SGLT-2抑制剂及GLP-1受体激动剂治疗2型糖尿病的心血管获益:一项系统回顾和网状Meta分析

Cardiovascular benefits of SGLT-2 inhibitors and GLP-1 receptor agonists in type 2 diabetes:a systematic review and network meta-analysis

目的通过贝叶斯网状Meta分析系统评价上市的11种钠-葡萄糖共转运蛋白-2(SGLT-2)抑制剂和胰高血糖素样多肽-1(GLP-1)受体激动剂治疗2型糖尿病患者的心血管获益。方法检索Medline、Embase和Cochrane数据库,检索日期为建库至2020年7月18日。研究终点为心血管不良事件,效应指标为风险比(hazard ratios,HR)及其95%可信区间(95%CI)。结果与安慰剂相比,恩格列净、卡格列净、达格列净、阿必鲁肽、度拉糖肽、艾塞那肽、利拉鲁肽和索马鲁肽可降低2型糖尿病患者主要心血管不良事件的发生风险,HR及95%CI为0.75(0.60-0.95)~0.90(0.82-0.99);恩格列净、卡格列净、达格列净和艾托格列净可降低心力衰竭的发生风险,HR及95%CI为0.64(0.49-0.82)~0.74(0.65-0.85);恩格列净、卡格列净、达格列净、艾塞那肽、利拉鲁肽和口服索马鲁肽可降低全因死亡的发生风险,HR及95%CI为0.52(0.33-0.84)~0.89(0.80-0.99);恩格列净、卡格列净、利拉鲁肽和口服索马鲁肽可降低心血管死亡事件的发生风险,HR及95%CI为0.54(0.30-0.95)~0.83(0.71-0.96)。结论应用SGLT-2抑制剂或GLP-1受体激动剂,对2型糖尿病合并动脉粥样硬化性心血管疾病患者的心血管获益依次是:卡格列净、恩格列净、度拉糖肽、利拉鲁肽;对2型糖尿病合并心衰的患者,心血管获益依次是:恩格列净、卡格列净、艾托格列净、达格列净。

Objective To evaluate cardiovascular benefits in patients with type 2 diabetes mellitus treated with the marketed 11 sodium-glucose co-transporter-2(SGLT-2)inhibitors and glucagon-like polypeptide-1(GLP-1)receptor agonism by Bayesian network meta-analysis system.Methods MEDLINE,Embase and Cochrane Library were searched from the establishment of the database to 18 July 2020.The endpoint of the study was adverse cardiovascular events.The effect measures were hazard ratios(HR)and 95%credible intervals(CI).Results Compared with placebo,empagliflozin,canagliflozin,dapagliflozin,albiglutide,dulaglutide,exenatide,liraglutide,semaglutide reduced the risk of major adverse cardiovascular events in patients with type 2 diabetes with HR and 95%CI ranging between 0.75(0.60-0.95)~0.90(0.82-0.99);The risk of heart failure was reduced by empagliflozin,canagliflozin,dapagliflozin and ertugliflozin,with HR and 95%CI ranging between 0.64(0.49-0.82)~0.74(0.65-0.85);Empagliflozin,canagliflozin,dapagliflozin,exenatide,liraglutide and oral semaglutide reduced the incidence of all-cause mortality with HR and 95%CI ranging between 0.52(0.33-0.84)~0.89(0.80-0.99);Empagliflozin,canagliflozin,liraglutide and oral semaglutide can reduce the risk of cardiovascular death events,with HR and 95%CI ranging between 0.54(0.30-0.95)~0.83(0.71-0.96).Conclusion The order of the cardiovascular benefits of SGLT-2 inhibitors or GLP-1 receptor agonists in patients with type 2 diabetes mellitus complicated with atherosclerotic cardiovascular disease are canagliflozin(the best),empagliflozin,dulaglutide,liraglutide;for patients with type 2 diabetes and heart failure.The order of the cardiovascular benefits for patients with type 2 diabetes and heart failure are empagliflozin,canagliflozin,ertugliflozin,and dapagliflozin.