葡萄糖钠转运体 2 抑制剂与糖尿病患者的相关肝脏结果

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-04-12 DOI:10.1016/j.diabres.2025.112174

Fu-Shun Yen , James Cheng-Chung Wei , Chen Wang , Ming-Chih Hou , Teng-Shun Yu , Yuhan Huang , Chii-Min Hwu , Chih-Cheng Hsu

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引用次数: 0

摘要

2型糖尿病（T2D）患者代谢功能障碍相关脂肪变性肝病（MASLD）与较差的肝脏相关预后相关。我们比较了T2D患者钠-葡萄糖共转运蛋白2抑制剂（SGLT-2i）使用者和非使用者之间肝脏相关结局和全因死亡率的风险。方法：我们从台湾全民健康保险研究数据库（2009-2020）中筛选出282,161例T2D患者，不包括病毒性肝炎或酒精相关疾病患者。倾向评分匹配创建了使用SGLT-2i和其他降糖药的患者配对，Cox比例风险模型评估了结果。结果在平均2.7年的随访中，SGLT-2i的使用与肝硬化（校正危险比[aHR] 0.78, 95% CI: 0.70-0.87）、失代偿性肝硬化（aHR 0.79, 95% CI: 0.70-0.89）、肝衰竭（aHR 0.78, 95% CI: 0.68-0.89）和全因死亡率（aHR 0.52, 95% CI: 0.51-0.54）的风险显著降低相关。与二肽基肽酶-4抑制剂（DPP-4i）、胰高血糖素样肽-1受体激动剂（GLP-1 RA）、吡格列酮和磺脲类药物相比，使用SGLT-2i可降低肝硬化、肝功能衰竭和全因死亡率的风险。使用SGLT-2i与使用DPP-4i或GLP-1 RA相比，肝脏相关死亡率较低。结论：该队列研究提示SGLT-2i可降低t2dm患者肝硬化、失代偿性肝硬化、肝功能衰竭以及肝脏相关和全因死亡率的风险。

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Sodium-Glucose Cotransporter2 inhibitors and associated Liver-Related outcomes in diabetes patients

Aims

Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with poorer liver-related outcomes in type 2 diabetes (T2D) patients. We compared risk of liver-related outcomes and all-cause mortality between sodium-glucose cotransporter-2 inhibitor (SGLT-2i) users and nonusers in T2D patients.

Methods

We identified 282,161 T2D patients from the Taiwan National Health Insurance Research Database (2009–2020), excluding those with viral hepatitis or alcohol-related disorders. Propensity score matching created patient pairs on SGLT-2i and other antidiabetic drugs, and Cox proportional hazard models assessed outcomes.

Results

Over a mean follow-up of 2.7 years, SGLT-2i use was associated with significantly lower risk of liver cirrhosis (adjusted hazard ratio [aHR] 0.78, 95 % CI: 0.70–0.87), decompensated cirrhosis (aHR 0.79, 95 % CI: 0.70–0.89), liver failure (aHR 0.78, 95 % CI: 0.68–0.89), and all-cause mortality (aHR 0.52, 95 % CI: 0.51–0.54). Compared to dipeptidyl peptidase-4 inhibitors (DPP-4i), glucagon-like peptide-1 receptor agonists (GLP-1 RA), pioglitazone, and sulfonylureas, SGLT-2i use was associated with lower risk of cirrhosis, liver failure, and all-cause mortality. SGLT-2i use was associated with lower liver-related mortality than DPP-4i or GLP-1 RA use.

Conclusions

This cohort study suggests that SGLT-2i may reduce the risk of liver cirrhosis, decompensated cirrhosis, liver failure, and liver-related and all-cause mortality in T2D patients.

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.