Balcıoğlu Akif Serhat, Çelik Enes, Aksu Ekrem, Aykan Ahmet Çağrı
Department of Cardiology, Kahramanmaraş Sütçü İmam University School of Medicine, Kahramanmaraş, Turkey.
Turk Kardiyol Dern Ars. 2022 Sep;50(6):415-421. doi: 10.5543/tkda.2022.22403.
Cardiac autonomic neuropathy is a serious microvascular complication of type 2 diabetes mellitus that affects a significant portion of patients. Due to decreased parasympathetic activity, the sympathetic nervous system becomes dominant, causing several problems that lead to increased cardiovascular morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors have been shown to reduce sympathetic nervous system activity previously. This is a promising finding for restoring the impaired sympathovagal balance in cardiac autonomic neuropathy. The aim of this study is to evaluate the effect of at least 6 months of sodium-glucose cotransporter-2 inhibitor treatment on sympathetic nervous system activity with sympathetic activity index and heart rate variability parameters in patients with type 2 diabetes mellitus.
Holter-electrocardiogram recordings of 50 patients who were using an sodiumglucose cotransporter-2 inhibitor (empagliflozin or dapagliflozin) for at least 6 months and 50 patients who did not were analyzed retrospectively. The sympathetic activity index and heart rate variability parameters of these 2 groups, which were similar in terms of age, gender, hemoglobin A1c, and duration of diabetes, were compared.
The ratio of low-frequency to high-frequency power reflecting the sympathovagal balance [-1.495 (-2.165/-1.196) vs. -1.224 (-1.619/-0.863), P=.008] and sympathetic activity index [1.44 (1.06/2.76) vs. 2.47 (1.42/3.68), P=.009] was lower in the sodiumglucose cotransporter-2 inhibitor group than in the control group. In addition, the sympathetic activity index was correlated with the ratio of low-frequency to high-frequency power (r=0.418, P < .001).
Sodium-glucose cotransporter-2 inhibitor treatment for at least 6 months was found to result in lower values of sympathetic activity index and the ratio of low-frequency to high-frequency power in patients with type 2 diabetes mellitus. These findings indicate lower sympathetic nervous system activity, which supports the sympathoinhibitor effects of sodiumglucose cotransporter-2 inhibitors.
心脏自主神经病变是2型糖尿病严重的微血管并发症，影响相当一部分患者。由于副交感神经活动减少，交感神经系统占主导地位，引发多种问题，导致心血管发病率和死亡率增加。钠-葡萄糖协同转运蛋白2抑制剂此前已被证明可降低交感神经系统活动。这对于恢复心脏自主神经病变中受损的交感-迷走神经平衡是一个有前景的发现。本研究的目的是评估至少6个月的钠-葡萄糖协同转运蛋白2抑制剂治疗对2型糖尿病患者交感神经系统活动的影响，采用交感神经活动指数和心率变异性参数进行评估。
回顾性分析50例使用钠-葡萄糖协同转运蛋白2抑制剂（恩格列净或达格列净）至少6个月的患者和50例未使用该抑制剂的患者的动态心电图记录。比较这两组在年龄、性别、糖化血红蛋白和糖尿病病程方面相似的交感神经活动指数和心率变异性参数。
反映交感-迷走神经平衡的低频与高频功率比值[-1.495（-2.165/-1.196）对-1.224（-1.619/-0.863），P=0.008]和交感神经活动指数[1.44（1.06/2.76）对2.47（1.42/3.68），P=0.009]在钠-葡萄糖协同转运蛋白2抑制剂组低于对照组。此外，交感神经活动指数与低频与高频功率比值相关（r=0.418，P<0.001）。
发现至少6个月的钠-葡萄糖协同转运蛋白2抑制剂治疗可使2型糖尿病患者的交感神经活动指数和低频与高频功率比值降低。这些发现表明交感神经系统活动较低，支持钠-葡萄糖协同转运蛋白2抑制剂的交感神经抑制作用。
