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腹腔代谢手术与葡萄糖样-1受体激动剂和死亡率
Dror Dicker1,2, Yael Wolff Sagy3, Noga Ramot3
1Internal Medicine Department D and Obesity Clinic, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Israel.
JAMA network open
|June 7, 2024
概括
腹代谢手术 (BMS) 降低了糖尿病持续时间较短的患者的死亡率,主要是由于体重减轻,比葡萄糖类-1受体激动剂 (GLP-1RAs) 减少了死亡率. 对于较长的糖尿病持续时间,没有发现死亡率或MACE的显著差异.
科学领域:
- 代谢性疾病研究研究.
- 预防心血管事件的预防.
- 手术和药理干预手术和药理干预
背景情况:
- 有有限的证据可以比较肥胖代谢手术 (BMS) 和类似葡萄糖-1受体激动剂 (GLP-1RAs) 降低死亡率和主要不良心血管事件 (MACEs).
- 肥胖和糖尿病需要进行比较有效性研究,以获得最佳的患者结果.
研究的目的:
- 在没有先前存在心血管疾病的肥胖和糖尿病的成年人中,比较BMS和GLP-1RA之间的全因死亡率和非致命的MACE.
- 调查糖尿病持续时间对这些干预措施比较有效性的影响.
主要方法:
- 一项观察性,回顾性队列研究利用了以色列克莱利特卫生服务机构的数据.
- 包括6070名糖尿病和肥胖的成年患者,没有先前的心血管疾病.
- 接受BMS的患者与接受GLP-1RA的患者根据年龄,性别和临床特征进行了1:1匹配,随访时间中位数为6.8年.
主要成果:
- 在糖尿病持续时间≤10年的患者中,BMS与显著降低的死亡率相关 (HR,0.38;95% CI,0.25-0.58),这种效应由体重减轻介导.
- 在糖尿病持续时间>10年 (HR,0.65;95% CI,0.39-1.08) 的患者中,没有观察到BMS的显著生存优势.
- 在所有糖尿病持续时间内,BMS和GLP-1RA之间,非致命MACE的风险没有显著差异.
结论:
- 与GLP-1RA相比,BMS在糖尿病持续时间为10年或更短的个体中显示出较大降低死亡率,以减肥为媒介.
- 在糖尿病持续时间较长的人群中,BMS和GLP-1RA之间没有发现死亡率或非致命MACE的显著差异.
- 这些发现强调了糖尿病持续时间对BMS和GLP-1RAs在控制肥胖和糖尿病方面的比较有效性的重要性.
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