De La Flor José C, Coto Morales Blanca, Basabe Elena, Rey Hernandez María, Zamora González-Mariño Rocío, Rodríguez Tudero Celia, Benites Flores Irwing, Espinoza Carlos, Cieza Terrones Michael, Cigarrán Guldris Secundino, Hernández Vaquero Jesús
Department of Nephrology, Hospital Central de la Defensa Gómez Ulla, 28047 Madrid, Spain.
Department of Medicine and Medical Specialties, Faculty of Medicine, Alcala University, 28805 Madrid, Spain.
Medicina (Kaunas). 2024 Dec 21;60(12):2096. doi: 10.3390/medicina60122096.
: Sodium glucose cotransporter-2 (SGLT-2) inhibitors have emerged as integral therapeutic tools in the management of patients with cardiovascular-kidney-metabolic (CKM) syndrome. In addition to their well-documented effects on lowering glucose levels and cardiovascular- and reno-protective actions, SGLT-2 inhibitors, through a reduction in body weight (BW), generate changes in the body composition and volume status that have not been clearly studied. : This retrospective, observational longitudinal cohort, single-center study analyzed and compared body composition and fluid status measured by bioelectrical impedance analysis (BIA) from weeks 0 to 12 after the initiation of the cardiac rehabilitation (CR) program for coronary artery disease and heart failure in 59 patients who started treatment with SGLT-2 inhibitors (SGLT-2iG) and 112 patients without SGLT-2 inhibitors (non-SGLT-2iG). Changes between the baseline and week 12 in the SGLT-2iG and non-SGLT-2iG were -0.3 L ( = 0.003) and -0.03 L ( = 0.82) in extracellular water (ECW) ( = 0.05), -0.39 L ( < 0.001) and -0.14 L ( = 0.33) in intracellular water (ICW) ( = 0.12), -0.69 ( < 0.001) and -0.16 ( = 0.52) in total body water (TBW) ( = 0.08), and -0.01 ( = 0.37) and -0.001 ( = 0.25) in the ECW/TBW ratio, respectively. After 3 months of exercise therapy in the CR program, patients in the SGLT-2iG showed a greater decrease than the non-SGLT-2iG in weight (-1.34 kg, < 0.001 vs. -0.99, = 0.02), body mass index (BMI) (-0.45 kg/m, < 0.001 vs. -0.38, = 0.004), arm circumference (-0.57 cm, = 0.008 vs. -0.12 cm, = 0.21), waist circumference (-1.5 cm, = 0.04 vs. -0.11 cm, = 0.83), systolic blood pressure (SBP) (-8.9 mmHg, = 0.049 vs. -4.19, = 0.08), and diastolic blood pressure (DBP) (-5.15, = 0.03 vs. -2.85, = 0.01). The bioelectrical impedance analysis (BIA) revealed a significant decrease in body fat mass (BFM) and visceral fat area, without a loss of lean body mass (LBM) or skeletal muscle mass in the SGLT-2iG. : SGLT-2 inhibitors exert beneficial effects on body compartments and volume status. Although they induce modest weight loss, this appears to be mainly directed at ECW, BFM, and visceral fat, without a loss of LBM nor skeletal muscle mass, which could contribute to the observed CKM benefits.
钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂已成为治疗心血管-肾脏-代谢（CKM）综合征患者的重要治疗手段。除了其在降低血糖水平以及心血管和肾脏保护作用方面有充分记录的效果外，SGLT-2抑制剂通过减轻体重（BW），引起了身体成分和容量状态的变化，但这些变化尚未得到明确研究。 这项回顾性、观察性纵向队列单中心研究，分析并比较了59例开始使用SGLT-2抑制剂（SGLT-2iG）治疗的患者和112例未使用SGLT-2抑制剂（非SGLT-2iG）的患者，在冠心病和心力衰竭心脏康复（CR）计划开始后0至12周通过生物电阻抗分析（BIA）测量的身体成分和液体状态。SGLT-2iG组和非SGLT-2iG组在基线和第12周之间细胞外液（ECW）的变化分别为-0.3L（P = 0.003）和-0.03L（P = 0.82）（P = 0.05），细胞内液（ICW）分别为-0.39L（P < 0.001）和-0.14L（P = 0.33）（P = 0.12），总体液（TBW）分别为-0.69（P < 0.001）和-0.16（P = 0.52）（P = 0.08），以及ECW/TBW比值分别为-0.01（P = 0.37）和-0.001（P = 0.25）。在CR计划进行3个月的运动治疗后，SGLT-2iG组患者的体重（-1.34kg，P < 0.001 vs. -0.99，P = 0.02）、体重指数（BMI）（-0.45kg/m²，P < 0.001 vs. -0.38，P = 0.004）、上臂围（-0.57cm，P = 0.008 vs. -0.12cm，P = 0.21）、腰围（-1.5cm，P = 0.04 vs. -0.11cm，P = 0.83）、收缩压（SBP）（-8.9mmHg，P = 0.049 vs. -4.19，P = 0.08）和舒张压（DBP）（-5.15，P = 0.03 vs. -2.85，P = 0.01）的下降幅度均大于非SGLT-2iG组。生物电阻抗分析（BIA）显示，SGLT-2iG组患者的体脂量（BFM）和内脏脂肪面积显著减少，而瘦体重（LBM）和骨骼肌质量没有损失。 SGLT-2抑制剂对身体腔室和容量状态有有益影响。虽然它们导致适度的体重减轻，但这似乎主要针对细胞外液、体脂量和内脏脂肪，而不会导致瘦体重和骨骼肌质量的损失，这可能有助于观察到的CKM益处。
