钠-葡萄糖协同转运蛋白2抑制剂给药对心力衰竭合并2型糖尿病患者红细胞分布宽度的影响：一项随机研究。

The effect of SGLT-2i administration on red blood cell distribution width in patients with heart failure and type 2 diabetes mellitus: A randomized study.

作者信息

Katsiadas Nikolaos, Xanthopoulos Andrew, Giamouzis Grigorios, Skoularigkis Spyridon, Skopeliti Niki, Moustaferi Evgenia, Ioannidis Ioannis, Patsilinakos Sotirios, Triposkiadis Filippos, Skoularigis John

机构信息

Department of Cardiology, Konstantopoulio General Hospital, Nea Ionia, Greece.

Department of Cardiology, University Hospital of Larissa, Larissa, Greece.

出版信息

Front Cardiovasc Med. 2022 Sep 29;9:984092. doi: 10.3389/fcvm.2022.984092. eCollection 2022.

DOI:10.3389/fcvm.2022.984092

PMID:36247420

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9557218/

Abstract

BACKGROUND

Recent studies suggest that the pivotal mechanism of sodium glucose co-transporter-2 inhibitors (SGLT-2i) favorable action in patients with heart failure (HF) and type 2 diabetes mellitus (DM) is the stimulation of erythropoiesis an early increase in erythropoietin (EPO) production which leads to hematocrit rise. Red blood cell distribution width (RDW) is a simple hematological parameter which reflects the heterogeneity of the red blood cell size (anisocytosis). Since, EPO has been also implicated in the pathophysiology of RDW increase, the current mechanistic study examined the effect of SGLT-2i administration on red blood cells size (RDW) in patients with HF and DM.

METHODS

The present was a prospective single-center study. Patients (N=110) were randomly assigned to dapagliflozin (10 mg a day on top of antidiabetic treatment) or the control group. Inclusion criteria were: (a) age > 18 years, (b) history of type 2 DM and hospitalization for HF exacerbation within 6 months. The evaluation of patients (at baseline, 6 and 12 months) included clinical assessment, laboratory blood tests, and echocardiography. Data were modeled using mixed linear models with dependent variable the RDW index. In order to find factors independently associated with prognosis (1-year death or HF rehospitalization), multiple logistic regression was conducted with death or HF rehospitalization as dependent variable.

RESULTS

An RDW increase both after 6 and after 12 months was observed in the SGLT-2i (dapagliflozin) group ( < 0.001 for all time comparisons), whereas RDW didn't change significantly in the control group. The increase in RDW was positively correlated with EPO, while negatively correlated with ferritin and folic acid ( < 0.005 for all). Baseline RDW was significantly associated with 1-year death or rehospitalization, after adjusting for group (SGLT-2i vs. control), age, gender, smoking and BMI at baseline.

CONCLUSION

RDW increased with time in patients with HF and DM who received SGLT-2i (dapagliflozin). The increased RDW rates in these patients may stem from the induction of hemopoiesis from dapagliflozin. Baseline RDW was found to be independently associated with outcome in patients with HF and DM.

摘要

背景

近期研究表明，钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）对心力衰竭（HF）合并2型糖尿病（DM）患者产生有益作用的关键机制是刺激红细胞生成，即促红细胞生成素（EPO）生成早期增加，进而导致血细胞比容升高。红细胞分布宽度（RDW）是一项反映红细胞大小异质性（红细胞大小不均一性）的简单血液学参数。由于EPO也与RDW升高的病理生理学有关，因此本机制研究探讨了SGLT-2i给药对HF合并DM患者红细胞大小（RDW）的影响。

方法

本研究为前瞻性单中心研究。患者（N = 110）被随机分配至达格列净组（在抗糖尿病治疗基础上加用每日10 mg达格列净）或对照组。纳入标准为：（a）年龄>18岁，（b）有2型糖尿病病史且在6个月内因HF加重住院。对患者（在基线、6个月和12个月时）的评估包括临床评估、实验室血液检查和超声心动图检查。使用以RDW指数为因变量的混合线性模型对数据进行建模。为了找出与预后（1年死亡或HF再次住院）独立相关的因素，以死亡或HF再次住院为因变量进行多因素逻辑回归分析。

结果

SGLT-2i（达格列净）组在6个月和12个月后均观察到RDW升高（所有时间比较P<0.001），而对照组的RDW无显著变化。RDW升高与EPO呈正相关，而与铁蛋白和叶酸呈负相关（所有P<0.005）。在对基线时的分组（SGLT-2i组与对照组）、年龄、性别、吸烟和BMI进行校正后，基线RDW与1年死亡或再次住院显著相关。