与二肽基肽酶-4 (DPP4)抑制剂相比，葡萄糖共转运蛋白2 (SGLT2)抑制剂可降低新发急性胰腺炎和胰腺癌的风险:一项倾向评分匹配研究与竞争风险分析

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2023-01-01 DOI:10.1016/j.deman.2022.100115

Oscar Hou In Chou , Jiandong Zhou , Jonathan V Mui MBBChir , Danish Iltaf Satti , Cheuk To Chung , Teddy Tai Loy Lee , Sharen Lee , Edward Christopher Dee , Kenrick Ng MBBChir , Bernard Man Yung Cheung , Fengshi Jing , Gary Tse

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引用次数: 0

摘要

背景二肽基肽酶-4抑制剂（DPP4I）可能与急性胰腺炎和癌症的高风险相关。本研究比较了钠-葡萄糖协同转运蛋白2抑制剂（SGLT2I）和DPP4I使用者患急性胰腺炎和癌症的风险。方法对香港2015年1月1日至2020年12月31日期间2型糖尿病SGLT2I或DPP4I患者进行回顾性人群队列研究。主要转归为新发急性胰腺炎和胰腺癌症。使用最近邻搜索进行倾向得分匹配（1:1比率）。应用单变量和多变量Cox回归来确定显著的预测因素。结果该队列包括31609名2型糖尿病患者（中位年龄：67.4岁[SD:12.5]；53.36%为男性）。6479名患者（20.49%）使用SGLT2I，25130名患者（70.50%）使用DPP4I。匹配后，SGLT2I使用者的急性胰腺炎发生率明显低于DPP4I使用者。多因素Cox回归显示，SGLT2I的使用与急性胰腺炎（危险比，HR:0.11；95%置信区间，CI:0.02-0.51；P=0.0017）和癌症（HR:0.22；95%CI:0.039-0.378；P=0.0003）的风险较低相关。使用竞争风险模型和不同倾向评分方法得出的结果是一致的。结论在倾向评分匹配和多变量调整后，使用SGLTII与新发急性胰腺炎和癌症的风险降低相关，强调需要在随机对照试验环境中进行进一步评估。

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Lower risks of new-onset acute pancreatitis and pancreatic cancer in sodium glucose cotransporter 2 (SGLT2) inhibitors compared to dipeptidyl peptidase-4 (DPP4) inhibitors: A propensity score-matched study with competing risk analysis

Background

Dipeptidyl peptidase-4 inhibitors (DPP4I) may be associated with higher risks of acute pancreatitis and pancreatic cancer. This study compared the risks of acute pancreatitis and pancreatic cancer between sodium glucose cotransporter 2 inhibitors (SGLT2I) and DPP4I users.

Methods

This was a retrospective population-based cohort study of patients with type-2 diabetes mellitus on either SGLT2I or DPP4I between January 1^st, 2015, and December 31^st 2020 in Hong Kong. The primary outcome was new-onset acute pancreatitis and pancreatic cancer. Propensity score matching (1:1 ratio) using the nearest neighbour search was performed. Univariable and multivariable Cox regressions were applied to identify significant predictors.

Results

This cohort included 31609 Type 2 Diabetes Mellitus patients (median age: 67.4 years old [SD: 12.5]; 53.36% males). 6479 patients (20.49%) used SGLT2I, and 25130 patients (70.50%) used DPP4I. After matching, the rate of acute pancreatitis was significantly lower in SGLT2I users compared to DPP4I users. Multivariable Cox regression showed that SGLT2I use was associated with lower risks of acute pancreatitis (Hazard ratio, HR: 0.11; 95% Confidence interval, CI: 0.02-0.51; P=0.0017) and pancreatic cancer (HR: 0.22; 95% CI: 0.039-0.378; P=0.0003). The results were consistent using competing risk models and different propensity score approaches.

Conclusions

SGLT2I use was associated with lower risks of new-onset acute pancreatitis and pancreatic cancer after propensity score matching and multivariable adjustment, underscoring the need for further evaluation in the randomised controlled trial setting.

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.