Kashiwagi Yusuke, Nagoshi Tomohisa, Ogawa Kazuo, Kawai Makoto, Yoshimura Michihiro
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JPN.
Cureus. 2022 Mar 2;14(3):e22762. doi: 10.7759/cureus.22762. eCollection 2022 Mar.
A recent study suggested that angiotensin receptor/neprilysin inhibitor (ARNI; sacubitril/valsartan) can improve functional capacity and cardiac reverse remodeling in patients with heart failure with reduced ejection fraction (HFrEF). Another study suggested that ARNI reduced glycated hemoglobin (HbA1c) in patients with diabetes and HFrEF; however, the details of its efficacy are unknown. We herein report a case of HFrEF with abnormal glucose metabolism in which ARNI was initiated. On the 7 day of admission (before the initiation of ARNI), blood tests showed an abnormal glucose metabolism as follows: fasting blood glucose 134 mg/dL; and fasting blood insulin 11.4 µU/mL (homeostasis model assessment of insulin resistance (HOMA-IR) index 3.77; homeostasis model assessment of β-cell function (HOMA-β), 57.8%). On the 23 day after the initiation of ARNI, even though the patient was not using hypoglycemic drugs, his fasting blood glucose markedly decreased to 70 mg/dL without hypoglycemic symptoms, and his fasting blood insulin decreased to 5.4 µU/mL (HOMA-IR decreased to 0.93, HOMA-β increased to 277.7%). These results imply that ARNI has the potential to improve insulin resistance and the islet beta-cell function in patients with heart failure, in addition to the original effect of improving the hemodynamics, although the effect of improving the glucose metabolism is also considered to have been influenced by the improvement of the heart failure status and other drugs that the patient was taking.
最近的一项研究表明，血管紧张素受体/中性肽链内切酶抑制剂（ARNI；沙库巴曲/缬沙坦）可改善射血分数降低的心力衰竭（HFrEF）患者的功能能力和心脏逆向重构。另一项研究表明，ARNI可降低糖尿病合并HFrEF患者的糖化血红蛋白（HbA1c）；然而，其疗效细节尚不清楚。我们在此报告一例启动ARNI治疗的伴有葡萄糖代谢异常的HFrEF病例。入院第7天（启动ARNI治疗前），血液检查显示葡萄糖代谢异常如下：空腹血糖134mg/dL；空腹血胰岛素11.4µU/mL（胰岛素抵抗稳态模型评估（HOMA-IR）指数3.77；β细胞功能稳态模型评估（HOMA-β），57.8%）。启动ARNI治疗后第23天，尽管患者未使用降糖药物，但其空腹血糖显著降至70mg/dL且无低血糖症状，空腹血胰岛素降至5.4µU/mL（HOMA-IR降至0.93，HOMA-β升至277.7%）。这些结果表明，ARNI除了具有改善血流动力学的原始作用外，还具有改善心力衰竭患者胰岛素抵抗和胰岛β细胞功能的潜力，尽管葡萄糖代谢的改善效果也被认为受到心力衰竭状态改善以及患者正在服用的其他药物的影响。
