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抗糖尿病疗法对2型糖尿病患者肝脏衰竭的比较有效性:一个向试验模拟试验
Jonggi Choi1,2,3, Ana Verma4, Vy H Nguyen4
1Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
JHEP reports : innovation in hepatology
|December 9, 2025
概括
与硫尿素和DPP4is相比,与葡萄糖类似的-1受体激活剂 (GLP-1RAs) 和-葡萄糖共运输体-2抑制剂 (SGLT2is) 在2型糖尿病 (T2DM) 患者中显著降低肝衰竭风险. 这些发现支持它们的优先使用.
科学领域:
- 内分泌学 在内分泌学.
- 肝病学 肝病学是一种肝病学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 对2型糖尿病 (T2DM) 肝脏结局的抗糖尿病疗法的比较有效性尚未得到充分证实.
- 需要现实世界的证据来指导T2DM患者的临床决策,这些患者有肝病风险.
研究的目的:
- 为了比较四个主要的抗糖尿病药物类别在减少肝脏不补偿方面的有效性.
- 在T2DM患者中评估与启动GLP-1RAs,SGLT2is,DPP4is或硫尿素相关的肝衰竭风险.
主要方法:
- 追溯性新用户队列研究,模拟使用电子健康记录的目标试验.
- 包括T2DM发起GLP-1RAs,SGLT2is,DPP4is,或硫基尿酸的成年人.
- 倾向性得分重叠权重用于平衡共变量和估计比较有效性.
主要成果:
- 与硫尿素相比,GLP-1RAs和SGLT2is与肝脏衰竭的风险显著降低 (HR分别为0.58和0.65).
- 与DPP4is相比,GLP-1RAs和SGLT2is的风险也降低了 (HR分别为0.59和0.66).
- 每项协议分析证实GLP-1RAs具有强烈的保护 (HR 0.43) 和SGLT2is (HR 0.61) 的趋势.
结论:
- 在T2DM患者中,GLP-1RA或SGLT2is的启动与肝脏衰退的风险明显降低.
- 这些发现支持GLP-1RAs和SGLT2is在临床实践中的首选使用,特别是在患有肝病风险的患者中.
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