钠-葡萄糖转运蛋白2抑制剂导致低血压风险的网状meta分析  

Risk of hypotension induced by sodium-glucose transporter 2 inhibitors:a network meta-analysis

作　　者：赵宏廷[1] 令娟 成晓琼 谢卓霖 张东鹏[4] 禚君[5] Zhao Hongting;Ling Juan;Cheng Xiaoqiong;Xie Zhuolin;Zhang Dongpeng;Zhuo Jun(Department of Neurology,Gansu Provincial Hospital of TCM,Lanzhou 730050,China;Clinical College of Chinese Medicine,Gansu University of Chinese Medicine,Lanzhou 730030,China;First School of Clinical Medical,Gansu University of Chinese Medicine,Lanzhou 730030,China;Department of Endocrinology,Gansu Provincial Hospital of TCM,Lanzhou 730050,China;Department of Clinical Pharmacy,Gansu Provincial Hospital of TCM,Lanzhou 730050,China)

机构地区：[1]甘肃省中医院神经内科,兰州730050 [2]甘肃中医药大学中医临床学院,兰州730030 [3]甘肃中医药大学第一临床医学院,兰州730030 [4]甘肃省中医院内分泌科,兰州730050 [5]甘肃省中医院临床药学科,兰州730050

出　　处：《药物不良反应杂志》2024年第5期291-298,共8页Adverse Drug Reactions Journal

基　　金：国家中医优势专科建设项目(甘卫中医函[2023]63号)。

摘　　要：目的系统评价钠葡萄糖转运蛋白2(SGLT2)抑制剂致2型糖尿病患者低血压的风险。方法检索国内外有关数据库(截至2023年2月15日),收集SGLT2抑制剂治疗2型糖尿病且不良事件的结局指标包含低血压的随机对照试验。采用Cochrane偏倚风险评估工具对纳入的研究进行质量评价。采用Stata 15.1软件贝叶斯方法进行网状meta分析,绘制SGLT2抑制剂不同干预措施低血压风险的网状证据图、两两比较的联赛图和累积概率排序曲线下面积图(SUCRA),并对SGLT2抑制剂不同干预措施低血压风险的大小进行排序。效应量为相对危险度(RR)及其95%置信区间(CI)。结果最终纳入20项研究进行分析,共包括22525例患者。试验组15260例,干预药物包括达格列净(1517例)、卡格列净(6053例)和艾托格列净(7690例);对照组7265例,包括格列美脲(482例)和安慰剂(6783例)。网状meta分析结果显示,与艾托格列净5mg、艾托格列净15mg及安慰剂相比,卡格列净300mg治疗发生低血压的风险增高(RR=2.13,95%CI:1.31~3.47;RR=2.21,95%CI:1.35~3.61;RR=2.49,95%CI:1.62~3.82;均P<0.05);卡格列净100mg与安慰剂相比低血压风险增加(RR=1.61,95%CI:1.04~2.50,P<0.05);SGLT2抑制剂其他干预措施之间的比较差异均无统计学意义。按SUCRA对SGLT2抑制剂不同干预措施致低血压发生风险的排序结果显示,低血压发生风险从低到高依次为艾托格列净5mg、安慰剂、达格列净2.5mg、艾托格列净10mg、艾托格列净15mg、卡格列净50mg、卡格列净100mg、达格列净5mg、达格列净10mg、卡格列净150mg、卡格列净300mg。结论不同SGLT2抑制剂治疗方案导致2型糖尿病患者发生低血压的风险不同。艾托格列净导致低血压的风险较小,尤其是艾托格列净5mg方案;而卡格列净导致低血压的风险较高,尤其在较高剂量治疗时。Objective To systematically evaluate the risk of hypotension induced by sodiumglucose transporter 2(SGLT2)inhibitors in patients with type 2 diabetes mellitus.Methods Randomized controlled trials of SGLT2 inhibitors in the treatment of type 2 diabetes mellitus,in which hypotension were evaluated as an outcome indicator of adverse events,were collected by searching relevant databases at home and abroad(up to February 15,2023).Cochrane risk of bias assessment tool was used to evaluate the quality of the included studies.Stata 15.1 software was used to conduct Bayesian network meta-analysis,including drawing the network evidence plot,the league map of pairwise comparison,and the surface under the cumulative ranking curve(SUCRA)for hypotension risk under different interventions of SGLT2 inhibitors,and ranking the risks of hypotension induced by different interventions of SCLT2 inhibitors.The effect sizes were expressed by relative risk(RR)and its 95%confidence interval(CI).Results A total of 20 studies were included in the analysis,involving 22525 patients with 15260 in the trial group and 7265 in the control group.Drugs that used in the trial group included dapagliflozin(in 1517 patients),canagliflozin(in 6053 patients),and ertugliflozin(in 7690 patients);drugs that used in the control group included glimepiride(in 482 patients)and placebo(in 6783 patients).The results of the network meta-analysis showed that the risk of hypotension was higher after treatment with 300 mg of canagliflozin,compared with those with 5 mg and 15 mg of ertugliflozin,and placebo(RR=2.13,95%CI:1.31-3.47;RR=2.21,95%CI:1.35-3.61;RR=2.49,95%Cl:1.62-3.82;all P<0.05);the risk of hypotension was higher after treatment with 100 mg of canagliflozin,compared with placebo(RR=1.61,95%CI:1.04-2.50,P<0.05);the differences in comparison between any other 2 interventions with SGLT2 inhibitors were not statistically significant.According to the relative risks for hypotension of different interventions with SGLT2 inhibitors in the results of SUCRA,intervent

关 键 词：糖尿病 2型 钠-葡萄糖转运蛋白2抑制剂 低血压 网状meta分析 

分 类 号：R544.2[医药卫生—心血管疾病] R587.2[医药卫生—内科学]