SGLT2抑制剂治疗心力衰竭的有效性和安全性的网状Meta分析  

Efficacy and safety of SGLT2 inhibitors for heart failure: a network meta-analysis

作　　者：武锋超 马兰虎 蓝庆肃 韩俊先 王姣 姚亚丽[2] WU Fengchao;MA Lanhu;LAN Qingsu;HAN Junxian;WANG Jiao;YAO Yali(The First Clinical Medical College,Lanzhou University,Lanzhou 730000,P.R.China;The First Hospital of Lanzhou University,Lanzhou 730000,P.R.China)

机构地区：[1]兰州大学第一临床医学院,兰州730000 [2]兰州大学第一医院心内科,兰州730000

出　　处：《中国循证医学杂志》2022年第3期291-298,共8页Chinese Journal of Evidence-based Medicine

基　　金：甘肃省卫生行业科研计划项目(编号:GSWSDY-2015-44)。

摘　　要：目的系统评价SGLT2抑制剂治疗心力衰竭患者的有效性和安全性。方法计算机检索The Cochrane Library、Web of Science、PubMed和EMbase数据库,搜集SGLT2抑制剂治疗心力衰竭患者有效性和安全性的随机对照试验,检索时限均从建库至2021年7月2日。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 16.0软件进行网状Meta分析。结果共纳入16个随机对照试验,包括15312例患者,涉及5种干预措施,分别为达格列净、恩格列净、卡格列净、索格列净和艾格列净。网状Meta分析结果显示:5种不同SGLT2抑制剂对于心力衰竭患者的心力衰竭住院或心血管死亡复合结局、心力衰竭住院、全因死亡、心血管死亡风险及严重不良反应方面的差异均无统计学意义(P>0.05)。与安慰剂相比,选择性SGLT2抑制剂与非选择性SGLT2抑制剂均可改善心衰住院、心衰住院或心血管死亡复合风险(P<0.05),仅选择性SGLT2抑制剂可改善心血管死亡、全因死亡及严重不良反应的发生风险(P<0.05),但选择性与非选择性SGLT2抑制剂比较差异无统计学意义(P>0.05)。除心力衰竭或心血管死亡复合结局外,在其余指标方面,选择性和非选择性SGLT2抑制剂累计排序概率曲线下面积(SUCRA)排名均为第一和第二。结论现有证据表明,使用5种不同SGLT2抑制剂治疗心力衰竭的疗效及安全性无明显差异,选择性SGLT2抑制剂与非选择性SGLT2抑制剂疗效和安全性也无明显差异。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。Objective To systematically review the efficacy and safety of different SGLT2 inhibitors in the treatment of heart failure.Methods The Cochrane Library,Web of Science,PubMed and EMbase databases were searched for randomized controlled trials on the efficacy and safety of SGLT2 inhibitors in patients with heart failure from inception to July 2,2021.Two researchers independently screened literature,extracted data and evaluated the risk of bias of the included studies.Network meta-analysis was then performed using Stata 16.0 software.Results A total of 16 randomized controlled trials,including 15312 patients,involving 5 interventions,namely dapagliflozin,empagliflozin,canagliflozin,sotagliflozin and ertugliflozin were included.Results of network meta-analysis showed that there was no significant difference in the compound outcome of hospitalization for heart failure or cardiovascular death,hospitalization for heart failure,all-cause mortality,risk of cardiovascular mortality and serious adverse reactions among patients with heart failure among 5 different SGLT2 inhibitors(P>0.05).Compared with placebo,both selective and non-selective SGLT2 inhibitors improved the risk of hospitalization for heart failure,hospitalization for heart failure,or compound cardiovascular mortality(P<0.05),while only selective SGLT2 inhibitors improved the risk of cardiovascular mortality,all-cause mortality,and serious adverse events(P<0.05).However,there was no significant difference between them(P>0.05).The area under the cumulative ordering probability curve of selective and non-selective SGLT2 inhibitors ranked first and second,except for the combined outcome of heart failure or cardiovascular death.Conclusion The current evidence indicates that there is no significant difference in the efficacy and safety of the 5 different SGLT2 inhibitors in the treatment of heart failure,and there is no significant difference between selective SGLT2 inhibitors and non-selective SGLT2 inhibitors.Due to the limited quantity and quality of included st

关 键 词：钠葡萄糖协同转运体2抑制剂 心力衰竭 有效性 安全性 网状Meta分析 

分 类 号：R541.6[医药卫生—心血管疾病]