アブストラクト
Japanese
| Title | SGLT2阻害薬の多種多様な臨床効果 : 症例提示と文献的知見 |
|---|---|
| Subtitle | ミニレビュー |
| Authors | 麻生裕規雄1, 片岡一2, 原田紗希1, 山崎悠1, 菅田哲治1 |
| Authors (kana) | |
| Organization | 1医療法人慈恵会西田病院薬剤部, 2内科 |
| Journal | 医療薬学 |
| Volume | 49 |
| Number | 9 |
| Page | 321-330 |
| Year/Month | 2023 / 9 |
| Article | 報告 |
| Publisher | 日本医療薬学会 |
| Abstract | 「緒言」 腎臓での糖再吸収は, 腎近位尿細管に発現するナトリウム・ブドウ糖共輸送担体(sodium-glucose-transporter: SGLT)受容体を通じて行われる. 近年, 糖尿病治療薬として開発されたSGLT2阻害薬は, SGLT type2受容体を阻害して尿糖排泄を促進, 血糖を降下し, 糖尿病を改善する. このSGLT2阻害薬は, 心血管イベント抑制や腎保護に効果を発揮することが明らかとなり, 糖尿病領域のみならず, 循環器-腎領域に携わる医療従事者からも注目を集めるようになった. さらに, 各種代謝改善作用や抗炎症作用と, 様々な効果が報告されている. 著者らの所属する西田病院では, 循環器領域を中心に, SGLT2阻害薬の臨床効果に関する研究を展開してきた. その過程で, 糖尿病に対する効果のほか, その利尿作用, 腎-電解質, 神経ホルモン, 呼吸, 血液ガスへの影響について分析し, 得られた新知見を幾つかの論文として報告している. |
| Practice | 薬学 |
| Keywords | SGLT2 inhibitor, cardiovascular system, neurohormones, renal-electrolytes, uric acid, respiratory function |
English
| Title | Diverse Clinical Effects of SGLT2 Inhibitor : Case Presentation and Literature Mini-review |
|---|---|
| Subtitle | Minireview |
| Authors | Yukio Aso1, Hajime Kataoka2, Saki Harada1, Yu Yamasaki1, Tetsuji Sugata1 |
| Authors (kana) | |
| Organization | 1Department of Pharmacy, 2Department of Internal Medicine, Medical Corporation Jikeikai Nishida Hospital |
| Journal | Japanese Journal of Pharmaceutical Health Care and Sciences |
| Volume | 49 |
| Number | 9 |
| Page | 321-330 |
| Year/Month | 2023 / 9 |
| Article | Report |
| Publisher | Japanese Society of Pharmaceutical Health Care and Sciences |
| Abstract | SGLT2 inhibitors are novel diabetes drugs with a wide variety of effects. In this mini-review, a case is presented and the multifaceted effects of SGLT2 inhibitors are discussed in the literature, including my findings on blood-urine electrolyte dynamics and blood gas analysis. The case is a 38-year-old male. He was diagnosed with hypertension and obesity during a routine medical checkup at his company and visited our internal medicine department. After close examination, he was found to have diabetes mellitus, obesity, hypertension, hyperuricemia, abnormal liver function, and sleep-apnea syndrome. After about 6 months, most of the above conditions were under control: weight decreased, blood pressure decreased, the HbA1c level and liver function abnormalities improved, LDL-cholesterol level tended to decrease, and uric acid level decreased. Creatinine levels remained unchanged. Serum electrolytes showed an increase in chloride, but no consistent trend in sodium and potassium. Plasma renin activity increased initially and decreased thereafter. Plasma aldosterone levels decreased. The sympathetic nervous system was not activated. Future studies are required to further elucidate the mechanism of action of SGLT2 inhibitors in various pathological conditions. |
| Practice | Pharmaceutical sciences |
| Keywords | SGLT2 inhibitor, cardiovascular system, neurohormones, renal-electrolytes, uric acid, respiratory function |
- 全文ダウンロード： 従量制、基本料金制の方共に770円(税込) です。
参考文献
- 1) Ghosh RK, Ghosh SM, Chawla S, Jasdanwala SA, SGLT2 inhibitors: A new emerging therapeutic class in the treatment of type 2 diabetes mellitus, J Clinical Pharmacol, 2012, 52, 457-463.
- 2) Lopaschuk GD, Verma S, Mechanisms of cardiovascular benefits of sodium glucose co-transporter 2 (SGLT2) inhibitors, JACC Basic Trans Science, 2020, 5, 632-644.
- 3) Kataoka H, Effects of SGLT2 inhibitor on neurohormonal activity and electrolyte management in an elderly patient with type 2 diabetes mellitus and acute heart failure: A case report, Ann Cardiol Vasc Med, 2020, 3, 1038.
- 4) Kataoka H, Yoshida Y, Enhancement of the serum chloride concentration by administration of sodium-glucose cotransporter-2 inhibitor and its mechanisms and clinical significance in type 2 diabetic patients: A pilot study, Diabetol Metab Syndr, 2020, 12, 5. doi: 10.1186/s13098-020-0515-x.
