在MASLD和2型糖尿病中GLP-1RA和肝纤维化进展:使用倾向性得分匹配的目标试验仿真
Jonggi Choi1,2,3, Tushar Kamath3, Vy H Nguyen4
1Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
概括
类似葡萄糖-1受体激动剂 (GLP-1RA) 在2型糖尿病和代谢功能障碍相关的脂肪性肝病 (MASLD) 患者中显著减缓了肝纤维化进展. 这表明GLP-1RA可能对早期MASLD管理有益.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 与代谢功能障碍相关的脂肪性肝病 (MASLD) 和2型糖尿病 (T2DM) 经常同时存在.
- 类似葡萄糖-1受体激动剂 (GLP-1RA) 是已建立的T2DM治疗方法,具有潜在的肝脏益处.
- 在现实环境中,GLP-1RA对MASLD患者肝纤维化进展的影响还不清楚.
研究的目的:
- 调查GLP-1RA使用与T2DM早期MASLD患者肝纤维化进展之间的关联.
- 为了比较GLP-1RA使用者和二乙酶-4抑制剂 (DPP-4i) 使用者之间的纤维化进展率.
主要方法:
- 使用电子健康记录 (2010-2023) 模拟目标试验的回顾性队列研究.
- 包括T2DM患者MASLD和基线纤维化-4 (FIB-4) 分数<2.67,启动GLP-1RA或DPP-4i.
- 使用倾向性得分匹配 (1:1);主要结局是进展到高风险FIB-4 (≥2.67).
主要成果:
- 分析了2238个匹配的对.
- 与DPP-4i相比,GLP-1RA的使用与纤维化进展的风险较低 (HR 0.75,95% CI 0.65-0.87).
- 这种风险降低在各个子组和敏感性分析中是一致的,二次肝脏结果没有显著差异.
结论:
- 在患有MASLD的T2DM患者中,GLP-1RA显著降低了肝纤维化进展.
- 这些发现支持GLP-1RA在修改早期MASLD中的潜在作用.
- 进一步的研究可能会阐明肝脏保护的具体机制.
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