钠-葡萄糖协同转运蛋白2抑制剂（SGLT2-I）对接受冠状动脉旁路移植术（CABG）合并体外循环（MiECC）治疗的缺血性心脏病（IHD）患者的影响：炎症负荷及5年随访的临床结局
Effects of Sodium-Glucose Transporter 2 Inhibitors (SGLT2-I) in Patients With Ischemic Heart Disease (IHD) Treated by Coronary Artery Bypass Grafting MiECC: Inflammatory Burden, and Clinical Outcomes at 5 Years of Follow-Up.
作者信息
Sardu Celestino, Massetti Massimo, Testa Nicola, Martino Luigi Di, Castellano Gaetano, Turriziani Fabrizio, Sasso Ferdinando Carlo, Torella Michele, De Feo Marisa, Santulli Gaetano, Paolisso Giuseppe, Marfella Raffaele
机构信息
Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
Department of Cardiovascular and Arrhythmias, Campobasso, Italy.
出版信息
Front Pharmacol. 2021 Nov 15;12:777083. doi: 10.3389/fphar.2021.777083. eCollection 2021.
Minimally invasive extracorporeal circulation (MiECC) reduced inflammatory burden, leading to best clinical outcomes in patients treated with coronary artery bypass grafting (CABG). Despite this, the patients with type 2 diabetes mellitus (T2DM) vs those without T2DM (non-T2DM) have a worse prognosis, caused by over-inflammation and modulated by sodium-glucose transporter 2 receptors. However, we evaluated the inflammatory burden and clinical outcomes in non-T2DM vs T2DM patients under sodium-glucose transporter 2 inhibitors (SGLT2-I users) vs non-SGLT2-I users at 5 years of follow-up post-CABG MiECC. In a multicenter study, we screened consecutive patients with indications to receive CABG. The study endpoints were the inflammatory burden (circulating serum levels of tumor necrosis factor-alpha (TNF-α), interleukin 1 and 6 (IL-1 and IL-6), C-reactive protein (CRP), and leucocytes count) and the clinical outcomes at follow-up of 5 years in non-T2DM vs SGLT2-I users, in non-T2DM vs non-SGLT2-I users, and SGLT2-I users vs non-SGLT2-I users. At baseline, and at one year and 5 years of follow-up, the non-T2DM vs SGLT2-I users, non-T2DM vs non-SGLT2-I users, and SGLT2-I users vs non-SGLT2-I users had the lowest values of IL-1, IL-6, and TNF-α ( < 0.05). At one year of follow-up, SGLT2-I users vs non-T2DM and non-SGLT2-I users vs non-T2DM users had a higher rate of all deaths, cardiac deaths, re-myocardial infarction, repeat revascularization, and stroke, and of the composite endpoint ( < 0.05). In a multivariate Cox regression analysis, the composite endpoint was predicted by IL-1 [2.068 (1.367-3.129)], TNF-α [1.989 (1.081-2.998)], and SGLT2-I [0.504 (0.078-0.861)]. In T2DM patients, the SGLT2-I significantly reduced the inflammatory burden and ameliorated clinical outcomes at 5 years of follow-up post-CABG MiECC.
微创体外循环（MiECC）减轻了炎症负担，使接受冠状动脉旁路移植术（CABG）的患者获得了最佳临床结局。尽管如此，2型糖尿病（T2DM）患者与非T2DM患者相比，预后更差，这是由过度炎症引起的，并受钠-葡萄糖转运蛋白2受体调节。然而，我们评估了在CABG MiECC术后5年随访中，非T2DM患者与T2DM患者在使用钠-葡萄糖转运蛋白2抑制剂（SGLT2-I使用者）与非SGLT2-I使用者情况下的炎症负担和临床结局。在一项多中心研究中，我们筛选了有CABG适应症的连续患者。研究终点为炎症负担（肿瘤坏死因子-α（TNF-α）、白细胞介素1和6（IL-1和IL-6）、C反应蛋白（CRP）的循环血清水平以及白细胞计数）以及非T2DM患者与SGLT2-I使用者、非T2DM患者与非SGLT2-I使用者、SGLT2-I使用者与非SGLT2-I使用者在5年随访时的临床结局。在基线、随访1年和5年时，非T2DM患者与SGLT2-I使用者、非T2DM患者与非SGLT-I使用者、SGLT2-I使用者与非SGLT2-I使用者的IL-1、IL-6和TNF-α值最低（<0.05）。在随访1年时，SGLT2-I使用者与非T2DM患者以及非SGLT2-I使用者与非T2DM患者相比，全因死亡、心源性死亡、再发心肌梗死、再次血管重建和中风以及复合终点的发生率更高（<0.05）。在多变量Cox回归分析中，复合终点由IL-1 [2.068（1.367 - 3.129）]、TNF-α [1.989（1.081 - 2.998）]和SGLT2-I [0.504（0.078 - 0.861）]预测。在T2DM患者中，SGLT2-I在CABG MiECC术后5年随访时显著减轻了炎症负担并改善了临床结局。
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