瑞典卡罗莱纳研究所Peter Ueda团队近期取得新进展。他们分析了使用钠-葡萄糖共转运蛋白2抑制剂发生严重肾脏事件的风险。该研究于2020年4月29日发表在《英国医学杂志》上。
为了评估在常规临床实践数据中，使用钠-葡萄糖共转运蛋白2（SGLT2）抑制剂与发生严重肾脏事件之间的相关性，2013-2018年，研究组在瑞典、丹麦和挪威使用活性对照剂，进行了一项全国注册数据的队列研究。
参与者为29887名SGLT2抑制剂新使用者和29887名活性对照剂二肽基肽酶-4抑制剂新使用者的队列，根据57个变量的倾向性评分，按1：1匹配。严重肾脏事件包括肾脏替代治疗、肾脏原因死亡和因肾脏事件入院的综合结局。
研究人群的中位年龄为61.3岁，19%患有心血管疾病，3%患有慢性肾脏疾病。SGLT2抑制剂组严重肾脏事件的发生率为每1000人年2.6例，显著低于二肽基肽酶-4抑制剂组（每1000人年6.2例）。
在次要结果分析中，SGLT2抑制剂组与二肽基肽酶-4抑制剂组相比，肾脏替代治疗的风险比为0.32，因肾脏事件住院的风险比为0.41，因肾脏原因死亡的风险比为0.77。
在瑞典和丹麦队列各部分的敏感性分析中，针对糖化血红蛋白和估计肾小球滤过率以及血压、体重指数和吸烟等进行校正后，瑞典的风险比从0.41升至0.50，丹麦的风险比从0.42升至0.55。
总之，与二肽基肽酶-4抑制剂相比，使用SGLT2抑制剂可显著降低严重肾脏事件发生的风险。
附：英文原文
Title: Use of sodium-glucose co-transporter 2 inhibitors and risk of serious renal events: Scandinavian cohort study
Author: Bjrn Pasternak, Viktor Wintzell, Mads Melbye, Bjrn Eliasson, Ann-Marie Svensson, Stefan Franzén, Soffia Gudbjrnsdottir, Kristian Hveem, Christian Jonasson, Henrik Svanstrm, Peter Ueda
Issue&Volume: 2020/04/29
Abstract: Objective To assess the association between use of sodium-glucose co-transporter 2 (SGLT2) inhibitors and risk of serious renal events in data from routine clinical practice.
Design Cohort study using an active comparator, new user design and nationwide register data.
Setting Sweden, Denmark, and Norway, 2013-18.
Participants Cohort of 29887 new users of SGLT2 inhibitors (follow-up time: dapagliflozin 66.1%; empagliflozin 32.6%; canagliflozin 1.3%) and 29887 new users of an active comparator, dipeptidyl peptidase-4 inhibitors, matched 1:1 on the basis of a propensity score with 57 variables. Mean follow-up time was 1.7 (SD 1.0) years.
Exposures SGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors, defined by filled prescriptions and analysed according to intention to treat.
Main outcome measures The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes, and hospital admission for renal events. Secondary outcomes were the individual components of the main outcome.
Results The mean age of the study population was 61.3 (SD 10.5) years; 11108 (19%) had cardiovascular disease, and 1974 (3%) had chronic kidney disease. Use of SGLT2 inhibitors, compared with dipeptidyl peptidase-4 inhibitors, was associated with a reduced risk of serious renal events (2.6 events per 1000 person years versus 6.2 events per 1000 person years; hazard ratio 0.42 (95% confidence interval 0.34 to 0.53); absolute difference 3.6 (–4.4 to 2.8) events per 1000 person years). In secondary outcome analyses, the hazard ratio for use of SGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors was 0.32 (0.22 to 0.47) for renal replacement therapy, 0.41 (0.32 to 0.52) for hospital admission for renal events, and 0.77 (0.26 to 2.23) for death from renal causes. In sensitivity analyses in each of the Swedish and Danish parts of the cohort, the model was further adjusted for glycated haemoglobin and estimated glomerular filtration rate (Sweden and Denmark) and for blood pressure, body mass index, and smoking (Sweden only); in these analyses, the hazard ratio moved from 0.41 (0.26 to 0.66) to 0.50 (0.31 to 0.81) in Sweden and from 0.42 (0.32 to 0.56) to 0.55 (0.41 to 0.74) in Denmark.
Conclusions In this analysis using nationwide data from three countries, use of SGLT2 inhibitors, compared with dipeptidyl peptidase-4 inhibitors, was associated with a significantly reduced risk of serious renal events.
DOI: 10.1136/bmj.m1186
Source: https://www.bmj.com/content/369/bmj.m1186
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
