心不全におけるエンパグリフロジン: 利尿薬と心臓への作用
Matthew Griffin1, Veena S Rao1, Juan Ivey-Miranda2
1Department of Internal Medicine, Section of Cardiovascular Medicine (M.G., V.S.R., J.F., D.M., C.M., T.A., D.J., L.B., J.M.T.), Yale University School of Medicine, New Haven, CT.
Circulation
|May 16, 2020
まとめ
エムパグリフロジンなどのナトリウム・グルコース・コトランスポーター2阻害剤は,神経ホルモンの活性化や腎機能障害を引き起こすことなく,ナトリウレスを促進し,血液量を減少させます. この好ましい利尿性プロファイルは,心不全の管理におけるその利点を説明するかもしれない.
科学分野:
- 心臓病科
- 腎臓科
- 内分泌学
背景:
- ナトリウム・グルコース・コトランスポーター2阻害剤 (SGLT2i) は心不全の治療において有望であるが,そのメカニズムは不明である.
- 排尿作用はSGLT2iの効果に寄与し,従来の排尿剤で見られる神経ホルモンの活性化を回避する可能性がある.
- SGLT2iの近接管の作用は,従来の利尿薬よりも,血管内容量の管理に優れている可能性があります.
研究 の 目的:
- 2型糖尿病および心不全の患者におけるエンパグリフロジンの利尿および心経効果を調査する.
- プラセボと比較して体積状態,電解質,神経ホルモンの活性化に対するエンパグリフロジンの効果を比較する.
- 心不全におけるSGLT2iの効果の潜在的メカニズムを調査する.
主な方法:
- 2型糖尿病と安定した心不全の患者20人を対象としたランダム化,プラセボ対照のクロスオーバー研究.
- 患者は14日間,エムパグリフロジン10mgまたはプラセボを投与し,その後は洗い流し期間とクロスオーバーを受けた.
- 治療開始時および各治療期間の後に,生物サンプルを集めて,心肺内フェノタイプを決定した.
主要な成果:
- ブメタニドと併用すると,エンパグリフロジンは尿中のグルコースとナトリウム分泌を有意に増加させ,シネージ効果を発揮した.
- 神経ホルモンの活性化が伴わないエンパグリフロジンでは,血量と血量の減少が観察されました.
- 血清マグネシウムと尿酸濃度が改善した.
結論:
- エムパグリフロジンは,特にループの利尿薬で,有意なナトリウレスを誘発し,血液量を改善しますが,副作用はありません.
- エレクトロライトの浪費,腎機能障害,神経ホルモンの活性化の欠如は,エンパグリフロジンの好ましい利尿作用を強調する.
- このプロファイルは,SGLT2阻害剤の観察された長期的な心不全の効果に寄与する可能性があります.
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