Lancet Diabetes Endocrinol:GLP-1受体激动剂可降低T2DM患者的多种心血管及肾脏不良事件的发生率

2021-08-24 Nebula MedSci原创

GLP-1受体激动剂可明显降低2型糖尿病患者的MACE、全因死亡、心衰住院和肾功能恶化的风险

GLP-1 受体激动剂可减少2型糖尿病(T2DM)患者的主要不良血管事件 (MACE)。但是,关于GLP-1 受体激动剂对 T2DM 肾脏结果的影响仍未完全明确。本研究旨在对关于T2DM患者的临床试验中GLP-1受体激动剂对心血管益处和风险的最新数据结果进行荟萃分析。

该分析纳入了来自AMPLITUDE-O试验的最新数据,采用随机效应模型估计了MACE及其具体事件,全因死亡率,心衰住院率,由大量白蛋白尿进展、血清肌酐翻倍或eGFR降低至少40%、肾脏替代疗法或肾病导致的死亡组成的复合肾脏结果,肾功能恶化的总风险比(HR);还估算了关键安全性结果(严重低血糖、视网膜病变、胰腺炎和胰腺癌)的优势比。

各种心血管事件的发生率变化

筛查了98项研究,纳入了其中8项,共60080位患者。总体上,GLP-1受体激动剂将MACE的发生率降低了14%(HR 0.86 [95% CI 0.80-0.93]; p<0.0001),而且具有结构同源性的不同的GLP-1受体激动剂之间无显著异质性。GLP-1受体激动剂将全因死亡率降低了12%(HR 0.88 [95% CI 0.82–0.94]; p=0.0001),将心衰住院率降低了11%(HR 0.89 [95% CI 0.82–0.98]; p=0.013),将复合肾脏结果发生率降低了21%(HR 0.79 [95% CI 0.73–0.87]; p<0.0001),而且未增加严重低血糖、视网膜病变或胰腺不良反应的风险。

敏感性分析去掉了一个仅限于急性冠脉综合征患者的试验(ELIXA),基于eGFR的变化,所有获益都略有增加,包括肾功能恶化的结果(HR 0.82 [95% CI 0.69–0.98];p=0.030)。

总之,GLP-1受体激动剂,无论结构同源性如何,都能降低2型糖尿病患者的MACE、全因死亡、心衰住院和肾功能恶化的风险

原始出处:

Sattar Naveed,Lee Matthew M Y,Kristensen Soren L et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials.[J] .Lancet Diabetes Endocrinol, 2021, https://doi.org/10.1016/S2213-8587(21)00203-5

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  8. 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time=2021-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1627859, encodeId=3288162e8594c, content=<a href='/topic/show?id=ab4f66e8913' target=_blank style='color:#2F92EE;'>#激动剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66789, encryptionId=ab4f66e8913, topicName=激动剂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=95bc21134754, createdName=medscijoin, createdTime=Thu Aug 26 08:22:41 CST 2021, time=2021-08-26, status=1, ipAttribution=)]
    2021-08-26 yibei
  9. 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