2型糖尿病患者接受SGLT2i治疗的临床结局分析

Clinical outcomes in patients with type 2 diabetes mellitus treated with sodium-glucose cotransporter 2 inhibitor

目的分析钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)对2型糖尿病(T2DM)患者临床结局的影响。方法2017年10月至2022年12月,回顾性纳入接受达格列净或恩格列净治疗患者各370例和未接受SGLT2i治疗的患者740例(对照组),并对三组的治疗结局进行比较分析。结果Kaplan-Meier生存曲线分析显示,三组中位无复合冠状动脉事件时间、中位无复合缺血事件时间、无心力衰竭住院治疗(HHF)时间、无肾脏事件时间、复合物HHF和肾脏事件时间(P<0.05)差异有统计学意义。在多变量分析中,SGLT2i的使用与较低的复合冠状动脉事件发生率显著相关,此外达格列净与复合缺血事件风险降低有关(P<0.05)。此外,与对照组相比,达格列净组和恩格列净组中SGLT2i对复合HHF和肾脏事件表现出显著的有益作用(P<0.05)。在治疗24个月时,与其他两组相比,恩格列净组低密度脂蛋白胆固醇水平较高,糖化血红蛋白水平较低(P<0.05)。治疗12~24个月时,达格列净组和恩格列净组的估计肾小球滤过率与对照组相比有统计学差异(P<0.05)。结论SGLT2i可显著降低T2DM患者的动脉粥样硬化性心血管疾病(ASCVD)、HHF和肾脏事件风险。

Objective To analyze the influence of sodium-glucose cotransporter 2 inhibitor(SGLT2i)on clinical outcomes in patients with type 2 diabetes mellitus(T2DM).Methods T2DM patients treated with dapagliflozin(dapagliflozin group,n=370)or empagliflozin(empagliflozin group,n=370)and patients without SGLT2i treatment(control group,n=740)were chosen from Oct.2017 to Dec.2022.The treatment outcomes were compared in 3 groups.Methods The results of Kaplan-Meier survival curve analysis showed that differences in median time without composite coronary event,median time without composite ischemic event,time without hospitalization due to heart failure(HHF),time without renal event,and time with composite HHF and renal event had statistical significance among 3 groups(P<0.05).The results of multivariate analysis showed that SGLT2i administration was significantly correlated to lower incidence of composite coronary event,and dapagliflozin was correlated to risk decrease of composite ischemic event(P<0.05).In addition,SGLT2i also showed significant beneficial effects on composite HHF and renal events in dapagliflozin group and empagliflozin group compared with control group(P<0.05).After treatment for 24 months,the level of low-density lipoprotein-cholesterol(LDL-C)was higher,and level of glycated hemoglobin(HbAlc)was lower in empagliflozin group than those in dapagliflozin group and control group(P<0.05).After treatment from 12 months to 24 months,the level of estimated glomerular filtration rate(eGFR)had statistical difference among dapagliflozin group,empagliflozin group and control group(P<0.05).Conclusion SGLT2i can significantly reduce the risks of arteriosclerotic cardiovascular disease,HHF and renal event in T2DM patients.