PDF(Pubmed)
Abstract：
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been used to reduce glucose levels in patients with type 2 diabetes mellitus since 2005. This meta-analysis discusses the mechanisms and potential benefits of several GLP-1 RAs. In particular, this meta-analysis focuses on the safety and associations with weight loss, glucose reduction, cardiovascular outcomes, heart failure, and renal outcomes of GLP-1 RAs to determine their benefits for patients with different conditions. In terms of glycemic control and weight loss, semaglutide was statistically superior to other GLP-1 RAs. In terms of cardiovascular outcomes, 14 mg of semaglutide taken orally once daily and 1.8 mg of liraglutide injected once daily reduced the incidence of cardiovascular death, whereas other GLP-1 RAs did not provide similar benefits. Moreover, semaglutide was associated with superior outcomes for heart failure and cardiovascular death in non-diabetic obesity patients, whereas liraglutide worsened heart failure outcomes in diabetic patients with a reduced ejection fraction. Additionally, semaglutide, dulaglutide, and liraglutide were beneficial in terms of composite renal outcomes: These GLP-1 RAs were significantly associated with less new or persistent macroalbuminuria, but not with improved eGFR deterioration or reduced requirement for renal replacement therapy. However, GLP-1 RAs may benefit patients with type 2 diabetes mellitus or obesity.
摘要：
自2005年以来，胰高血糖素样肽-1受体激动剂（GLP-1RA）已用于降低2型糖尿病患者的葡萄糖水平。本荟萃分析讨论了几种GLP-1RA的机制和潜在益处。特别是,这项荟萃分析侧重于安全性和与体重减轻的关联，葡萄糖还原，心血管结果，心力衰竭,和GLP-1RA的肾脏结局，以确定其对不同疾病患者的益处。在血糖控制和减肥方面，semaglutide在统计学上优于其他GLP-1RA。就心血管结局而言，每天一次口服14毫克司马鲁肽和每天一次注射1.8毫克利拉鲁肽可降低心血管死亡的发生率。而其他GLP-1RA没有提供类似的益处.此外，semaglutide与非糖尿病肥胖患者的心力衰竭和心血管死亡的优越结局相关,而利拉鲁肽恶化了射血分数降低的糖尿病患者的心力衰竭结局。此外,塞马鲁肽,杜拉鲁肽,和利拉鲁肽在复合肾脏结局方面是有益的：这些GLP-1RA与较少的新的或持续的大量白蛋白尿显著相关，但没有改善eGFR恶化或减少肾脏替代疗法的需求。然而,GLP-1RA可能使2型糖尿病或肥胖症患者受益。
