Dapagliflozin Improves Cardiac Autonomic Function Measures in Type 2 Diabetic Patients with Cardiac Autonomic Neuropathy.
Dapagliflozin Improves Cardiac Autonomic Function Measures in Type 2 Diabetic Patients with Cardiac Autonomic Neuropathy.
复制标题
达帕格列净可改善患有心脏自主神经病变的 2 型糖尿病患者的心脏自主神经功能测量。
DOI：
10.5152/anatoljcardiol.2022.1934
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发表时间：
2022-11
影响因子：
1.3
通讯作者：
Aykan AÇ
中科院分区：
文献类型：
--
作者：
Balcıoğlu AS;Çelik E;Şahin M;Göçer K;Aksu E;Aykan AÇ
心脏自主神经病变是2型糖尿病的常见并发症。心脏自主神经病变（交感神经张力超过副交感神经活动）会增加心血管疾病的发病率和死亡率，不幸的是没有明确的治疗方法。根据之前的研究结果，钠-葡萄糖协同转运蛋白 2 抑制剂被认为可以减少交感神经系统的活动。在本研究中，我们旨在探讨达格列净（一种钠-葡萄糖协同转运蛋白 2 抑制剂）24 周治疗对 2 型糖尿病合并心脏自主神经病变患者心脏自主神经功能指标的影响。对于现有治疗无法控制血糖的患者，在治疗中添加达格列净 10 mg/天 (n = 42) 或非钠-葡萄糖协同转运蛋白 2 抑制剂口服降糖药 (n = 38)。经心血管自主反射测试诊断为明确或确诊的心脏自主神经病变的患者在开始额外用药前和24周治疗期后接受24小时动态心电图记录以获得心率变异性和心率紊乱参数。组内分析显示，达格列净 10 mg/天，持续 24 周，可改善心率变异性和心率紊乱参数，并相对于基线值降低室性早搏频率。尽管血糖控制相似，但对照组并未观察到此类发现。达格列净组与对照组的比较显示，达格列净的这些效果明显优于非钠-葡萄糖协同转运蛋白2抑制剂口服降糖药。与对照组相比，达格列净改善了患有心脏自主神经病变的 2 型糖尿病患者的心脏自主功能测量。这种组间益处首次得到证实，可能有望通过钠-葡萄糖协同转运蛋白 2 抑制剂来消退心脏自主神经病变。
Cardiac autonomic neuropathy is a frequent complication of type 2 diabetes mellitus. Cardiac autonomic neuropathy, in which sympathetic tone predominates over parasympathetic activity, increases both cardiovascular morbidity and mortality and unfortunately has no definitive treatment. Sodium-glucose cotransporter-2 inhibitors have been suggested to reduce sympathetic nervous system activity, based on the results from previous studies. In this study, we aimed to investigate the effect of 24-week treatment with dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, on cardiac autonomic function measures in patients with type 2 diabetes mellitus and cardiac autonomic neuropathy. Dapagliflozin 10 mg/day (n = 42) or non-sodium-glucose cotransporter-2 inhibitor oral antidiabetic(s) (n = 38) was added to the treatment of patients whose glycemic control could not be achieved with existing treatments. The patients with definite or confirmed cardiac autonomic neuropathy diagnosed by cardiovascular autonomic reflex tests underwent 24-hour Holter-electrocardiogram recordings to obtain heart rate variability and heart rate turbulence parameters before starting additional medication and after a 24-week treatment period. In-group analyses showed that dapagliflozin 10 mg/day for 24 weeks improved heart rate variability and heart rate turbulence parameters and decreased the frequency of ventricular premature beats relative to their baseline values. No such findings were observed in the control group despite similar glycemic control. Comparisons between dapagliflozin group and the control group showed that these effects of dapagliflozin were significantly better than non-sodium-glucose cotransporter-2 inhibitor oral antidiabetics. Dapagliflozin improves measures of cardiac autonomic function compared to the control group in type 2 diabetic patients with cardiac autonomic neuropathy. This intergroup benefit, demonstrated for the first time, may be promising for the regression of cardiac autonomic neuropathy with sodium-glucose cotransporter-2 inhibitors.