美国布列根和妇女医院Elisabetta Patorno团队研究了上消化道内窥镜检查前使用胰高血糖素样肽-1（GLP-1）受体激动剂对患者预后的影响。相关论文发表在2024年10月22日出版的《英国医学杂志》上。

为了评估与钠-葡萄糖协同转运蛋白-2（SGLT-2）抑制剂相比，在上消化道内窥镜检查前使用胰高血糖素样肽-1（GLP-1）受体激动剂是否与肺吸入风险增加或手术中断有关，研究组使用两个身份待明的美国商业医疗数据库进行了一项队列分析。

共43365名成人（≥18岁）患有2型糖尿病，在上消化道内窥镜检查前30天内使用GLP-1受体激动剂或SGLT-2抑制剂。主要结局为内窥镜检查当天或后一天的肺部吸入，使用诊断代码定义。次要结局是停止内镜检查。基于倾向评分进行精细分层加权后，估计风险比和相应的95%置信区间（CI）。

加权后，24817名成年人使用GLP-1受体激动剂（平均年龄59.9岁；63.6%为女性），18537名成年人使用SGLT-2抑制剂（59.8岁；63.7%为女性）。在GLP-1受体激动剂和SGLT-2抑制剂的使用者中，每1000人肺部吸入的加权风险分别为4.15和4.26，停止内窥镜检查的加权风险为9.79和4.91。与SGLT-2抑制剂的使用相比，GLP-1受体激动剂的使用与肺吸入风险增加无关（合并风险比0.98，95%CI 0.73至1.31），尽管其与内窥镜检查中断的风险更高有关（1.99，1.56至2.53）。

研究结果表明，在这项比较队列研究中，与SGLT-2抑制剂相比，在手术后30天内，使用GLP-1受体激动剂的2型糖尿病成年人在上消化道内窥镜检查期间肺部吸入的风险没有增加；然而，GLP-1受体激动剂与内窥镜检查中断的风险较高有关，这可能是由于胃内容物滞留的风险较高。在缺乏随机试验证据的情况下，这些发现可以为需要内窥镜检查的患者提供有关术前方案的未来实践建议。

附：英文原文

Title: Glucagon-like peptide-1 receptor agonists before upper gastrointestinal endoscopy and risk of pulmonary aspiration or discontinuation of procedure: cohort study

Author: Wajd Alkabbani, Karine Suissa, Kristine D Gu, Sara J Cromer, Julie M Paik, Katsiaryna Bykov, Ion Hobai, Christopher C Thompson, Deborah J Wexler, Elisabetta Patorno

Issue&Volume: 2024/10/22

Abstract:

Objective To assess whether use of glucagon-like peptide-1 (GLP-1) receptor agonists before upper gastrointestinal endoscopy is associated with increased risk of pulmonary aspiration or discontinuation of the procedure compared with sodium-glucose cotransporter-2 (SGLT-2) inhibitors.

Design Cohort study.

Setting Two deidentified US commercial healthcare databases.

Participants 43365 adults (≥18 years) with type 2 diabetes who used a GLP-1 receptor agonist or SGLT-2 inhibitor within 30 days before upper gastrointestinal endoscopy.

Main outcome measures The primary outcome was pulmonary aspiration on the day of or the day after endoscopy, defined using diagnostic codes. The secondary outcome was discontinuation of endoscopy. Risk ratios and corresponding 95% confidence intervals (CIs) were estimated after fine stratification weighting based on propensity score.

Results After weighting, 24817 adults used a GLP-1 receptor agonist (mean age 59.9 years; 63.6% female) and 18537 used an SGLT-2 inhibitor (59.8 years; 63.7% female). Among users of GLP-1 receptor agonists and SGLT-2 inhibitors, the weighted risk per 1000 people was, respectively, 4.15 and 4.26 for pulmonary aspiration and 9.79 and 4.91 for discontinuation of endoscopy. Compared with SGLT-2 inhibitor use, GLP-1 receptor agonist use was not associated with an increased risk of pulmonary aspiration (pooled risk ratio 0.98, 95% CI 0.73 to 1.31), although it was associated with a higher risk for discontinuation of endoscopy (1.99, 1.56 to 2.53).

Conclusions In this comparative cohort study, no increased risk of pulmonary aspiration during upper gastrointestinal endoscopy was observed among adults with type 2 diabetes using GLP-1 receptor agonists compared with SGLT-2 inhibitors within 30 days of the procedure; however, GLP-1 receptor agonists were associated with a higher risk of discontinuation of endoscopy, possibly owing to a higher risk of retained gastric content. In the absence of evidence from randomized trials, these findings could inform future practice recommendations on the preprocedural protocol for patients requiring endoscopy.

DOI: 10.1136/bmj-2024-080340

Source: https://www.bmj.com/content/387/bmj-2024-080340