Diabetes Care:西他列汀对2型糖尿病患者的肾功能和心血管结局有什么影响?

2016-10-15 MedSci MedSci原创

本研究纳入了TECOS试验中的患者,为2型糖尿病和心血管疾病患者,使用二肽基肽酶4抑制剂西他列汀治疗,评估这些患者的慢性肾脏疾病(CKD)和心血管结局。 研究纳入了14671例患者,根据基线估计的肾小球滤过率(eGFR)将患者分类:1、2、3a和3b期(对应的eGFR值分别为≥90、60–89、45–59和30–44 mL/min/1.73 m2),研究的中位时间超过3年,评估患者的心血管和

本研究纳入了TECOS试验中的患者,为2型糖尿病和心血管疾病患者,使用二肽基肽酶4抑制剂西他列汀治疗,评估这些患者的慢性肾脏疾病(CKD)和心血管结局。

研究纳入了14671例患者,根据基线估计的肾小球滤过率(eGFR)将患者分类:1、2、3a和3b期(对应的eGFR值分别为≥90、60–89、45–59和30–44 mL/min/1.73 m2),研究的中位时间超过3年,评估患者的心血管和CKD结局。

数据显示,eGFR 3b期患者年龄更大、女性、糖尿病持续时间更长。基线eGFR值更低组患者的主要不良心血管事件的发生率增加(对于1到3b期患者,发生率分别为3.52, 3.55, 5.74, 7.34个事件/100人年)。2、3a和3b期与1期比较,校正后的HR值分别为0.93 (95% CI 0.82–1.06), 1.28 (1.10–1.49), 1.39 (1.13–1.72)。

不管患者的eGFR值处于什么水平,使用西他列汀治疗与心血管结局无关(相互作用P值均>0.44)。西他列汀治疗组和对照组患者的肾功能以相同的速率下降,不过西他列汀治疗组患者的eGFR稍微更低(−1.3 mL/min/1.73 m2)。校正地区、基线eGFR值、基线HbA1c、评估时间和研究期间的HbA1c水平后,eGFR值的治疗差异仍存在。

结果表明,肾功能受损与更严重的心血管结局有关。不管患者的eGFR值处于什么水平,使用西他列汀治疗与心血管结局无关。

原始出处:

Jan H. Cornel, George L. Bakris, Susanna R.et al.Effect of Sitagliptin on Kidney Function and Respective Cardiovascular Outcomes in Type 2 Diabetes: Outcomes From TECOS.Diabetes Care 2016 Oct

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    2017-07-28 yese
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近期的研究显示,对于2型糖尿病成人患者,利拉鲁肽可改变肠道菌群,而西他列汀可能增加肝脏胆汁酸的产生。 阿姆斯特丹VU大学医学中心的Mark M. Smits博士和同事们对56名使用二甲双胍和/或磺脲类治疗的2型糖尿病成人患者进行了研究,患者的平均年龄为62.8岁,平均HbA1c为7.3%。 患者被随机分为胰高血糖素样肽-1受体激动剂利拉鲁肽(Victoza, Novo Nordisk;