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Circulation：钠葡萄糖共转运体2抑制剂可改善2型糖尿病患者的心血管预后，但会增加下肢截肢风险

2018-04-16 MedSci MedSci原创

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已有临床试验表明钠葡萄糖共转运体2抑制剂（SGLT2i）可有益于心血管，同时存在潜在风险。但该试验仍不能指定解决个人终点或安全问题。现有研究人员于2013年4月1日-2016年12月31日开展一个基于人群的队列研究，招募确诊合并心血管疾病的刚开始应用降糖药的2型糖尿病患者。对比刚开始应用SGLT2i或其他降糖药物的患者的所有原因的死亡率、心衰导致的住院和不良心血管事件。安全结点为膝盖以下的下肢截肢

已有临床试验表明钠葡萄糖共转运体2抑制剂（SGLT2i）可有益于心血管，同时存在潜在风险。但该试验仍不能指定解决个人终点或安全问题。

现有研究人员于2013年4月1日-2016年12月31日开展一个基于人群的队列研究，招募确诊合并心血管疾病的刚开始应用降糖药的2型糖尿病患者。对比刚开始应用SGLT2i或其他降糖药物的患者的所有原因的死亡率、心衰导致的住院和不良心血管事件。安全结点为膝盖以下的下肢截肢。

经倾向性匹配，共有25 258位患者，随访中位时间1.6年。与非SGLT2i相比，应用SGLT2i可降低患者所有原因的死亡率和心衰导致住院的概率（1.73 vs 3.01/[每100人年]；HR 0.57，95% CI 0.50-0.65)，还可减少心血管不良事件（2.31 vs 3.45/[每100人年]；HR 0.67，95% CI 0.60-0.75）。但SGLT2i，同时与膝盖以下的下肢截肢风险升高（2倍）相关（0.17 vs 0.09/[每100人年]；HR 1.99，95% CI 1.12-3.51）。

本研究结果强调在这一高危人群中，运用SGLT2i可降低所有原因的死亡率、心衰住院和不良心血管事件的风险，但同时还可增加膝盖以下截肢的风险。

原始出处：

Jacob A. Udell， et al.Cardiovascular Outcomes and Risks After Initiation of a Sodium Glucose Cotransporter 2 Inhibitor.Circulation. April 03，2018. https：//doi.org/10.1161/CIRCULATIONAHA.117.031227

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    2018-10-26 liuquan

    #2抑制剂#

    0

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    2018-05-15 jklm09

    #抑制剂#

    0

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    2019-03-26 yzh409

    #转运#

    0

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    2018-04-18 aids213

    #2型糖尿病患者#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1995524, encodeId=36f3199552432, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Fri Oct 26 08:30:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1851690, encodeId=9eb418516907e, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Tue May 15 00:30:00 CST 2018, time=2018-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1696309, encodeId=0b3c169630991, content=<a href='/topic/show?id=0107934e0a5' target=_blank style='color:#2F92EE;'>#转运#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93470, encryptionId=0107934e0a5, topicName=转运)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=47c429881595, createdName=yzh409, createdTime=Tue Mar 26 04:30:00 CST 2019, time=2019-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1383433, encodeId=98951383433a4, content=<a href='/topic/show?id=196a1101f7' target=_blank style='color:#2F92EE;'>#2型糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1101, encryptionId=196a1101f7, topicName=2型糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec19483, createdName=aids213, createdTime=Wed Apr 18 08:30:00 CST 2018, time=2018-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388185, encodeId=778b138818581, content=<a href='/topic/show?id=e51454180b6' target=_blank style='color:#2F92EE;'>#截肢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54180, encryptionId=e51454180b6, topicName=截肢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1292500019, createdName=124984edm22暂无昵称, createdTime=Wed Apr 18 08:30:00 CST 2018, time=2018-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474487, encodeId=6f4514e448789, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Wed Apr 18 08:30:00 CST 2018, time=2018-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508633, encodeId=0af9150863393, content=<a href='/topic/show?id=884c51916cd' target=_blank style='color:#2F92EE;'>#心血管预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51916, encryptionId=884c51916cd, topicName=心血管预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de8d9990502, createdName=xiaogang320, createdTime=Wed Apr 18 08:30:00 CST 2018, time=2018-04-18, status=1, ipAttribution=)]
    2018-04-18 124984edm22暂无昵称