- 5) Kataoka H, Favorable effect of sodium-glucose cotransporter-2 inhibitor on respiratory function in type 2 diabetic patients, J Endocrine Dis & Ther, 2020, 1, 5-9.
残りの30件を表示する
- 6) 日本呼吸器学会, 睡眠時無呼吸症候群(SAS)の診療ガイドライン2020, 睡眠時無呼吸症候群 (SAS)の診療ガイドライン作成委員会, 南江堂, 東京, 2020.
- 7) Suzuki Y, Kaneko H, Okada A, Itoh H, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Kamiya K, Matsunaga A, Ako J, Node K, Yasunaga H, Komuro I, Comparison of cardiovascular outcomes between SGLT2 inhibitors in diabetes mellitus, Cardiovasc Diabetol, 2022, 21, 67. doi: 10.1186/s12933-022-01508-6.
- 8) Tager T, Atar D, Agewall S, Katus HA, Grundtvig M, Cleland JGF, Clark AL, Frohlich H, Frankenstein L, Comparative efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) for cardiovascular outcomes in type 2 diabetes: A systematic review and network meta-analysis of randomized controlled trials, Heart Fail Rev, 2021, 26, 1421-1435.
- 9) Roden M, Weng J, Eilbracht J, Delafont B, Kim G, Woerle HJ, Broedl UC; EMPA-REG MONO trial investigators, Empagliflozin monotherapy with sitagliptin as an active comparator in patients with type 2 diabetes: A randomised, double-blind, placebo-controlled, phase 3 trial, Lancet Diabetes Endocrinol, 2013, 1, 208-219.
- 10) Rajeev SP, Cuthbertson DJ, Wilding JP, Energy balance and metabolic changes with sodium-glucose co-transporter 2 inhibition, Diabetes Obes Metab, 2016, 18, 125-134.
- 11) Szekeres Z, Toth K, Szabados E, The effects of SGLT2 inhibitors on lipid metabolism, Metabolites, 2021, 11, 87. doi: 10.3390/metabo11020087.
- 12) Hayashi T, Fukui T, Nakanishi N, Yamamoto S, Tomoyasu M, Osamura A, Ohara M, Yamamoto T, Ito Y, Hirano T, Dapagliflozin decreases small dense low-density lipoprotein-cholesterol and increases high-density lipoprotein 2-cholesterol in patients with type 2 diabetes: Comparison with sitagliptin, Cardiovasc Diabetol, 2017, 16, 8. doi: 10.1186/s12933-016-0491-5.
- 13) Kuchay MS, Krishan IS, Mishra SK, Farooqui KJ, Singh MK, Wasir JS, Bansal B, Kaur P, Jevalikar G, Gill HK, Choudhary NS, Mithal A, Effect of empagliflozin on liver fat in patients with type 2 diabetes and nonalcoholic fatty liver disease: A randomized controlled trial (E-LIFT Trial), Diabetes Care, 2018, 41, 1801-1808.
- 14) Wei Q, Xu X, Guo L, Li J, Li L, Effect of SGLT2 inhibitors on type 2 diabetes mellitus with nonalcoholic fatty liver disease: A meta-analysis of randomized controlled trials, Front Endocrinol, 2021, 12, 635556. doi: 10.3389/fendo.2021.635556.
- 15) Bolinder J, Ljunggren O, Kullberg J, Johansson L, Wilding J, Langkidle AM, Sugg J, Parikh S, Effects of dapagliflozin on body weight, total fat mass, and regional adipose tissue distribution in patients with type 2 diabetes mellitus with inadequate glycemic control on metformin, J Clin Endocrinol Metab, 2012, 97, 1020-1031.
- 16) Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, Mattheus M, Biomath D, Devins T, Johansen OE, Woerle HJ, Broedl UC, Inzucchi SE, for the EMPA-REG OUTCOME Investigators, Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes, N Engl J Med, 2015, 373, 2117-2128.
- 17) Mazidi M, Rezaie P, Gao H-K, Kengne AP, Effect of sodium-glucose cotransporter-2 inhibitors on blood pressure in people with type 2 diabetes mellitus: A systematic review and meta-analysis of 43 randomized control trials with 22 528 patients, J Am Heart Assoc, 2017, 6, e004007. doi: 10.1161/JAHA.116.004007.
- 18) Mudaliar S, Alloju S, Henry RR, Can a shift in fuel energetics explain the beneficial outcomes in the EMPA-REG OUTCOME study?: A unifying hypothesis, Diabetes Care, 2016, 39, 1115-1122.
- 19) Cherney DZ, Perkins BA, Soleymanlou N, Maione M, Lai V, Lee A, Fagan NM, Woerle HJ, Johansen OE, Broedl UC, von Eynatten M, Renal hemodynamic effect of sodium-glucose cotransporter 2 inhibition in patients with type 1 diabetes mellitus, Circulation, 2014, 129, 587-597.
- 20) Ansary TM, Nakano D, Nishiyama A, Diuretic effects of sodium glucose cotransporter 2 inhibitors and their influence on the renin-angiotensin system, Int J Mol Sci, 2019, 20, 629. doi: 10.3390/ijms20030629.
