Lancet Diabetes Endocrinol:达格列净可否改善有心脏代谢风险因素的新冠肺炎患者的临床预后?

2021-08-04 Nebula MedSci原创

SGLT2抑制剂达格列净对心脏和肾脏具有显著的保护作用,是否能改善有心脏代谢风险因素的新冠肺炎患者的临床预后?

虽然我国新冠疫情的总体控制很好,但总有一些地区会突然出现一波,正如现下的南京。现已明确,新冠肺炎可诱发有器官衰竭。SGLT2抑制剂达格列净对心脏和肾脏具有显著的保护作用。

DARE-19是一项随机、双盲、安慰剂为对照的临床试验,目的是明确达格列净是否可通过影响急性疾病期间失调的过程来为新冠肺炎住院患者提供器官保护作用。

受试患者是至少存在一种心脏代谢风险因素(如高血压、2型糖尿病、动脉粥样硬化血管疾病、心力衰竭和慢性肾病)的因新冠肺炎住院的患者,按1:1随机分至达格列净组(10 mg/日,口服)或安慰剂组,连续治疗30天。在意向治疗人群中评估了双重主要终点:不良结局预防效果(出现新的或恶化的器官功能障碍或死亡的时间)和康复的分层复合结果(第30天时的临床状态的改变)。

不良结局的累积发生率

2020年4月22日-2021年1月1日,共1250位患者被随机分组(每组各625人)。对于不良结局预防终点:达格列净组有70位(11.2%)患者发生了器官功能障碍或死亡,而安慰剂组有86位(13.8%;风险比[HR] 0.80, 95%CI 0.58-1.10;p=0.17)。对于康复结果:达格列净组和安慰剂组分别有547位(87.5%)和532位(85.1%)患者的临床状态有所改善,虽然两组间的差异无统计学意义(p=0.14)。

不良反应事件发生情况

达格列净组和安慰剂组分别发生了41例(6.6%)和54例(8.6%)死亡(HR 0.77, 95%CI 0.52-1.16)。此外,达格列净组613位患者中有65位(10.6%)和安慰剂组616位患者中有82位(13.3%)报告了重度不良反应事件。

简而言之,对于有心脏代谢风险因素的新冠肺炎住院患者,达格列净治疗并不能显著降低其器官功能障碍或死亡的风险,也不能显著提高其临床恢复情况,但耐受性良好。

原始出处:

Kosiborod Mikhail N,Esterline Russell,Furtado Remo H M et al. Dapagliflozin in patients with cardiometabolic risk factors hospitalised with COVID-19 (DARE-19): a randomised, double-blind, placebo-controlled, phase 3 trial.[J] .Lancet Diabetes Endocrinol, 2021, https://doi.org/10.1016/S2213-8587(21)00180-7

