摘要

目的：探討鈉- 葡萄糖協同轉運蛋白-2 抑制劑 (Sodium-glucose cotransporter 2 inhibitor, SGLT2i) 對糖尿病病人腎功能和糖尿病控制的影響。

方法：本研究納入2018 年5 月至2021 年8 月曾於本院門診處方empagliflozin (EMPA) 或canagliflozin (CANA) 超過84 天的病人。追蹤服藥後18 個月之尿液白蛋白與肌酸酐比值 (urine albumin/creatinine ratio, UACR) 、預估腎絲球過濾率(estimated glomerular filtration rate, eGFR) 和糖化血色素 (HbA1c) 之檢驗數值進行差異趨勢分析，並依年齡65 歲分組進行次族群分析。

結果： 215 名病人中，115 人使用 EMPA，100 人使用 CANA。年齡 ≥ 65 歲者分別為 52 人 (45.2%) 與38 人 (38.0%)。EMPA 與CANA 組之起始中位數UACR (mg/g) 分別為26.0 與35.8 為中低風險蛋白尿；eGFR (mL/min/1.73 m2) 分別為72.5 與63.7；HbA1c (%) 分別為 7.9 與 8.1。與期初之基線值相比，EMPA 組之UACR 有明顯改善 (p< 0.001)，eGFR 有明顯降低 (p < 0.001)，HbA1c 降低 0.5%。CANA 組之UACR 改善較不明顯 (p < 0.449)，eGFR 有明顯降低 (p < 0.001)，HbA1c 降低0.7%。高齡病人（ ≥ 65歲） 的EMPA 使用者較CANA 組顯著改善UACR (p = 0.004)；但eGFR 與HbA1c 改善無顯著差異。

結論：對於中低風險蛋白尿之糖尿病病人，empagliflozin 可顯著降低整體與高齡病人UACR，canagliflozin 則有改善趨勢；而eGFR 與 HbA1c 的變化在藥物間或年齡分組並無明顯差異。

 

ABSTRACT

Objective: To evaluate the effectiveness of SGLT2 inhibitors, empagliflozin (EMPA) and canagliflozin (CANA), on kidney function and diabetes control.

Methods: Patients who used EMPA or CANA for ≥ 84 days between May 2018 and August 2021 were included. Changes in urine microalbumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and glycated hemoglobin (HbA1c) were analyzed over an 18-month follow-up period. A subgroup analysis was conducted based on age, dividing patients into those younger than 65 years and those aged 65 years or older.

Results: Among 215 patients (115 on EMPA, 100 on CANA), 62 (45.2%) EMPA users and 38 (38.0%) CANA users were aged ≥ 65 years. At baseline, median UACR (mg/g) was 26.0 (EMPA) and 35.8 (CANA), eGFR (mL/min/1.73m2) was 72.5 and 63.7, and HbA1c (%) was 7.9 and 8.1. EMPA significantly reduced UACR (p < 0.001), lowered eGFR (p < 0.001), and decreased HbA1c by 0.5%, while CANA showed no significant UACR change (p = 0.449), a similar eGFR decline (p < 0.001), and a 0.7% HbA1c reduction. In patients ≥ 65 years, EMPA improved UACR more than CANA (p = 0.004), with no significant differences in eGFR or HbA1c.

Conclusion: Empagliflozin significantly improved UACR, particularly in elderly patients, while canagliflozin showed a non-significant trend toward improvement. eGFR and HbA1c changes were comparable between groups.

 

 

Submitted for publication: 2024.11.9; Accepted for publication: 2025.3.26