JAMA子刊：GLP-1受体激动剂与DPP-4抑制剂的使用与2型糖尿病和晚期慢性肾病患者死亡率的关系

2022-03-08 MedSci原创 MedSci原创

与DPP-4抑制剂相比，GLP-1受体激动剂治疗与2型糖尿病、晚期CKD和ESKD患者的全因死亡率降低相关。

2型糖尿病是慢性肾病（CKD）最常见的病因，糖尿病和CKD都与全因死亡率、感染率和心血管事件增加有关。在普通糖尿病人群中，胰高血糖素样肽-1（GLP-1）受体激动剂和钠-葡萄糖共转运蛋白-2（SGLT-2）抑制剂与更好的血糖控制、更大的体重减轻幅度、更低的死亡率和心血管事件发生率相关。

根据美国糖尿病协会指南，GLP-1受体激动剂治疗建议用于肾小球滤过率低于60 mL/min/1.73 m²且有心血管疾病风险的糖尿病和CKD患者。根据慢性糖尿病肾病管理临床实践指南，GLP-1受体激动剂建议用于无法使用二甲双胍或SGLT-2抑制剂的个体。最近的一项网络荟萃分析表明，在普通糖尿病人群中使用GLP-1受体激动剂和二肽基肽酶-4（DPP-4）抑制剂后，可能会出现不同的临床结果。在该研究中，与使用DPP-4抑制剂相比，使用GLP-1受体激动剂与提高生存率相关。

本研评估了在糖尿病和晚期CKD或ESKD人群中使用GLP-1受体激动剂是否与使用DPP-4抑制剂相比具有更好的预后。

这项回顾性队列研究使用了来自台湾国家健康保险研究数据库的2型糖尿病和5期CKD或ESKD患者的数据。该研究于2012年1月1日至2018年12月31日期间进行。数据分析从2020年6月到2021年7月。比较了GLP-1受体激动剂治疗患者和DPP-4抑制剂治疗患者的全因死亡率、败血症和感染相关死亡率以及与主要不良心脑血管事件相关的死亡率。倾向评分权重用于缓解组间协变量之间的不平衡。

结果显示，在纳入研究的27279名患者中，26578名在DPP-4抑制剂组，701名在GLP-1受体激动剂组。加权后，GLP-1受体激动剂的使用与较低的全因死亡率和较低的败血症及感染相关死亡率相关。亚组分析显示，与DDP-4抑制剂相比，脑血管病患者使用GLP-1受体激动剂的死亡率低于非脑血管病患者。

主要和次要结果分析

总之，本研究结果显示，与DPP-4抑制剂相比，GLP-1受体激动剂治疗与2型糖尿病、晚期CKD和ESKD患者的全因死亡率降低相关。还需要更多设计良好的前瞻性研究来证实GLP-1受体激动剂治疗晚期CKD或ESKD患者的潜在益处。

参考文献：Chen J, Wu C, Jenq C, et al. Association of Glucagon-Like Peptide-1 Receptor Agonist vs Dipeptidyl Peptidase-4 Inhibitor Use With Mortality Among Patients With Type 2 Diabetes and Advanced Chronic Kidney Disease. JAMA Netw Open. 2022;5(3):e221169. doi:10.1001/jamanetworkopen.2022.1169

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2022-12-17 gostraight

#肾病患者#

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2023-02-10 jklm09

#抑制剂#

64 0
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2022-10-01 sunylz

#患者死亡#

64 0
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content=<a href='/topic/show?id=dad4621545' target=_blank style='color:#2F92EE;'>#DPP-4抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6215, encryptionId=dad4621545, topicName=DPP-4抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8d7373, createdName=ewsr1, createdTime=Thu Mar 10 10:19:31 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401969, encodeId=d41514019691f, content=<a href='/topic/show?id=7ff0621125' target=_blank style='color:#2F92EE;'>#DPP-4#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6211, encryptionId=7ff0621125, topicName=DPP-4)], attachment=null, authenticateStatus=null, 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2022-07-18 snowpeakxu

#慢性肾病患者#

70 0
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encryptionId=d088536467a, topicName=慢性肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Mon Jul 18 01:19:31 CST 2022, time=2022-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1784713, encodeId=04d81e8471300, content=<a href='/topic/show?id=6a926214b8' target=_blank style='color:#2F92EE;'>#DPP-4抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6214, encryptionId=6a926214b8, topicName=DPP-4抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Sat Apr 30 14:19:31 CST 2022, time=2022-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2076736, encodeId=c77720e673690, content=<a href='/topic/show?id=e9955983549' target=_blank style='color:#2F92EE;'>#晚期慢性肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59835, encryptionId=e9955983549, topicName=晚期慢性肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Sun Jul 17 04:19:31 CST 2022, time=2022-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1294050, encodeId=c43c12940502a, content=<a href='/topic/show?id=bb0e8081b2' target=_blank style='color:#2F92EE;'>#GLP-1受体激动剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8081, encryptionId=bb0e8081b2, topicName=GLP-1受体激动剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e183245, createdName=Eleven11, createdTime=Thu Mar 10 10:19:31 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1374132, encodeId=314013e41326e, content=<a href='/topic/show?id=dad4621545' target=_blank style='color:#2F92EE;'>#DPP-4抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6215, encryptionId=dad4621545, topicName=DPP-4抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8d7373, createdName=ewsr1, createdTime=Thu Mar 10 10:19:31 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401969, encodeId=d41514019691f, content=<a href='/topic/show?id=7ff0621125' target=_blank style='color:#2F92EE;'>#DPP-4#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6211, encryptionId=7ff0621125, topicName=DPP-4)], attachment=null, authenticateStatus=null, 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2022-04-30 xue8602

