钠-葡萄糖共转运蛋白2抑制剂引起2型糖尿病患者尿路或生殖器感染风险的网状Meta分析  

Sodium-glucose cotransporter 2 inhibitors and the risk of urinary tract infections or genital infections in adult patients with type 2 diabetes mellitus:a systematic review and network Meta-analysis of randomized controlled trials

作　　者：刘凤琪 柴三葆[2] 赵厚宇 刘佐相 武珊珊 杨智荣 詹思延[1] 孙凤[1] Liu Fengqi;Chai Sanbao;Zhao Houyu;Liu Zuoxiang;Wu Shanshan;Yang Zhirong;Zhan Siyan;Sun Feng(Department of Epidemiology and Health Statistics,School of Public Health,Peking University,Beijing 100191,China;Department of Endocrinology,Peking University International Hospital,Beijing 102206,China;National Clinical Research Center for Digestive Diseases,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Faculty of Computer Science and Control Engineering,Shenzhen Institute of Advanced Technology,Chinese Academy of Sciences,Shenzhen 518055,China)

机构地区：[1]北京大学公共卫生学院流行病与卫生统计学系,北京100191 [2]北京大学国际医院内分泌科,北京102206 [3]首都医科大学附属北京友谊医院国家消化系统疾病临床医学研究中心,北京100050 [4]中国科学院深圳理工大学计算机科学与控制工程学院,深圳518055

出　　处：《中华糖尿病杂志》2022年第8期799-808,共10页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金(72074011);中国中医药循证医学中心业务研究室主任专项(2020YJSZX-2)。

摘　　要：目的:探讨钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)引起2型糖尿病患者发生尿路或生殖器感染的风险。方法:检索美国国立医学图书馆数据库(PubMed)、医学文摘数据库(EMbase)、Web of Science、Clinical trials和Cochrane循证医学数据库(Cochrane Library),以及中国期刊全文数据库(CNKI)、万方数据库、维普数据库、中国生物医学文献库(SinoMed)等从建库到2021年8月31日收录的,涉及SGLT2i类药物且报告了生殖器感染或尿路感染结局的随机对照试验(RCT)。提取纳入文献的标题、试验组与对照组的干预措施、背景用药、结局事件、样本量等信息。对所有现有证据进行多层面的网状Meta分析,尿路感染和生殖器感染相对效应值均表示为OR值及其95%CI。结果:最终纳入100篇文献,97篇报告了尿路感染数据,28篇报告了生殖器感染数据。SGLT2i类药物治疗组总样本量为46697例,纳入文献涉及的SGLT2i类药物具体包括卡格列净、达格列净、贝格列净、荣格列净、埃格列净、恒格列净等,涉及的对照组干预措施包括其他降糖药及安慰剂,总样本量为33284例,其他降糖药具体包括二肽基肽酶Ⅳ抑制剂(DPP-4i)、胰岛素、磺脲类等。对于尿路感染结局,卡格列净引起尿路感染的风险较达格列净(OR=0.67,95%CI 0.45~0.99)、贝格列净(OR=0.43,95%CI 0.19~0.98)和荣格列净(OR=0.27,95%CI 0.08~0.97)均更低;与安慰剂相比,埃格列净增加尿路感染的风险(OR=1.21,95%CI 1.04~1.40);与恒格列净、胰岛素相比,贝格列净增加尿路感染的风险,其OR值(95%CI)分别为4.15(1.08~15.95)和12.16(1.27~116.55);与荣格列净相比,恒格列净降低尿路感染风险(OR=0.15,95%CI 0.03~0.80);与胰岛素和磺脲类相比,荣格列净可能增加尿路感染的风险,其OR值(95%CI)分别为19.32(1.65~226.07)和5.82(1.11~30.57)。对于生殖器感染结局,与其他降糖药相比,SGLT2i类药物显著增加患者发生生殖器感染的风险(OR=4.18,95%CI 2.Objective To systematically evaluate the effects of sodium-glucose cotransporter 2 inhibitors(SGLT2i)on urinary tract infections or genital infections in patients with type 2 diabetes mellitus.Methods We searched PubMed,EMbase,Web of Science,Clinical trials and Cochrane Library,as well as Chinese literature databases such as China national knowledge infrastructure(CNKI),Wanfang,VIP,and SinoMed databases from the establishment of the databases to 31st,August 2021 for randomized controlled trials(RCT)that involved SGLT2i and safety events of urinary tract infections or genital infections.A series of network Meta-analysis were performed on all available evidence.The titles,interventions,background medication,outcome events,sample size and other information of the included studies were extracted.In a multi-layered mesh Meta-analysis of all available evidence,the relative effect values of urinary tract infection or genital infection were showed as odds ratio(OR)values and 95%confidence intervals(95%CI).Results A total of 100 studies were included,97 of which reported urinary tract infections and 28 of which reported genital infections.The total sample size of SGLT2i group was 46697,including Canagliflozin,Dapagliflozin,Bexagliflozin,Remogliflozin,Ertugliflozin and Henagliflozin,etc.The total sample size of the control group including other hypoglycemic drugs and placebo was 33284.Other hypoglycemic drugs included dipeptidyl peptidaseⅣinhibitor(DPP-4i),insulin,sulfonylureas,etc.Some kinds of SGLT2i were associated with an increasing risk of urinary tract infections at different magnitude.The risk of urinary tract infection induced by Canagliflozin was lower than that of Dapagliflozin(OR=0.67,95%CI 0.45-0.99),Bexagliflozin(OR=0.43,95%CI 0.19-0.98)and Remogliflozin(OR=0.27,95%CI 0.08-0.97).Ertugliflozin increased the risk of urinary tract infection(OR=1.21,95%CI 1.04-1.40)compared with placebo.Compared with Henagliflozin and insulin,Bexagliflozin increased the risk of urinary tract infection with the OR values(95%CI)of

关 键 词：糖尿病 2型 钠-葡萄糖共转运蛋白2抑制剂 尿路感染 生殖器感染 网状Meta分析 

分 类 号：R587.2[医药卫生—内分泌]