4种SGLT2抑制剂治疗射血分数降低的心力衰竭有效性和安全性的网状meta分析  

Efficacy and safety of four SGLT2 inhibitors in the treatment of heart failure with reduced ejection fraction:a network meta-analysis

作　　者：王凯阳 杨燕[1] 祖丽皮耶·艾乃斯 李秀芬[1,2] WANG Kaiyang;YANG Yan;ZULIPIYE Ainaisi;LI Xiufen(Department of Cardiology,Fourth Affiliated Hospital of Xinjiang Medical University,Urumqi,830000,China;Xinjiang Autonomous Region Institute of Traditional Chinese Medicine)

机构地区：[1]新疆医科大学第四附属医院心内科,乌鲁木齐830000 [2]新疆维吾尔自治区中医药研究院

出　　处：《临床心血管病杂志》2023年第1期21-28,共8页Journal of Clinical Cardiology

基　　金：新疆维吾尔自治区自然科学基金-面上项目(No:2022D01C165)。

摘　　要：目的:系统评价4种钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂治疗射血分数降低的心力衰竭(HFrEF)患者的有效性和安全性。方法:计算机检索PubMed、EMBASE、The Cochrane Library、中国知网、维普和万方等数据库,搜集关于达格列净、卡格列净、恩格列净及艾托格列净4种SGLT2抑制剂治疗HFrEF患者的随机对照试验(RCT),检索时限均为建库至2022年7月1日。由2名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R4.0.1软件进行网状meta分析。结果:共纳入24个RCT,包含11 972例HFrEF患者。网状meta分析结果显示:与安慰剂组比较,在降低心血管死亡和全因死亡发生率方面,达格列净更有优势(心血管死亡:RR=0.81,95%CI:0.69~0.94;全因死亡:RR=0.81,95%CI:0.70~0.92);在降低再入院发生率方面,达格列净和恩格列净更有优势(达格列净:RR=0.74,95%CI:0.65~0.85;恩格列净:RR=0.73,95%CI:0.63~0.84);在降低N末端B型利钠肽前体(NT-proBNP)方面,卡格列净、达格列净和恩格列净之间差异无统计学意义;在改善左心室射血分数(LVEF)方面,达格列净更有优势(MD=3.3,95%CI:1.27~5.29);在生殖器感染发生率方面,恩格列净发生风险更高(RR=2.09,95%CI:1.29~3.52);在低血糖、容量不足、尿路感染发生率及堪萨斯城心肌病问卷(KCCQ)评分方面,达格列净和恩格列净之间差异无统计学意义。累积排序概率图下面积(SUCRA)显示:在降低心血管死亡和全因死亡发生率方面,达格列净疗效排在第1位;在降低再入院发生率方面,艾托格列净疗效排在第1位;在降低NT-proBNP和改善LVEF方面,卡格列净疗效排在第1位;在提升KCCQ评分方面,恩格列净排疗效在第1位;在低血糖、容量不足、尿路感染、生殖器感染等不良反应发生率方面,不同SGLT2抑制剂安全性均劣于安慰剂。结论:当前证据表明,4种SGLT2抑制剂治疗HFrEF患者的有效性和安全性差异无统计学意义。无论使用哪一�Objective: To systematically review the efficacy and safety of sodium-glucose cotransporter 2(SGLT2) inhibitors in patients with heart failure with reduced ejection fraction(HFrEF). Methods: PubMed, EMBASE, The Cochrane Library, CNKI, VIP, and WanFang Data databases were electronically searched to collect randomized controlled trials(RCTs) on the treatment of HFrEF with four SGLT2 inhibitors: dapagliflozin, canagliflozin, empagliflozin and itogliflozin from inception to July 1, 2022. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, network meta-analysis was performed by using R4.0. 1 software. Results: A total of 24 RCTs involving 11 972 patients with HFrEF were included. The results of the network meta-analysis show that: compared with the placebo group, dapagliflozin was superior in reducing the incidence of cardiovascular mortality and all-cause mortality(cardiovascular mortality: RR=0.81, 95%CI: 0.69-0.94;all-cause mortality: RR=0.81, 95%CI: 0.70-0.92), dapagliflozin and empagliflozin superior in reducing the incidence of readmission(dapagliflozin: RR=0.74, 95%CI: 0.65-0.85;empagliflozin: RR=0.73, 95%CI: 0.63-0.84), there was no significant difference between canagliflozin, dapagliflozin, and empagliflozin in reducing the nerve terminal type B natriuretic peptide(NT-proBNP), dapagliflozin was superior in improving left ventricular ejection fraction(LVEF)(MD=3.3, 95%CI: 1.27-5.29), empagliflozin had a higher risk of genital infection(RR=2.09, 95%CI: 1.29-3.52), there was no significant difference between dapagliflozin and empagliflozin in the incidence of hypoglycemia, volume depletion, urinary tract infection and KCCQ score. The results of SUCRA show that: Dapagliflozin ranks first in terms of reducing the incidence of cardiovascular mortality and all-cause mortality;Ertugliflozin ranks first in terms of reducing the incidence of readmission;Canagliflozin ranks first in terms of reducing NT-proBNP and improving LVEF;Empagliflozin ranks first

关 键 词：钠-葡萄糖协同转运蛋白2抑制剂 心力衰竭 射血分数降低的 网状meta分析 随机对照试验 

分 类 号：R541.6[医药卫生—心血管疾病]