Shirakabe Akihiro, Matsushita Masato, Kiuchi Kazutaka, Okazaki Hirotake, Inami Toru, Takayasu Tsutomu, Asano Miwako, Nomura Akiko, Kobayashi Nobuaki, Okajima Fumitaka, Miyauchi Yasushi, Asai Kuniya, Shimizu Wataru
Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital Chiba Japan.
Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital Chiba Japan.
Circ Rep. 2020 Sep 15;2(10):565-575. doi: 10.1253/circrep.CR-20-0041.
Whether the dose of loop diuretics can be decreased by administration of a sodium-glucose cotransporter 2 (SGLT2) inhibitor in diabetic outpatients with compensated heart failure (HF) is unclear. This study prospectively enrolled 60 diabetic outpatients with compensated HF. Patients were randomly divided into 2 groups: those administered the SGLT2 inhibitor empagliflozin (n=28) and those not (n=30). Changes in the daily dose of loop diuretics, blood sampling data, and urinary renal tubular biomarkers were evaluated 6 months after the intervention. The median (interquartile range) furosemide dose decreased significantly over the 6-month follow-up period in the empagliflozin group (from 40 [20-40] to 20 [10-20] mg), but not in the non-empagliflozin group (from 23 [20-40] to 40 [20-40] mg). Hemoglobin levels increased significantly in the empagliflozin group (from 13.2 [11.9-14.6] to 14.0 [12.7-15.0] g/dL). In addition, excretion of acetyl-β-D-glucosaminidase decreased significantly over the 6-month follow-up in the empagliflozin group (from 4.8 [2.6-11.7] to 3.3 [2.1-5.4] IU/L), especially in the group in which the dose of loop diuretics decreased (from 4.7 [2.5-14.8] to 3.3 [2.1-4.5] IU/L). Empagliflozin administration decreased the dose of loop diuretics and increased the production of erythropoietin, which may help prevent renal tubular injury in diabetic outpatients with HF.
在代偿性心力衰竭（HF）的糖尿病门诊患者中，给予钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂是否可以降低襻利尿剂的剂量尚不清楚。本研究前瞻性纳入了60例代偿性HF的糖尿病门诊患者。患者被随机分为2组：给予SGLT2抑制剂恩格列净的患者（n = 28）和未给予的患者（n = 30）。干预6个月后评估襻利尿剂每日剂量的变化、血液采样数据和尿肾小管生物标志物。在恩格列净组中，袢利尿剂剂量在6个月的随访期内显著降低（从40[20 - 40]mg降至20[10 - 20]mg），但在非恩格列净组中未降低（从23[20 - 40]mg增至40[20 - 40]mg）。恩格列净组的血红蛋白水平显著升高（从13.2[11.9 - 14.6]g/dL升至14.0[12.7 - 15.0]g/dL）。此外，在恩格列净组中，乙酰-β-D-氨基葡萄糖苷酶的排泄在6个月的随访中显著降低（从4.8[2.6 - 11.7]IU/L降至3.3[2.1 - 5.4]IU/L），尤其是在襻利尿剂剂量降低的组中（从4.7[2.5 - 14.8]IU/L降至3.3[2.1 - 4.5]IU/L）。给予恩格列净可降低襻利尿剂的剂量并增加促红细胞生成素的产生，这可能有助于预防代偿性HF的糖尿病门诊患者的肾小管损伤。
