在心力衰竭中使用Empagliflozin:利尿和心脏效应
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
概括
在没有引起神经激素激活或功能障碍的情况下,像empagliflozin这样的- 葡萄糖共传递剂抑制剂可促进自然和降低心力衰竭患者的血液体积. 这种有利的利尿作用可能解释了它们在心力衰竭治疗中的好处.
科学领域:
- 心脏病学
- 肝脏病学
- 内分泌学
背景情况:
- 在心力衰竭治疗中,-葡萄糖携带体-2 抑制剂 (SGLT2i) 是有前途的,但其作用机制尚不清楚.
- 利尿作用可能有助于SGLT2i的益处,可能避免传统利尿剂所见的神经激素激活.
- 在控制血管内体积方面,SGLT2i的近管作用可能比传统的利尿剂具有优势.
研究的目的:
- 调查empagliflozin在2型糖尿病和心力衰竭患者中的利尿和心脏效应.
- 为了比较empagliflozin对体积状态,电解质和神经激素激活与安慰剂的影响.
- 探索SGLT2i在心力衰竭中的潜在作用机制.
主要方法:
- 一个随机的,安慰剂控制的交叉研究,涉及20名2型糖尿病患者和稳定的心力衰竭.
- 患者每天接受empagliflozin10毫克或安慰剂14天,随后进行洗期和交叉治疗.
- 在基线和每次治疗后进行了密集的生物样本采集和心表型鉴定.
主要成果:
- 恩帕格利弗洛辛可显著增加尿液中的葡萄糖和部分分泌,与布梅坦胺结合时具有协同作用.
- 在没有相关的神经激素激活的情况下,观察到empagliflozin减少了血液体积和血体积.
- 没有发现损耗或功能障碍的证据;血清和尿酸水平有所改善.
结论:
- 恩帕格利弗洛辛诱导显著的自然和改善血液体积,特别是循环利尿剂,没有不良影响.
- 没有电解质浪费,功能障碍和神经激素激活,凸显了empagliflozin有利的利尿作用.
- 这种特征可能有助于观察到SGLT2抑制剂对心力衰竭的长期益处.
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