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createdBy=0045169, createdName=木头人513, createdTime=Sun Jun 26 04:06:00 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761650, encodeId=935c1e6165078, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Mon Nov 22 03:06:00 CST 2021, time=2021-11-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1831259, encodeId=88d8183125956, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sun Aug 15 00:06:00 CST 2021, time=2021-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1337236, encodeId=1307133e23690, content=<a href='/topic/show?id=f4c251404aa' target=_blank style='color:#2F92EE;'>#心脏代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51404, encryptionId=f4c251404aa, topicName=心脏代谢)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIUEDhSibBFt8TicgFCCSBtW10SxVJicDpibTCucns8L1YaiaKpibWOkv8hYpJ0LeTVUH1Ab4sfica9bxiccA/132, createdBy=dd282500126, createdName=ms3830150583600765, createdTime=Thu Aug 05 13:06:00 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534769, encodeId=0d471534e690e, content=<a href='/topic/show?id=6be9230842e' target=_blank style='color:#2F92EE;'>#临床预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23084, encryptionId=6be9230842e, topicName=临床预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72412536387, createdName=budeshao, createdTime=Thu Aug 05 13:06:00 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546001, encodeId=be7b1546001e0, content=<a href='/topic/show?id=31a351414ef' target=_blank style='color:#2F92EE;'>#心脏代谢风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51414, encryptionId=31a351414ef, topicName=心脏代谢风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caae13850815, createdName=ms8538335253054589, createdTime=Thu Aug 05 13:06:00 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1005035, encodeId=8a7d100503562, content=了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Wed Aug 04 07:54:41 CST 2021, time=2021-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029819, encodeId=77921029819fc, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Wed Aug 04 01:06:00 CST 2021, time=2021-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034410, encodeId=abb2103441043, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Wed Aug 04 01:06:00 CST 2021, time=2021-08-04, status=1, ipAttribution=)]
    2021-08-15 howi
  5. [GetPortalCommentsPageByObjectIdResponse(id=1639832, encodeId=04781639832d7, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Sat Jun 04 01:06:00 CST 2022, time=2022-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1902600, encodeId=72351902600c5, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, 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GetPortalCommentsPageByObjectIdResponse(id=1534769, encodeId=0d471534e690e, content=<a href='/topic/show?id=6be9230842e' target=_blank style='color:#2F92EE;'>#临床预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23084, encryptionId=6be9230842e, topicName=临床预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72412536387, createdName=budeshao, createdTime=Thu Aug 05 13:06:00 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546001, encodeId=be7b1546001e0, content=<a href='/topic/show?id=31a351414ef' target=_blank style='color:#2F92EE;'>#心脏代谢风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51414, encryptionId=31a351414ef, topicName=心脏代谢风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=caae13850815, createdName=ms8538335253054589, createdTime=Thu Aug 05 13:06:00 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1005035, encodeId=8a7d100503562, content=了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Wed Aug 04 07:54:41 CST 2021, time=2021-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029819, encodeId=77921029819fc, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Wed Aug 04 01:06:00 CST 2021, time=2021-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034410, encodeId=abb2103441043, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Wed Aug 04 01:06:00 CST 2021, time=2021-08-04, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1639832, encodeId=04781639832d7, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Sat Jun 04 01:06:00 CST 2022, time=2022-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1902600, encodeId=72351902600c5, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, 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GetPortalCommentsPageByObjectIdResponse(id=1534769, encodeId=0d471534e690e, content=<a href='/topic/show?id=6be9230842e' target=_blank style='color:#2F92EE;'>#临床预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23084, encryptionId=6be9230842e, topicName=临床预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72412536387, createdName=budeshao, createdTime=Thu Aug 05 13:06:00 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546001, encodeId=be7b1546001e0, content=<a href='/topic/show?id=31a351414ef' target=_blank style='color:#2F92EE;'>#心脏代谢风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51414, encryptionId=31a351414ef, topicName=心脏代谢风险)], attachment=null, authenticateStatus=null, createdAvatar=null, 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GetPortalCommentsPageByObjectIdResponse(id=1034410, encodeId=abb2103441043, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Wed Aug 04 01:06:00 CST 2021, time=2021-08-04, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1639832, encodeId=04781639832d7, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Sat Jun 04 01:06:00 CST 2022, time=2022-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1902600, encodeId=72351902600c5, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, 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topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sun Aug 15 00:06:00 CST 2021, time=2021-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1337236, encodeId=1307133e23690, content=<a href='/topic/show?id=f4c251404aa' target=_blank style='color:#2F92EE;'>#心脏代谢#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51404, encryptionId=f4c251404aa, topicName=心脏代谢)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIUEDhSibBFt8TicgFCCSBtW10SxVJicDpibTCucns8L1YaiaKpibWOkv8hYpJ0LeTVUH1Ab4sfica9bxiccA/132, createdBy=dd282500126, createdName=ms3830150583600765, createdTime=Thu Aug 05 13:06:00 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534769, encodeId=0d471534e690e, content=<a href='/topic/show?id=6be9230842e' target=_blank style='color:#2F92EE;'>#临床预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23084, encryptionId=6be9230842e, topicName=临床预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72412536387, createdName=budeshao, createdTime=Thu Aug 05 13:06:00 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1546001, encodeId=be7b1546001e0, content=<a href='/topic/show?id=31a351414ef' target=_blank style='color:#2F92EE;'>#心脏代谢风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51414, encryptionId=31a351414ef, topicName=心脏代谢风险)], attachment=null, authenticateStatus=null, createdAvatar=null, 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GetPortalCommentsPageByObjectIdResponse(id=1034410, encodeId=abb2103441043, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Wed Aug 04 01:06:00 CST 2021, time=2021-08-04, status=1, ipAttribution=)]
  8. 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GetPortalCommentsPageByObjectIdResponse(id=1034410, encodeId=abb2103441043, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Wed Aug 04 01:06:00 CST 2021, time=2021-08-04, status=1, ipAttribution=)]
    2021-08-04 学医无涯

    了解一下

    0

  9. 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    2021-08-04 公卫新人

    新冠肺炎,疫情何时才能消失

    0

  10. 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    2021-08-04 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

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