主动脉瓣介入治疗主动脉狭窄后使用SGLT2抑制剂治疗：关于死亡率、心力衰竭、心律、肾脏及瓣膜相关结局的系统评价与荟萃分析。
完整摘要 · 中文译文
背景：严重主动脉瓣狭窄患者接受主动脉瓣介入治疗后，残余死亡率和心力衰竭事件仍然常见。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）可改善心力衰竭、糖尿病和慢性肾脏病人群的心血管和肾脏结局，但其在经导管或外科主动脉瓣介入治疗后的作用仍不明确。 方法：检索至2026年6月的PubMed、Scopus、ScienceDirect、Cochrane Library、引文追踪以及手动识别的符合条件研究，纳入比较主动脉瓣介入治疗后使用SGLT2i与常规治疗或不使用SGLT2i的随机研究和观察性研究。本综述已在PROSPERO注册（CRD420251059332）。符合条件的患者人群包括TAVR、SAVR以及可获得的生物瓣膜主动脉瓣证据。使用随机效应模型合并校正后的风险比（HR），而非HR估计值和不具有可比性的终点则进行叙述性总结。 结果：共纳入12篇符合条件的报告，包括1项随机试验和11项观察性研究。大多数时间-事件估计来自TAVR队列；两项仅包含SAVR的研究和一项混合生物瓣膜AVR研究补充了手术和瓣膜耐久性数据。在合并的时间-事件分析中，使用SGLT2i与较低的全因死亡率相关（HR 0.69，95% CI 0.60-0.79；I²=5%；p < 0.001）。研究定义的综合临床结局也较低（HR 0.68，95% CI 0.53-0.89；I²=57%；p = 0.005），尽管各研究的组分定义有所不同。心力衰竭住院的估计值 或加重、心房颤动和急性肾损伤的差异均无统计学意义。结论：在合并时间-事件分析中，主动脉瓣干预后使用钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）与较低的全因死亡率相关。外科主动脉瓣置换术（SAVR）的数据具有临床参考价值，但同质性不足，无法单独进行定量合并。复合结局、心力衰竭、心律、肾脏及瓣膜相关结局的结果仍欠确定。尚需开展专门的随机试验，以证实所观察到的关联是否反映治疗效应，并明确患者选择、治疗时机和围手术期安全性。
完整摘要 · 英文原文
BACKGROUND: Residual mortality and heart-failure events remain common after aortic valve intervention for severe aortic stenosis. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve cardiovascular and renal outcomes in heart-failure, diabetes, and chronic kidney disease populations, but their role following transcatheter or surgical aortic valve intervention remains uncertain. METHODS: PubMed, Scopus, ScienceDirect, Cochrane Library, citation tracking, and manually identified eligible studies were screened through June 2026 for randomized and observational studies comparing SGLT2i with usual care or no SGLT2i after aortic valve intervention. The review was registered in PROSPERO (CRD420251059332). Eligible populations included TAVR, SAVR, and bioprosthetic aortic valve evidence where available. Adjusted hazard ratios (HRs) were pooled using random-effects models while non-HR estimates and non-comparable endpoints were summarized narratively. RESULTS: Twelve eligible reports were included, comprising one randomized trial and 11 observational studies. Most time-to-event estimates were reported from TAVR cohorts; two SAVR-only studies and one mixed bioprosthetic AVR study added complementary surgical and valve-durability data. In the pooled time-to-event analysis, SGLT2i use was associated with lower all-cause mortality (HR 0.69, 95% CI 0.60-0.79; I²=5%; p < 0.001). The study-defined composite clinical outcome was also lower (HR 0.68, 95% CI 0.53-0.89; I²=57%; p = 0.005), although component definitions differed across studies. Estimates for heart-failure hospitalization or exacerbation, atrial fibrillation, and acute kidney injury were not statistically significant. CONCLUSIONS: SGLT2i use after aortic valve intervention was associated with lower all-cause mortality in pooled time-to-event analysis. SAVR data were clinically informative but were not sufficiently homogeneous for separate quantitative pooling. Findings for composite, heart-failure, rhythm, renal, and valve-related outcomes remain less certain. Dedicated randomized trials are needed to confirm whether the observed association reflects a treatment effect and to define patient selection, treatment timing, and peri-procedural safety.