在急性心血管疾病中的达帕格利弗洛辛:来自DEFENDER试验的见解
Caio A M Tavares1, Luciano C P Azevedo2, Patrícia O Guimarães2
1Academic Research Organization, Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
JACC. Advances
|December 20, 2025
概括
像达帕格利弗洛辛这样的-葡萄糖共运输体-2 抑制剂,根据入院原因,在危急病患者的结果中没有差异. 在心血管疾病患者中,达帕格利弗洛辛表现出安全的利尿作用,需要最小的血管活性支持.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 关键护理医学 关键护理医学
背景情况:
- -葡萄糖共运输体-2 (SGLT2) 抑制剂在各种临床环境中改善了结果.
- 它们在患有急性心血管疾病的重症患者中的疗效和安全性仍在调查中.
研究的目的:
- 分析大帕格利弗洛辛在重症患者的治疗效果,比较心血管与非心血管入院原因.
- 评估在患有急性心血管疾病的患者中启动达帕格利弗洛辛的急性影响.
主要方法:
- 对DEFENDER试验的二次分析,涉及507名重症患者,随机分配给达帕格利弗洛辛或标准护理.
- 使用胜率分析对心血管 (n=162) 和非心血管 (n=345) 亚组的结果 (死亡率,置换疗法,ICU停留时间) 进行比较.
- 在134名心血管患者的每日参数分析中,使用贝叶斯混合模型.
主要成果:
- 心血管和非心血管亚组之间没有观察到治疗效果的显著差异 (相互作用P=0.69).
- 达帕格利弗洛辛在心血管病患者中表现出适度的利尿作用,增加尿量212毫升/天,减少液体平衡-237毫升/天.
- 达帕格利弗洛辛和标准护理组之间的严重不良事件相似;注意到血管活性支持的最小增加.
结论:
- 在重症患者中开始使用达帕格利弗洛辛时,基于ICU入院原因的治疗效果没有异质性.
- 达帕格利弗洛辛在危急心血管疾病患者中似乎是安全的,它提供了利尿剂的好处,对血管活性支持的影响最小,值得进一步研究.
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