SGLT2抑制剂对2型糖尿病患者心血管结局影响的网状meta分析

目的 2型糖尿病是一种慢性疾病,而心血管事件是2型糖尿病常见的并发症,已有大型研究表明钠-葡萄糖共转运体抑制剂(SGLT2i)对改善2型糖尿病患者心血管结局具有一定作用。本文通过系统评价,间接比较了5种不同的SGLT2i对2型糖尿病并发不良心血管事件的疗效作用。方法 检索PubMed、Web of science、Cochrane Library、中国知网、万方、维普数据库,收集相关文献,检索时限为建库至2022年7月,由两位研究员独立筛选文献,并提取相应数据,以心力衰竭住院和心血管死亡复合结局为主要结局指标,以心力衰竭住院、心血管死亡和全因死亡为次要结局指标,使用Stata 16.0以及network程序包进行网状meta分析。结果 共检索到340篇文献,最终纳入11篇文献,包括62 904例患者,涉及5种干预手段,分别为:恩格列净、索格列净、达格列净、埃格列净和卡格列净。5种不同的SGLT2i在改变2型糖尿病患者的心力衰竭住院和心血管死亡复合结局、心血管死亡、心力衰竭住院和全因死亡方面差异无统计学意义(P>0.05)。与安慰剂相比,5种不同的SGLT2i均可显著改善2型糖尿病患者心力衰竭住院结局;恩格列净和索格列净在改善心力衰竭住院和心血管死亡复合结局方面差异有统计学意义;而在改善心血管死亡或全因死亡结局方面,安慰剂和5种不同的SGLT2i之间的差异均无统计学意义。结论 在改善2型糖尿病患者心力衰竭住院和心血管死亡复合结局和心力衰竭住院结局方面,恩格列净和索格列净有较显著的获益趋势,而针对心血管死亡或全因死亡结局,5种不同的SGLT2i与安慰剂间的差异无统计学意义,具体机制和原因仍需大型研究进行探索和验证。

A network meta-analysis of SGLT2 inhibitors on cardiovascular outcomes in patients with type 2 diabetes

Objective Type 2 diabetes is a chronic disease and heart failure is a common complication of type 2 diabetes, and large studies have demonstrated the role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in improving cardiovascular outcomes of patients with type 2 diabetes. In this paper, the efficacy effects of five different SGLT2i were indirectly compared by systematic evaluation. Methods PubMed, Web of science, Cochrane Library, CNKI, WanFang, and VIP databases were searched to collect relevant literature with a search time frame of build to July 2022. Two researchers independently screened the literature and extracted the corresponding data, using the composite outcome of heart failure hospitalization and cardiovascular death as the primary outcome indicator, with heart failure hospitalization, cardiovascular death and all-cause death as secondary outcome indicators, and a network meta-analysis was performed using Stata 16.0 as well as the network program package. Results A total of 340 publications were retrieved, eligible 11 publications representing 62 904 patients were included. The five intervention methods were involved, namely: empagliflozin, sotagliflozin, dapagliflozin, ertugliflozin and canagliflozin. There were no statistically significant differences (P>0.05) between the five different SGLT2i in altering the composite outcomes of heart failure hospitalization and cardiovascular death, cardiovascular death, heart failure hospitalization and all-cause death in patients with type 2 diabetes. All five different SGLT2i significantly improved heart failure hospitalization outcomes in patients with type 2 diabetes compared to placebo. There was a statistically significant difference between empagliflozin and sotagliflozin in improving the composite outcome of heart failure hospitalization and cardiovascular death. No significant difference between placebo and the five different SGLT2i in improving the outcome of cardiovascular death or all-cause death. Conclusion There was a trend towards a more significant benefit of empagliflozin and sotagliflozin improving the composite outcome of heart failure hospitalization and cardiovascular death and heart failure hospitalization outcome in type 2 diabetic patients, while for cardiovascular death or all-cause death outcome, there was no statistically significant difference between the five different SGLT2i and placebo, and the exact mechanisms and causes still need to be explored and validated in large studies.