Department of Nuclear Medicine.
Department of Clinical Epidemiology and Biostatistics.
Nucl Med Commun. 2021 Sep 1;42(9):972-978. doi: 10.1097/MNM.0000000000001429.
Sodium-glucose co-transporter 2 inhibitors reduce the risk of cardiovascular events in type 2 diabetic patients with coronary artery disease (CAD); however, the underlying mechanisms remain unclear.
We compared the effects of empagliflozin vs. sitagliptin therapy on myocardial perfusion reserve (MPR) using dynamic single-photon emission computed tomography (SPECT) imaging.
In total, 100 patients with type 2 diabetes, CAD and an MPR <2.5 were randomized to receive either empagliflozin (10 mg once daily) or sitagliptin (100 mg once daily). Dynamic SPECT examinations were performed at baseline and at 6 months. The primary endpoint was the percent change of global MPR. Evaluable SPECT data were available for 98 patients.
Baseline clinical characteristics and SPECT data were well balanced between the two groups. At a 6-month follow-up, the fasting glucose and glycated hemoglobin levels significantly decreased in both groups. Hematocrit and hemoglobin levels significantly increased in the empagliflozin group but not in the sitagliptin group. The global MPR significantly improved after treatment in both groups (34.5 ± 70.6%; P = 0.005 for empagliflozin vs. 22.4 ± 45.7%; P = 0.024 for sitagliptin). However, there was no significant difference in the global MPR between the two groups (P = 0.934). Similar findings were detected with regard to the regional MPR.
Among patients with type 2 diabetes and CAD, both empagliflozin and sitagliptin significantly improved the global MPR with no significant difference between the groups.
钠-葡萄糖协同转运蛋白 2 抑制剂可降低合并冠心病的 2 型糖尿病患者发生心血管事件的风险，但具体机制仍不清楚。
本研究旨在比较恩格列净与西格列汀对心肌灌注储备（MPR）的影响，采用动态单光子发射计算机断层扫描（SPECT）成像技术进行评估。
本研究共纳入 100 例合并 2 型糖尿病和冠心病且 MPR＜2.5 的患者，按 1:1 随机分配至恩格列净（10 mg，qd）或西格列汀（100 mg，qd）组。两组患者分别于基线和 6 个月时进行动态 SPECT 检查。主要终点为 MPR 的总体变化百分比。98 例患者的 SPECT 数据可评估。
两组患者的基线临床特征和 SPECT 数据均衡可比。与基线相比，两组患者的空腹血糖和糖化血红蛋白水平在治疗 6 个月后均显著降低。恩格列净组的红细胞比容和血红蛋白水平显著升高，但西格列汀组无明显变化。两组患者的 MPR 均显著改善（分别为 34.5±70.6%，P=0.005；22.4±45.7%，P=0.024），但两组间无显著差异（P=0.934）。区域 MPR 也存在类似的变化趋势。
在合并冠心病的 2 型糖尿病患者中，恩格列净和西格列汀均可显著改善 MPR，且两组间无显著差异。
