Hepatic Events Prevention by Antihyperglycemic Therapies and Intervention Comparisons in Type 2 Diabetes: The HEPATIC-T2DM Network Meta-analysis.

To compare associations between glucose-lowering drug classes and major adverse liver outcomes (MALOs) in adults with T2DM.

比较不同降糖药物类别与2型糖尿病成人患者主要不良肝事件（MALOs）之间的关联。

data_sources

PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched from December 1946 through 23 August 2025.

检索了PubMed、EMBASE和Cochrane中央控制试验登记处，时间范围从1946年12月到2025年8月23日。

study_selection

Studies enrolling adults with T2DM that evaluated associations between glucose-lowering drug classes with regard to MALOs were included.

纳入了评估降糖药物类别与主要不良心脏事件（MALOs）相关性的研究，这些研究招募了患有2型糖尿病的成年人。

data_extraction

Data were extracted on study characteristics, drug exposures, and MALOs.

提取了研究特征、药物暴露和MALOs（主要不良事件）的数据。

data_synthesis

A three-level Bayesian network meta-analysiswith study- and database-level random effects was performed.

进行了具有研究和数据库水平随机效应的三层贝叶斯网络荟萃分析。

Outcomes are reported as hazard ratios (HRs) and ranked using the surface under the cumulative ranking curve.

结果以风险比（HRs）报告，并使用累积排名曲线下面积进行排名。

Forty-six observational studies (N = 7,124,845) were included.

纳入了46项观察性研究（N = 7,124,845）。

Thiazolidinediones were least associated with hepatocellular carcinoma incidenceand significantly lower than dipeptidyl peptidase 4 (DPP-4) inhibitors (HR 0.50), glucagon-like peptide 1 receptor agonists (GLP-1RAs) (HR 0.72), insulin (HR 0.20), and sulfonylureas (HR 0.69).

噻唑烷二酮类药物与肝细胞癌发生率的关联最小，且显著低于二肽基肽酶-4（DPP-4）抑制剂（HR 0.50）、胰高血糖素样肽-1受体激动剂（GLP-1RAs）（HR 0.72）、胰岛素（HR 0.20）和磺脲类药物（HR 0.69）。

For decompensation (composite), GLP-1RAs were associated with the lowest hazard compared with all other classes (HRs 0.16-0.91; all significant).

对于失代偿（综合指标），与所有其他类别相比，GLP-1RAs相关的风险最低（HRs 0.16-0.91；均具有统计学意义）。

Sodium-glucose cotransporter 2 (SGLT2) inhibitors were least associated with cirrhosis (HR 0.66 vs. DPP-4 inhibitors; HR 0.66 vs. GLP-1RAs).

钠-葡萄糖共转运蛋白 2 (SGLT2) 抑制剂与肝硬化的关联性最小（与 DPP-4 抑制剂相比，风险比为 0.66；与 GLP-1RAs 相比，风险比为 0.66）。

GLP-1RAs were least associated with variceal bleeding and hepatic encephalopathy, whereas SGLT2 inhibitors were least associated with liver-related mortality.

GLP-1RAs 与食管静脉曲张出血和肝性脑病的关联性最小，而 SGLT2 抑制剂与肝相关死亡率的关联性最小。

limitations

All included studies were observational, precluding causal inference.

所有纳入的研究均为观察性研究，无法推断因果关系。

Conclusions

Liver-specific risk reduction is not uniform across antihyperglycemic drug classes.

肝脏特异性风险降低在各类降糖药物中并不一致。

Randomized trials are needed to determine whether these associations reflect true drug effects.

需要进行随机试验来确定这些关联是否反映了真正的药物效果。