SGLT2 抑制剂的使用和心脏结局在2型糖尿病与肝硬化2型糖尿病

Mu-Chi Chung^1,2,3, Tung-Min Yu¹, Laing-You Wu⁴

¹Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.

JAMA network open

|February 23, 2026

概括

与二二酶-4抑制剂 (DPP4is) 相比,-葡萄糖共运输体-2抑制剂 (SGLT2is) 在患有肝硬化的2型糖尿病患者中显著降低了,心血管和肝脏问题的风险. SGLT2is提供心脏和肝脏的保护.

科学领域:

心脏病学心脏病学
腎臟病學 (nephrology) 是一種醫學專業.
肝病学肝病学是一种肝病学.
内分泌学在内分泌学.

背景情况:

2型糖尿病 (T2D) 和肝硬化经常同时存在,对健康构成重大风险.
患有这两种疾病的患者面临脏和心血管并发症的风险增加.
对这一群体进行最佳的抗糖尿病治疗仍未得到充分研究.

研究的目的:

为了评估-葡萄糖配运输体-2 抑制剂 (SGLT2i) 与二二酶-4 抑制剂 (DPP4i) 的相关性,使用.
评估对结局,心血管事件和肝脏衰竭的影响.
分析T2D和肝硬化同时发生的患者的这些影响.

主要方法:

使用台湾国家医疗保险数据库 (2016年5月 - 2023年12月) 进行全国性回顾性队列研究.
包括T2D和肝硬化发病的成年人,开始SGLT2is或DPP4is.
使用治疗权重的逆概率来平衡基线特征.

主要成果:

与DPP4is相比,SGLT2i治疗与末期病 (ESKD) (aHR,0.34) 和急性损伤 (AKI) (aHR,0.66) 的风险显著降低.
此外,SGLT2i的使用也显著降低了主要不良心血管事件 (MACE) 的风险 (aHR,0.67),全因死亡率 (aHR,0.58),以及肝脏衰竭的风险 (aHR,0.65).
该研究包括24,259名患者,平均随访时间为2.3年.

结论:

与T2D和肝硬化患者的DPP4抑制剂相比,SGLT2抑制剂显示脏,心血管和肝脏不良结果的风险明显较低.
这些发现表明,SGLT2在这种高风险人群中具有显著的心脏,脏和肝脏保护益处.
在患有肝硬化并存的患者中,SGLT2is代表了管理T2D的潜在优越治疗选择.

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