- 21) Mori I, Ishizuka T, Effects of SGLT2 inhibitors on renin-aldosterone system for one month and six months in type 2 diabetes, Diabetes, 2018, 67 (Suppl 1), 1196-P. doi: 10.2337/db18-1196-P.
- 22) Masuda T, Muto S, Fukuda K, Watanabe M, Ohara K, Koepsell H, Vallon V, Nagata D, Osmotic diuresis by SGLT2 inhibition stimulates vasopressin-induced water reabsorption to maintain body fluid volume, Physiological Reports, 2020, 8, e14360. doi: 10.14814/phy2.14360.
- 23) Wanner C, Inzucchi SE, Lachin JM, Fitchett D, von Eynatten M, Mattheus M, Biomath D, Johansen OE, Woerle HJ, Broedl UC, Zinman B, for the EMPA-REG OUTCOME Investigators, Empagliflozin and progression of kidney disease in type 2 diabetes, N Engl J Med, 2016, 375, 323-334.
- 24) Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM, Edwards R, Agarwal R, Bakris G, Bull S, Cannon CP, Capuano G, Chu P-L, de Zeeuw D, Greene T, Levin A, Pollock C, Wheeler DC, Yavin Y, Zhang H, Zinmen B, Meininger G, Brenner BM, Mahaffey KW, for the CREDENCE Trial Investigators, Canagliflozin and renal outcomes in type 2 diabetes and nephropathy, N Engl J Med, 2019, 380, 2295-2306.
- 25) Heerspink HJL, Stefansson BV, Correa-Rotter R, Chertow GM, Greene T, Hou F-F, Mann JFE, McMurray JJV, Lindberg M, Rossing P, Sjostrom CD, Toto RD, Langkilde A-M, Wheeler DC, Dapagliflozin in patients with chronic kidney disease, N Engl J Med, 2020, 383, 1436-1446.
- 26) Tahara A, Kurosaki E, Yokono M, Yamajuku D, Kihara R, Hayashizaki Y, Takasu T, Imamura M, Qun L, Tomiyama H, Kobayashi Y, Noda A, Sasamata M, Shibasaki M, Pharmacological profile of ipragliflozin (ASP1941): A novel selective SGLT2 inhibitor, in vitro and in vivo, Naunyn Schmiedebergs Arch Pharmacol, 2012, 385, 423-436.
- 27) Masuda T, Watanabe Y, Fukuda K, Watanabe M, Onishi A, Ohara K, Imai T, Koepsell H, Muto S, Vallon V, Nagata D, Unmasking a sustained negative effect of SGLT2 inhibition on body fluid volume in the rat, Am J Physiol Renal Physiol, 2018, 315, F653-F664.
- 28) Hallow KM, Helmlinger G, Greasly PJ, McMurray JJ, Boulton DW, Why do SGLT2 inhibitors reduce heart failure hospitalization?: A differential volume regulation hypothesis, Diabetes Obes Metab, 2018, 20, 479-487.
- 29) Ferreira JP, Zannad F, Butler J, Filipattos G, Ritter I, Schuler E, Kraus BJ, Pocock SJ, Anker SD, Packer M, Empagliflozin and serum potassium in heart failure: An analysis from EMPEROR-Pooled, Eur Heart J, 2022, 43, 2984-2993.
- 30) 栗山哲, 中野知子, 田邉智子, 槙田真由美, 宮川佳也, 込田英夫, 平尾磨樹, 長田眞, 三穂乙哉, SGLT2阻害薬による血清尿酸値低下作用の検討, 痛風と尿酸・核酸, 2020, 44, 41-74.
- 31) Doehner W, Anker SD, Butler J, Zannad F, Filippatos G, Ferreira JP, Salsali A, Kaempfer C, Brueckmann M, Pocock SJ, Januzzi JL, Packer M, Uric acid and sodium-glucose cotransporter-2 inhibition with empagliflozin in heart failure with reduced ejection fraction: The EMPEROR-reduced trial, Eur Heart J, 2022, 43, 3435-3447.
- 32) Sawada K, Karashima S, Kometani M, Oka R, Takeda Y, Sawamura T, Fujimoto A, Demura M, Wakayama A, Usukura M, Yagi K, Takeda Y, Yoneda T, Effect of sodium glucose cotransporter 2 inhibitors on obstructive sleep apnea in patients with type 2 diabetes, Endocrine J, 2018, 65, 461-467.
- 33) Brikman S, Dori G, Sodium glucose cotransporter 2 inhibitor-possible treatment for patients with diabetes, pulmonary disease and CO2 retention, Med Hypotheses, 2020, 139, 10963. doi: 10.1016/j.mehy.2020.109631.
- 34) Sano M, Goto S, Possible mechanism of hematocrit elevation by sodium glucose cotransporter 2 inhibitors and associated beneficial renal and cardiovascular effects, Circulation, 2019, 139, 1985-1987.
- 35) Rocha NA, Neeland IJ, McCullough PA, Toto RD, McGuire DK, Effects of sodium glucose co-transporter 2 inhibitors on the kidney, Diab Vasc Dis Res, 2018, 15, 375-386.
