钠-葡萄糖共转运体抑制剂对糖尿病患者心肾结局影响的网状Meta分析

Efficacy of Cardiorenal Outcomes for Diabetic Patients Treated by Sodium-Glucose Transporter Inhibitors:A Network Meta-Analysis

目的评价不同钠-葡萄糖共转运体抑制剂(SGLTi)治疗糖尿病远期心肾结局指标的差异。方法检索PubMed,Embase,WebofScience及中国期刊全文数据库、万方数据库、维普数据库,收集不同SGLTi治疗糖尿病的文献,检索时限为各数据库自建库起至2021年5月。由2名研究人员分别进行文献筛选、资料提取及质量评价;以主要心血管事件(MACE)为主要结局指标,以肾脏复合终点为次要结局指标,以心血管源性死亡、因心衰再住院率、全因死亡率为其他结局指标,进行网状Meta分析。结果检索到919篇文献,最终纳入9篇。降低未合并心血管疾病糖尿病患者MACE风险效果方面,达格列净劣于卡格列净[RR=1.48,95%CI(1.15,1.92),P<0.05]。改善心血管源性死亡的效果方面,索格列净[RR=1.34,95%CI(1.04,1.72),P<0.05]、埃格列净[RR=1.33,95%CI(1.06,1.66),P<0.05]及达格列净[RR=1.37,95%CI(1.11,1.69),P<0.05]劣于卡格列净,索格列净[RR=1.50,95%CI(1.11,2.02),P<0.05]及埃格列净[RR=1.48,95%CI(1.12,1.96),P<0.05]劣于恩格列净,恩格列净优于达格列净[RR=0.65,95%CI(0.50,0.86),P<0.05]。结论不同SGLTi治疗糖尿病时患者的肾脏复合结局、因心衰再住院率、全因死亡率并无明显差异;但对心血管源性死亡风险的影响可能不同,达格列净降低未合并心血管疾病糖尿病患者MACE风险效果劣于卡格列净。

Objective To evaluate the difference of long term cardiorenal outcomes of diabetic patients treated by different sodium-glucose transporter inhibitors(SGLTi).Methods The randomized controlled trals(RCTs)of diabetic treated with different SGLTi were searched from PubMed,Embase,Web of Science,and CNKI,WanFang,VIP database from inception to May 2021.The studies were screened,the data was extracted and the quality was evaluated by two researchers,respectively.The major adverse cardiovascular events(MACE)was selected as primary outcome,the kidney composite endpoint was selected as secondary outcome,cardiovascular(CV)death,hospitalization rate for heart failure(HHF)and all cause mortality were selected as other outcomes to conduct the network meta-analysis.Results A total of 919 studies were retrieved,nine sutdies were included.In terms of reducing MACE risk in diabetic patients without cardiovascular disease,the efficacy of dapagliflozin was worse than canagliflozin[RR=1.48,95%CI(1.15,1.92),P<0.05];In terms of improving cardiovascular mortality,the efficacy of sotagliflozin[RR=1.34,95%CI(1.04,1.72),P<0.05],ertugliflozin[RR=1.33,95%CI(1.06,1.66),P<0.05],dapagliflozin[RR=1.37,95%CI(1.11,1.69),P<0.05]were worse than canagliflozin.The efficacy of sotagliflozin[RR=1.50,95%CI(1.11,2.02),P<0.05]and ertugliflozin[RR=1.48,95%CI(1.12,1.96),P<0.05]were worse than empagliflozin.Empagliflozin was better than dapagliflozin[RR=0.65,95%CI(0.50,0.86),P<0.05].Conclusion Kidney composite outcome,HHF and all cause mortality of diabetic patients treated with different SGLTi have no significant difference.While the efficacy on the risk of CV death may be different.Compared with dapagliflozin,the efficacy of reducing MACE risk of diabetic patients without cardiovascular disease of canagliflozin is better.