2 型糖尿病和代谢功能障碍相关的脂肪肝病（糖尿病 MASLD）经常共存，并使肝脏和非肝脏结果恶化，但有效的药物治疗有限。我们的目的是评估钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT-2i) 对糖尿病 MASLD 患者肝脏和非肝脏结局的长期影响。这项基于人群的队列研究从 Merative Marketscan Research 检索糖尿病 MASLD 患者数据库（2013 年 4 月和 2021 年 12 月）。活性比较剂是其他降糖药物（oGLD）。主要结局是肝脏并发症，包括肝细胞癌（HCC）和肝硬化，以及非肝脏并发症，包括心血管疾病（CVD）、慢性肾病（CKD）和非肝癌。应用倾向评分匹配并建立Cox回归模型。与oGLD相比，SGLT-2i用户患HCC（HR 0.76，95% CI 0.62至0.93）、肝硬化（HR 0.80，95% CI 0.76至0.84）的风险显着降低）、CVD（HR 0.82，95% CI 0.79至0.85）和CKD（HR 0.66，95% CI 0.62至0.70）、非肝癌（HR 0.81，95% CI 0.76至0.86）。与未服用二甲双胍和 SGLT-2i 的患者相比，二甲双胍或 SGLT-2i 使用者（HR 0.76-0.97）以及两种药物使用者（HR 0.58-0.79）的风险逐步降低。肝脏失代偿、代偿性肝硬化、主要心血管疾病、终末期肾病和特定常见癌症的风险也较低（HR 0.61-0.84）。在一项全国性队列中，SGLT-2i 用户的肝癌风险显着降低糖尿病 MASLD 患者的非肝脏并发症发生率高于 oGLD 用户。同时使用二甲双胍可进一步降低风险。© 作者（或其雇主）2024。禁止商业重复使用。请参阅权利和权限。英国医学杂志出版。

Type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease (diabetic MASLD) frequently coexist and worsen liver and non-liver outcomes, but effective pharmacological therapies are limited. We aimed to evaluate the long-term effect of sodium-glucose cotransporter-2 inhibitor (SGLT-2i) on liver and non-liver outcomes among patients with diabetic MASLD.This population-based cohort study retrieved patients with diabetic MASLD from Merative Marketscan Research Databases (April 2013 and December 2021). The active comparator was other glucose-lowering drugs (oGLDs). Primary outcomes were liver complications including hepatocellular carcinoma (HCC) and liver cirrhosis, as well as non-liver complications including cardiovascular disease (CVD), chronic kidney disease (CKD) and non-liver cancer. Propensity score matching was applied and Cox regression models were conducted.Compared with oGLD, SGLT-2i users had significantly lower risk of HCC (HR 0.76, 95% CI 0.62 to 0.93), liver cirrhosis (HR 0.80, 95% CI 0.76 to 0.84), CVD (HR 0.82, 95% CI 0.79 to 0.85) and CKD (HR 0.66, 95% CI 0.62 to 0.70), non-liver cancer (HR 0.81, 95% CI 0.76 to 0.86). Compared with patients without metformin and SGLT-2i, a stepwise decreasing risk was observed in users of either metformin or SGLT-2i (HRs 0.76-0.97) and in users of both medications (HRs 0.58-0.79). The lower risk also was shown in liver decompensation, compensated cirrhosis, major CVD, end-stage renal disease and specific common cancers (HRs 0.61-0.84).In a nationwide cohort, SGLT-2i users were associated with a substantially lower risk of liver and non-liver complications than oGLD users among patients with diabetic MASLD. The risk was further reduced with concomitant metformin use.© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.