    #截肢#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1995524, encodeId=36f3199552432, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Fri Oct 26 08:30:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1851690, encodeId=9eb418516907e, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Tue May 15 00:30:00 CST 2018, time=2018-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1696309, encodeId=0b3c169630991, content=<a href='/topic/show?id=0107934e0a5' target=_blank style='color:#2F92EE;'>#转运#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93470, encryptionId=0107934e0a5, topicName=转运)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=47c429881595, createdName=yzh409, createdTime=Tue Mar 26 04:30:00 CST 2019, time=2019-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1383433, encodeId=98951383433a4, content=<a href='/topic/show?id=196a1101f7' target=_blank style='color:#2F92EE;'>#2型糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1101, encryptionId=196a1101f7, topicName=2型糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec19483, createdName=aids213, createdTime=Wed Apr 18 08:30:00 CST 2018, time=2018-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388185, encodeId=778b138818581, content=<a href='/topic/show?id=e51454180b6' target=_blank style='color:#2F92EE;'>#截肢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54180, encryptionId=e51454180b6, topicName=截肢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1292500019, createdName=124984edm22暂无昵称, createdTime=Wed Apr 18 08:30:00 CST 2018, time=2018-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474487, encodeId=6f4514e448789, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Wed Apr 18 08:30:00 CST 2018, time=2018-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508633, encodeId=0af9150863393, content=<a href='/topic/show?id=884c51916cd' target=_blank style='color:#2F92EE;'>#心血管预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51916, encryptionId=884c51916cd, topicName=心血管预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de8d9990502, createdName=xiaogang320, createdTime=Wed Apr 18 08:30:00 CST 2018, time=2018-04-18, status=1, ipAttribution=)]
    2018-04-18 xue8604

    #糖尿病患者#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1995524, encodeId=36f3199552432, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Fri Oct 26 08:30:00 CST 2018, time=2018-10-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1851690, encodeId=9eb418516907e, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Tue May 15 00:30:00 CST 2018, time=2018-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1696309, encodeId=0b3c169630991, content=<a href='/topic/show?id=0107934e0a5' target=_blank style='color:#2F92EE;'>#转运#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93470, encryptionId=0107934e0a5, topicName=转运)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=47c429881595, createdName=yzh409, createdTime=Tue Mar 26 04:30:00 CST 2019, time=2019-03-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1383433, encodeId=98951383433a4, content=<a href='/topic/show?id=196a1101f7' target=_blank style='color:#2F92EE;'>#2型糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1101, encryptionId=196a1101f7, topicName=2型糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec19483, createdName=aids213, createdTime=Wed Apr 18 08:30:00 CST 2018, time=2018-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388185, encodeId=778b138818581, content=<a href='/topic/show?id=e51454180b6' target=_blank style='color:#2F92EE;'>#截肢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54180, encryptionId=e51454180b6, topicName=截肢)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c1292500019, createdName=124984edm22暂无昵称, createdTime=Wed Apr 18 08:30:00 CST 2018, time=2018-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1474487, encodeId=6f4514e448789, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Wed Apr 18 08:30:00 CST 2018, time=2018-04-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508633, encodeId=0af9150863393, content=<a href='/topic/show?id=884c51916cd' target=_blank style='color:#2F92EE;'>#心血管预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51916, encryptionId=884c51916cd, topicName=心血管预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de8d9990502, createdName=xiaogang320, createdTime=Wed Apr 18 08:30:00 CST 2018, time=2018-04-18, status=1, ipAttribution=)]
    2018-04-18 xiaogang320

    #心血管预后#

    0