基于网络Meta分析对比不同钠-葡萄糖协同转运蛋白2抑制剂对慢性心力衰竭患者预后的影响

doi:10.3969/j.issn.1674-490X.2024.05.001

摘要/Abstract

摘要： 目的运用贝叶斯网状Meta分析对比不同钠-葡萄糖协同转运蛋白2抑制剂(sodium-glucose cotransporter 2 inhibitor, SGLT2i)对慢性心力衰竭患者预后的影响。方法利用计算机全面检索CNKI、CBM、Wanfang、VIP、Pubmed、Web of Science、Embase、Cochrane Library。检索时间从建库至2022年12月1日。收集SGLT2i治疗心力衰竭的临床随机对照试验。由3名研究者独立进行筛选、提取数据。依据Cochrane系统评价手册进行偏倚风险评价。以RevMan 5.4软件进行异质性检验及直接Meta分析,ADDIS 1.16.6软件进行网状Meta分析。结果共纳入9项随机对照研究,包含3种不同的SGLT2i,共涉及23 285例患者。与安慰剂相比,3种SGLT2i均能降低心血管死亡/心力衰竭住院复合终点的发生率,从优到劣排序为索格列净>达格列净>恩格列净>安慰剂。与安慰剂相比,3种SGLT2i中仅达格列净能降低心血管死亡或全因死亡发生率。3种SGLT2i与安慰剂在降低低血糖事件发生率方面差异无统计学意义。结论 SGLT2i能降低慢性心力衰竭患者心血管死亡/心力衰竭住院复合终点发生率,且不增加低血糖事件发生率,而在降低心血管死亡和全因死亡方面,达格列净可能优于恩格列净和索格列净。

关键词: 心力衰竭, 钠-葡萄糖协同转运蛋白2抑制剂, 网状Meta分析

Abstract: Objective To compare the effects of different sodium-glucose cotransporter 2 inhibitors(SGLT2i)on the prognosis of patients with chronic heart failure by Bayesian network Meta-analysis. Methods CNKI, CBM, Wanfang, VIP, Pubmed, Web of Science, Embase, and Cochrane Library were comprehensively searched with computer. The retrieval time was from the establishment of the database to December 1, 2022. Clinical randomized controlled trials of SGLT2i in the treatment of heart failure were collected. Three researchers independently screened and extracted the data. Inexpensive risk assessments were determined according to the Cochrane Handbook of Systematic Reviews. Heterogeneity test and direct Meta-analysis were performed with RevMan5.4 software, and Bayesian network Meta-analysis was performed with ADDIS1.16.6 software. Results A total of 9 RCTs were included, including 3 different SGLT2i types, involving a total of 23 285 patients. Compared with placebo, the three SGLT2i could significantly reduce the incidence of the composite endpoint of cardiovascular death/heart failure hospitalization, order from superior to inferior was: soxagliflozin>dapagliflozin>empagliflozin>placebo. Compared with placebo, dagliazine alone could reduce the incidence of cardiovascular or all-cause death. There was no statistically significant in reducing incidence of hypoglycemic events between the three SGLT2i and placebo. Conclusion SGLT2i can reduce the incidence of the composite endpoint of cardiovascular death/heart failure hospitalization in patients with chronic heart failure, without increasing the risk of hypoglycemia events, and dapagliflozin may be superior to soxagliflozin and empagliflozin in terms of cardiovascular death and all-cause mortality.

Key words: heart failure, sodium-glucose cotransporter 2 inhibitor, network Meta-analysis

中图分类号:

赵代鑫, 胡晓军, 晏凯利, 王四坤, 刘恒友. 基于网络Meta分析对比不同钠-葡萄糖协同转运蛋白2抑制剂对慢性心力衰竭患者预后的影响[J]. 医学研究与教育, 2024, 41(5): 1-10.

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