SGLT-2抑制剂致2型糖尿病患者低血糖的网状Meta分析  

Network meta-analysis of SGLT-2 inhibitor-induced hypoglycemia risk in type 2 diabetes patients

作　　者：禚君[1] 令娟 江燕 李婷 王洁 ZHUO Jun;LING Juan;JIANG Yan;LI Ting;WANG Jie(Dept.of Clinical Pharmacy,Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050,China;Dept.of Infection Management,GansuProvincial People’s Hospital,Lanzhou 730030,China;The First School of Clinical Medicine,Gansu University of Chinese Medicine,Lanzhou 730030,China;Dept.of Pharmacy,the Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China)

机构地区：[1]甘肃省中医院临床药学科,兰州730050 [2]甘肃省人民医院感染管理科,兰州730030 [3]甘肃中医药大学第一临床医学院,兰州730030 [4]陕西中医药大学附属医院药剂科,咸阳712000

出　　处：《中国药房》2023年第12期1509-1514,共6页China Pharmacy

基　　金：甘肃省卫生健康行业科研计划项目(No.GSWSKY-2022-44)。

摘　　要：目的评价钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂致2型糖尿病(T2DM)患者低血糖的发生风险。方法计算机检索PubMed、Web of Science、Cochrane图书馆、中国知网、维普网、万方数据、中国生物医学文献数据库,收集SGLT-2抑制剂治疗T2DM的随机对照试验(RCT),检索时限均为建库起至2022年10月15日。筛选文献、提取数据,采用Cochrane系统评价员手册推荐的5.1.0偏倚风险评估工具对纳入文献进行质量评价后,采用Stata 15.1软件进行网状Meta分析和发表偏倚分析。结果共纳入22项RCT,共计18734例患者。Meta分析结果显示,与埃格列净15 mg[RR=3.26,95%CI(1.13,8.11),P<0.05]及埃格列净25 mg[RR=3.08,95%CI(1.12,6.34),P<0.05]比较,使用卡格列净300 mg时患者的低血糖发生率显著升高;与埃格列净15 mg[RR=1.48,95%CI(1.24,6.93),P<0.05]及埃格列净25 mg[RR=6.74,95%CI(1.33,9.34),P<0.05]比较,使用卡格列净100 mg时患者的低血糖发生率显著升高;其他各组间比较,差异均无统计学意义(P>0.05)。网状Meta分析排序结果显示,低血糖发生率从低到高依次为:埃格列净15 mg>安慰剂>埃格列净25 mg>恩格列净25 mg>恩格列净10 mg>恩格列净1 mg>达格列净5 mg>达格列净10 mg>达格列净2.5 mg>卡格列净300 mg>埃格列净10 mg>埃格列净5 mg>恩格列净50 mg>卡格列净200 mg>卡格列净100 mg>卡格列净50 mg>埃格列净1 mg>恩格列净5 mg。发表偏倚分析结果显示,本研究存在发表偏倚的可能性较小。结论SGLT-2抑制剂治疗T2DM时,以使用埃格列净15 mg低血糖发生率最低,使用恩格列净5 mg最高。OBJECTIVE To evaluate the risk of hypoglycemia caused by sodium-glucose co-transporter protein 2(SGLT-2)inhibitors in type 2 diabetes(T2DM)patients.METHODS Retrieved from PubMed,Web of Science,Cochrane Library,CNKI,VIP,Wanfang Data and CBM,randomized controlled trials(RCTs)about SGLT-2 inhibitors in the treatment of T2DM were collected from the inception to Oct.15th,2022.After literature screening,data extraction and quality evaluation of included literature with bias risk assessment tool recommended by the Cochrane system evaluator handbook 5.1.0,Stata 15.1 software was used for network meta-analysis and publication bias analysis.RESULTS A total of 22 RCTs were included,with a total of 18734 patients.The results of meta-analysis showed that compared with ertugliflozin 15 mg[RR=3.26,95%CI(1.13,8.11),P<0.05]and ertugliflozin 25 mg[RR=3.08,95%CI(1.12,6.34),P<0.05],the incidence of hypoglycemia was significantly increased in patients using canagliflozin 300 mg.Compared with ertugliflozin 15 mg[RR=1.48,95%CI(1.24,6.93),P<0.05]and ertugliflozin 25 mg[RR=6.74,95%CI(1.33,9.34),P<0.05],the incidence of hypoglycemia in patients treated with canagliflozin 100 mg was significantly increased.There was no statistically significant difference between other groups(P>0.05).The ranking results of the network meta-analysis showed that the incidence of hypoglycemia was from low to high,ie.ertugliflozin 15 mg>placebo>ertugliflozin 25 mg>empgaliflozin 25 mg>empgaliflozin 10 mg>empgaliflozin 1 mg>dapagliflozin 5 mg>dapagliflozin 10 mg>dapagliflozin 2.5 mg>canagliflozin 300 mg>ertugliflozin 10 mg>ertugliflozin 5 mg>empgaliflozin 50 mg>canagliflozin 200 mg>canagliflozin 100 mg>canag-liflozin 50 mg>ertugliflozin 1 mg>empgaliflozin 5 mg.Results of publication bias analysis showed that there was little possibility of publication bias in this study.CONCLUSIONS When SGLT-2 inhibitors are used in patients with T2DM,the incidence of hypoglycemia is the lowest when using ertugliflozin 15 mg,and the incidence of hypoglycemia is the highest when

关 键 词：钠-葡萄糖共转运蛋白2抑制剂 低血糖 2型糖尿病 网状Meta分析 

分 类 号：R977.15[医药卫生—药品]