Sodium-glucose cotransporter 2 inhibitors (SGLT2i) may have favourable neurohumoral and metabolic effects in patients with chronic liver disease. However, studies examining SGLT2i in this population have been limited to patients with non-alcoholic fatty liver disease and have focused on surrogate biomarkers. Our aim was to evaluate whether SGLT2i can reduce the incidence of ascites and death over a period of 36 months in patients with cirrhosis and diabetes mellitus. Using electronic health data from Veterans Affairs hospitals in the United States, we conducted a propensity score matched intention-to-treat analysis among veterans on metformin who subsequently received either SGLT2i or dipeptidyl peptidase-4 inhibitors. Among 423 matched pairs (in total, 846 patients), we found no significant difference in the risk for ascites (hazard ratio 0.68 for SGLT2i, 95% confidence interval 0.37-1.25; p = .22) but did find that SGLT2i users had a reduced risk for death (adjusted hazard ratio 0.33, 95% confidence interval 0.11-0.99; p < .05). In comparison with dipeptidyl peptidase-4 inhibitors, SGLT2i may improve survival for patients with cirrhosis who require additional pharmacotherapy for diabetes mellitus beyond metformin, but confirmatory studies are necessary.

中文翻译：

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SGLT2 抑制剂与 DPP4 抑制剂相比对二甲双胍治疗的肝硬化退伍军人腹水和死亡的影响

钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2i) 可能对慢性肝病患者具有良好的神经体液和代谢作用。然而，在该人群中检查 SGLT2i 的研究仅限于非酒精性脂肪肝患者，并且侧重于替代生物标志物。我们的目的是评估 SGLT2i 是否可以在 36 个月内降低肝硬化和糖尿病患者的腹水和死亡发生率。使用来自美国退伍军人事务部医院的电子健康数据，我们对随后接受 SGLT2i 或二肽基肽酶 4 抑制剂治疗的二甲双胍退伍军人进行了倾向评分匹配的意向治疗分析。在 423 对配对（总共 846 名患者）中，我们发现腹水风险没有显着差异（风险比 0.p  = .22）但确实发现 SGLT2i 使用者的死亡风险降低（调整后的风险比为 0.33，95% 置信区间为 0.11-0.99；p  < .05）。与二肽基肽酶 4 抑制剂相比，SGLT2i 可以提高肝硬化患者的生存率，这些患者需要在二甲双胍之外进行额外的糖尿病药物治疗，但有必要进行验证性研究。