SGLT-2抑制剂对非酒精性脂肪性肝病疗效的Meta分析

Efficacy of Sodium-Glucose Transporter 2 Inhibitors in the Treatment of Non-Alcoholic Fatty Liver Disease: A Meta-Analysis

摘要: 目的：系统评价钠–葡萄糖共转运蛋白2抑制剂用于非酒精性脂肪性肝病治疗的有效性。方法：通过计算机检索Cohrane Library、PubMed、Embase、Web of Science等数据库符合标准的研究，检索时限是建库至2024年5月，使用Stata 17 Meta分析。结果：纳入14项随机对照试验，包含896名患者。1) 与对照组相比，SGLT-2抑制剂可以降低丙氨酸转氨酶(ALT) (MD = −3.64 [−6.68, −0.59], P = 0.019)、天冬氨酸转氨酶(AST) (MD = −2.71 [−4.78, −0.63], P = 0.011)、受控制衰减参数(CAP) (MD = −10.6 [−18.16, −3.04], P = 0.006)、质子密度脂肪分数(MRI-PDFF) (MD = −4.49 [−7.24, −1.74], P = 0.01)和肝脏硬度(LSM) (MD = −0.39 [−0.71, −0.08], P = 0.014)；2) 亚组分析结果：基于试验组不同的亚组分析结果表明，恩格列净能显著降低MRI-PDFF和LSM，差异具有统计学意义(P < 0.05)；基于对照组不同的亚组分析结果表明SGLT-2抑制剂与吡格列酮比较对ALT、AST、CAP和LSM降低的差异没有统计学意义(P > 0.05)。结论：本研究结果表明SGLT-2抑制剂可以降低2型糖尿病合并非酒精性脂肪性肝病患者转氨酶、肝脏脂肪含量，改善肝脏纤维化和脂肪变性，在不合并糖尿病的非酒精性脂肪性肝病患者中也观察到类似结果，并且SGLT-2抑制剂与吡格列酮比较对非酒精性脂肪性肝病的治疗效果相近。

Abstract: Objective: To systematically review the efficacy of sodium-glucose transporter 2 inhibitors in the treatment of non-alcoholic fatty liver disease. Methods: By searching Cohrane Library, PubMed, Embase, Web of Science, and other databases to build the database to May 2024 conforming studies. Stata 17 was applied for meta-analysis. Results: Include 14 randomized controlled trials comprising 896 patients. 1) SGLT-2 inhibitors reduce alanine aminotransferase (ALT) (MD = −3.64 [−6.68, −0.59], P = 0.019), aspartate transaminase (AST) (MD = −2.71 [−4.78, −0.63], P = 0.011), controlled attenuation parameter (CAP) (MD = −10.6 [−18.16, −3.04], P = 0.006), magnetic resonance imaging-proton density fat fraction (MRI-PDFF) (MD = −4.49 [−7.24, −1.74], P = 0.01) and liver stiffness measurement (LSM) (MD = −0.39 [−0.71, −0.08], P = 0.014); 2) Subgroup analysis results: Based on the analysis results of different subgroups in the experimental group, the results showed that empagliflozin could significantly reduce MRI-PDFF and LSM, with statistical significance (P < 0.05); based on different subgroup analysis results of the control group, there was no statistical significance in the reduction of ALT, AST, CAP and LSM between SGLT-2 inhibitor and pioglitazone (P > 0.05). Conclusions: The results of this study suggest that SGLT-2 inhibitors can reduce transaminase, liver fat content, improve liver fibrosis and steatosis in patients with type 2 diabetes and non-alcoholic fatty liver disease. Similar results were observed in patients with nonalcoholic fatty liver disease without diabetes. SGLT-2 inhibitor and pioglitazone were similar in the treatment of non-alcoholic fatty liver disease.