Nakagaito Masaki, Joho Shuji, Ushijima Ryuichi, Nakamura Makiko, Kinugawa Koichiro
Second Department of Internal Medicine, University of Toyama Toyama Japan.
Circ Rep. 2019 Sep 27;1(10):405-413. doi: 10.1253/circrep.CR-19-0070.
Three sodium-glucose cotransporter-2 inhibitors (SGLT2i), canagliflozin, dapagliflozin and empagliflozin, successfully reduced hospitalization for heart failure (HF) in patients with type 2 diabetes mellitus (T2DM). It remains unclear, however, whether the efficacy of the 3 SGLT2i for HF in T2DM patients is similar. Eighty-one T2DM patients hospitalized due to decompensated HF were enrolled. After treatment for HF, one of the 3 SGLT2i was non-randomly used, and clinical parameters for HF and T2DM were followed for 7 days. The attending physician was allowed to adjust the dose of furosemide. No differences were observed between the 3 groups in the increase of glycosuria, or in the decreases of body weight and blood pressure 7 days after SGLT2i (interaction P>0.05). Urine volume was similarly increased on day 1, and returned to the baseline on day 7 in each group. Decrease in B-type natriuretic peptide and increase in plasma renin activity were significant in each group. Plasma aldosterone concentration, however, was significantly increased in the empagliflozin and canagliflozin groups (P<0.01, respectively), but not in the dapagliflozin group. Additionally, plasma noradrenaline was significantly increased in the empagliflozin group (P<0.01), but not in the canagliflozin and dapagliflozin groups. The neurohumoral responses to the 3 SGLT2i are different under similar volume correction in HF patients with T2DM.
三种钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i），即卡格列净、达格列净和恩格列净，成功降低了2型糖尿病（T2DM）患者因心力衰竭（HF）住院的发生率。然而，这三种SGLT2i对T2DM患者HF的疗效是否相似仍不清楚。招募了81例因失代偿性HF住院的T2DM患者。在HF治疗后，非随机使用三种SGLT2i中的一种，并对HF和T2DM的临床参数进行7天的随访。主治医师可调整呋塞米的剂量。SGLT2i治疗7天后，三组在糖尿增加、体重和血压降低方面未观察到差异（交互作用P>0.05）。每组第1天尿量均有类似增加，第7天恢复至基线水平。每组B型利钠肽降低和血浆肾素活性增加均显著。然而，恩格列净和卡格列净组血浆醛固酮浓度显著升高（分别为P<0.01），而达格列净组未升高。此外，恩格列净组血浆去甲肾上腺素显著升高（P<0.01），而卡格列净和达格列净组未升高。在T2DM合并HF患者中，在相似的容量校正情况下，三种SGLT2i的神经体液反应不同。