#DPP-4抑制#

69 0
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content=<a href='/topic/show?id=dad4621545' target=_blank style='color:#2F92EE;'>#DPP-4抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6215, encryptionId=dad4621545, topicName=DPP-4抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8d7373, createdName=ewsr1, createdTime=Thu Mar 10 10:19:31 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401969, encodeId=d41514019691f, content=<a href='/topic/show?id=7ff0621125' target=_blank style='color:#2F92EE;'>#DPP-4#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6211, encryptionId=7ff0621125, topicName=DPP-4)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJmFzSicR3biaepTGaMtOl8hS8SjNQ92YP4GmFUlefPkcPnZJWBsHM057ogFrQEPrgdTgPrlxG70KYA/132, createdBy=eeb42370314, createdName=gaoxiaoe, createdTime=Thu Mar 10 10:19:31 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1422772, encodeId=f7cb1422e7259, content=<a href='/topic/show?id=54fa80e701' target=_blank style='color:#2F92EE;'>#GLP-1#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8077, encryptionId=54fa80e701, topicName=GLP-1)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8f23732777, createdName=yibei, createdTime=Thu Mar 10 10:19:31 CST 2022, time=2022-03-10, status=1, ipAttribution=)]
2022-07-17 1249842em09(暂无昵称)

#晚期慢性肾病患者#

48 0
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2022-03-10 Eleven11

#GLP-1受体激动剂#

44 0
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2022-03-10 ewsr1

#DPP-4抑制剂#

55 0
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2022-03-10 gaoxiaoe

#DPP-4#

43 0
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encryptionId=d088536467a, topicName=慢性肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Mon Jul 18 01:19:31 CST 2022, time=2022-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1784713, encodeId=04d81e8471300, content=<a href='/topic/show?id=6a926214b8' target=_blank style='color:#2F92EE;'>#DPP-4抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6214, encryptionId=6a926214b8, topicName=DPP-4抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d139492, createdName=xue8602, createdTime=Sat Apr 30 14:19:31 CST 2022, time=2022-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2076736, encodeId=c77720e673690, content=<a href='/topic/show?id=e9955983549' target=_blank style='color:#2F92EE;'>#晚期慢性肾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59835, encryptionId=e9955983549, topicName=晚期慢性肾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Sun Jul 17 04:19:31 CST 2022, time=2022-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1294050, encodeId=c43c12940502a, content=<a href='/topic/show?id=bb0e8081b2' target=_blank style='color:#2F92EE;'>#GLP-1受体激动剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8081, encryptionId=bb0e8081b2, topicName=GLP-1受体激动剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e183245, createdName=Eleven11, createdTime=Thu Mar 10 10:19:31 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1374132, encodeId=314013e41326e, content=<a href='/topic/show?id=dad4621545' target=_blank style='color:#2F92EE;'>#DPP-4抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6215, encryptionId=dad4621545, topicName=DPP-4抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8d7373, createdName=ewsr1, createdTime=Thu Mar 10 10:19:31 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401969, encodeId=d41514019691f, content=<a href='/topic/show?id=7ff0621125' target=_blank style='color:#2F92EE;'>#DPP-4#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6211, encryptionId=7ff0621125, topicName=DPP-4)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJmFzSicR3biaepTGaMtOl8hS8SjNQ92YP4GmFUlefPkcPnZJWBsHM057ogFrQEPrgdTgPrlxG70KYA/132, createdBy=eeb42370314, createdName=gaoxiaoe, createdTime=Thu Mar 10 10:19:31 CST 2022, time=2022-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1422772, encodeId=f7cb1422e7259, content=<a href='/topic/show?id=54fa80e701' target=_blank style='color:#2F92EE;'>#GLP-1#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8077, encryptionId=54fa80e701, topicName=GLP-1)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8f23732777, createdName=yibei, createdTime=Thu Mar 10 10:19:31 CST 2022, time=2022-03-10, status=1, ipAttribution=)]
2022-03-10 yibei

#GLP-1#

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JAMA子刊：GLP-1受体激动剂与DPP-4抑制剂的使用与2型糖尿病和晚期慢性肾病患者死亡率的关系

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