT2i significantly reduced the risk of the composite events of AF and AFL in patients with CKD (0.65% vs. 0.91%; RR 0.73, 95% CI 0.56-0.95, = 0.02) in overall population, but did not reduce the risk of AF (0.56% vs. 0.75%; RR 0.76, 95% CI 0.57-1.01, = 0.06) or AFL (0.097% vs. 0.17%; RR 0.58, 95% CI 0.30-1.13, = 0.11). Subgroup analysis based on sample size and follow-up duration showed that SGLT2i reduced the risk of AF in trials with sample size more than 1,000 and follow-up duration longer than 2 years (0.59% vs. 0.80%; RR 0.74, 95% CI 0.55-0.99, = 0.04). Subgroup analysis based on different populations showed that SGLT2i reduced the risk of AF in patients with CKD (partial without diabetes) (0.48% vs. 0.90%; RR 0.53, 95% CI 0.33-0.85, = 0.009), while had no effect on AF in patients with both diabetes and CKD. Subgroup analysis based on different types of SGLT2i showed that only empagliflozin reduced the risk of AF compared to placebo (0.51% vs. 0.94%; RR 0.55, 95% CI 0.31-0.96, = 0.04).

CONCLUSION

SGLT2i could reduce the risk of the composite events of AF and AFL in patients with CKD, and also could reduce the risk of AF in trials with large sample size and long follow-up duration.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251053244.

摘要

背景

慢性肾脏病（CKD）患者出现心房颤动（AF）和心房扑动（AFL）会加重肾功能不全，而肾功能不全反过来又会增加AF或AFL的发病风险。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）已被证明具有心脏和肾脏保护作用。本荟萃分析旨在研究SGLT2i是否能降低CKD患者发生AF/AFL的风险。

方法

检索截至2024年12月的PubMed、Embase、Cochrane图书馆和ClinicalTrials.gov。纳入比较SGLT2i与安慰剂对CKD患者AF/AFL影响的随机对照试验（RCT）。计算总体人群和选定亚组的风险比（RR）及95%置信区间（CI）。

结果

纳入10项RCT，共28,712例患者。总体人群中，SGLT2i显著降低了CKD患者AF和AFL复合事件的风险（0.65%对0.91%；RR 0.73，95%CI 0.56 - 0.95，P = 0.02），但未降低AF风险（0.56%对0.75%；RR 0.76，95%CI 0.57 - 1.01，P = 0.06）或AFL风险（0.097%对0.17%；RR 0.58，95%CI 0.30 - 1.13，P = 0.11）。基于样本量和随访时间的亚组分析显示，在样本量超过1000且随访时间超过2年的试验中，SGLT2i降低了AF风险（0.59%对0.80%；RR 0.74，95%CI 0.55 - 0.99，P = 0.04）。基于不同人群的亚组分析显示，SGLT2i降低了CKD（部分无糖尿病）患者的AF风险（0.48%对0.90%；RR 0.53，95%CI 0.33 - 0.85，P = 0.009），而对糖尿病合并CKD患者的AF无影响。基于不同类型SGLT2i的亚组分析显示，与安慰剂相比，仅恩格列净降低了AF风险（0.51%对0.94%；RR 0.55，95%CI 0.31 - 0.96，P = 0.04）。