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篇名
SGLT2抑制劑之心血管和腎臟結果試驗及嚴重副作用:統合分析
並列篇名
Cardiovascular and Renal Outcomes and Serious Side Effects of SGLT2 Inhibitors: A Meta-analysis
作者 蔡崇煌 (Chung-Huang Tsai)張加憲 (Chia-Hsien Chang)王俊堯 (Jiun-Yao Wang)曾立年 (Li-Nien Tseng)
中文摘要
背景:國內使用的3種口服降血糖藥之鈉-葡萄糖協同轉運蛋白2抑制劑(SGLT2i)的大型心血管結果試驗(CVOTs)皆已發表,但尚缺乏其分析比較,本研究目的為探討SGLT2i的CVOTs和腎臟結果試驗及較嚴重副作用,並做一統合分析。方法:以關鍵字“SGLT2 inhibitor”OR“SGLT2 inhibitors”,AND“metaanalysis”OR“systematic review”,搜尋2018年11月24日前之PubMed medline、Cochrane、Web of Science及CEPS中文思博網等資料庫。使用Review Manager 5.3軟體計算風險比(HRs)、95%信賴區間(CIs)及權重,並用MS-Excel及其VBA(Visual Basic for Applications)做森林圖(forest plot),若誤差線(error bar)未交叉到1.0無效線,表示達統計學上顯著的差異。結果:共找到3篇相關文獻做引用,整體而言,SGLT2i可顯著地降低因心衰竭住院(HHF)31%(HR 0.69, 0.61-0.79)和腎臟疾病進展組合(renal composite)45%(0.55, 0.48-0.64),且在3個研究中有相當一致的結果,其HRs皆相差不多。其餘除了心血管死亡(CVM)、非死亡腦中風及全因死亡率(ACM)外之變項亦皆有相當一致的結果。在主要不良心血管事件(MACE)雖只降低11%(0.89, 0.83- 0.96),但有統計學上顯著差異。Canagliflozin在截肢(1.97, 1.41-2.75)、骨折(1.55, 1.21-1.97)及糖尿病酮酸中毒(DKA)(2.33, 0.76-7.17)皆有較高風險,且其前2項皆達統計學上顯著的差異,三種藥物之三者副作用之統合分析依序上昇26%(1.26, 1.06-1.51)、11%(1.11, 1.00-1.23)及120%(2.20, 1.25-3.87),且皆達統計學上顯著的差異。結論:SGLT2i可降低MACE、HHF和renal composite,除了CVM、非死亡腦中風及ACM外之變項皆有相當一致的結果。截肢、骨折及DKA皆以canagliflozin有較高風險。
英文摘要
Purpose: In spite of the publication of three large-scale cardiovascular outcome trials (CVOTs) of sodium-glucose cotransporters 2 inhibitors (SGLT2i), comparative analysis remains rare. The study accordingly aimed to compare the cardiovascular and renal outcomes and serious side effects of SGLT2i and to conduct a meta-analysis (M-A). Methods: We searched PubMed, Cochrane and Web of Science in EndNote X9 for trials published up to November 24, 2018, using the following keywords: “SGLT2 inhibitor” OR “SGLT2 inhibitors” AND “meta-analysis” OR “systematic review.” The study also searched CEPS with the same keywords in Chinese. Review Manager was used to calculate the hazard ratios (HRs) with 95% CI and weights, and forest plots drawn with MS-Excel with VBA. Significant difference was indicated if the error bars did not cross the no-effect line 1.0. Results: A total of three references were cited. Overall, SGLT2i was able to robustly reduce hospitalization for heart failure (HHF) by 31% (HR 0.69, 95% CI 0.61-0.79) and renal composite by 45% (0.55, 0.48-0.64), and the results appeared to be fairly consistent in three of the four references. Except cardiovascular mortality (CVM), non-fatal stroke, and all-cause mortality (ACM), the results concerning other variables stayed consistent. SGLT2i moderately reduce major adverse cardiovascular events (MACE) by 11.0% with significant difference (0.89, 0.83- 0.96) noted. Compared to the other two agents, Canagliflozin incurred a higher risk in amputation (1.97, 1.41-2.75), fracture (1.55, 1.21-1.97) and diabetic ketoacidosis (DKA) (2.33, 0.76-7.17), while the M-A found all the three side effects reaching significant differences with 26% (1.26, 1.06-1.51), 11% (1.11, 1.00-1.23), and 120% (2.20, 1.25-3.87) respectively. Conclusion: SGLT2i helps reduce MACE, HHF and the progression of renal disease. Except CVM, non-fatal stroke, and ACM, variables are marked with fairly consistent results. Canagliflozin poses greater risks on amputation, fracture and DKA than the other two agents.
起訖頁 57-67
關鍵詞 心血管結果試驗因心衰竭住院主要不良心血管事件腎臟疾病進展組合CVOTsEndNoteHHFMACErenal composite
刊名 家庭醫學與基層醫療  
期數 201906 (29:2期)
出版單位 台灣家庭醫學醫學會
該期刊-下一篇 低骨密之相關危險因子其性別差異探討──以某區域醫院健檢個案
 

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