eClinicalMed:SGLT2i对2型糖尿病患者肾脏功能的保护作用更胜一筹!

2022-06-27 MedSci原创 MedSci原创

SGLT2i对于2型糖尿病患者的肾脏保护作用优于GLP1-PA

与安慰剂相比,钠-葡萄糖协同转运蛋白2抑制剂 (SGLT2i) 和胰高血糖素样肽-1受体激动剂 (GLP1-RA) 对2型糖尿病患者的肾脏有保护作用。本研究旨在比较SGLT2i和GLP1-RA对估计肾小球滤过率 (eGFR) 变化趋势及其他肾脏结局的影响。

研究人员利用香港医院管理局 (HA) 基于真实世界人口的数据库,纳入了于2008年1月至2020年12月期间接受诊疗的2型糖尿病患者,对比开设接受SGLT2i或GLP1-RA治疗的患者的肾脏预后,并进行1对1倾向评分匹配。主要终点是eGFR下降持续≥50%、终末期肾病(ESKD)、大量蛋白尿和肾脏相关死亡的综合结果。

共有2551位SGLT2i新使用者和2551位GLP1-PA新使用者被纳入分析。在基线时,受试患者的平均年龄是56.2岁,平均eGFR是78.0mL/min/1·73m2,11.9%的患者有大量蛋白尿。


两组患者肾脏功能的变化情况

中位随访了13个月后,SGLT2i组患者的综合肾脏结局的风险更低(HR 0.77,p=0.02),主要是ESKD的发生率降低(HR 0.53, p=0.01)。SGLT2i组患者发生大量蛋白尿的风险也趋于更低(HR 0.74, p=0.05)。


两组患者eGFR的变化情况

亚组分析显示,年龄、性别、基线eGFR/蛋白尿状态、糖化血红蛋白(HbA1c)和肾素-血管紧张素系统抑制剂的使用均不影响SGLT2i对综合肾脏结局的益处。此外,SGLT2i组患者的eGFR降低速度也慢于GLP1-RA组患者(SGLT2i:-1.19mL/min/1·73m2/year;GLP1-PA:-1.95mL/min/1·73m2/year,p<0.01)。

综上所述,该研究结果证明,SGLT2i对于2型糖尿病患者的肾脏保护作用优于GLP1-PA

原始出处:

David Tak Wai Lui, et al. Kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: A real-world population-based analysis. eClinicalMedicine. June 25, 2022. https://doi.org/10.1016/j.eclinm.2022.101510

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    2023-02-22 tulenzi
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    2022-06-28 jiekemin
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