Objective: To investigate the effect of Dapagliflozin, sodium-glucose cotransporter 2 inhibitor (SGLT2i), on contrast-induced acute kidney injury (CIAKI) in patients with type 2 diabetes mellitus (T2DM) after percutaneous coronary intervention(PCI). Methods: A cohort study. The clinical data of 366 patients with coronary heart disease combined with T2DM who underwent PCI in the Department of Cardiology, Tianjin University Chest Hospital, from June 2021 to June 2022 were retrospectively analyzed, including 218 males and 148 females, aged (64.6±11.0) years old. According to whether the patients had used Dapagliflozin or not, the selected patients were divided into SGLT2i group(n=124) and control group(n=242). The changes in cardiac indicators, renal function, and inflammatory response indicators before and 72 hours after PCI treatment were analyzed and compared between the two groups. The incidence rate of CIAKI in the two groups was analyzed, and the influencing factors of CIAKI were analyzed by multivariate logistic regression. The major adverse cardiac events (MACE) were recorded during the follow-up period of the two groups, and Kaplan-Meier survival analysis and log-rank test were used to compare the differences in MACE occurrence between the two group. Results: The left ventricular ejection fraction (LVEF) of the SGLT2i group was lower than that of the control group, and the proportion of patients with LVEF<45% and CIAKI risk score were higher than those of the control group, with statistical significance (all P<0.05). 72 h after PCI treatment, β-2 Microglobulin(β-2MG), cystatin-C(Cys-C), and neutrophil gelatinase-associated lipocalin (NGAL) in both groups were all increased compared to those before PCI treatment, with statistical significance (all P<0.05).β-2MG, Cys-C, and NGAL in SGLT2i group were all lower than those in the control group, with statistical significance(all P<0.05).The levels of interleukin-6(IL-6), hypersensitive C-reactive protein (hs-CRP), and malondialdehyde in both groups of patients increased compared to preoperative levels, while the levels of superoxide dismutase (SOD) decreased compared to preoperative levels, with statistical significance (all P<0.05). The levels of IL-6, hs-CRP, and malondialdehyde in the SGLT2i group were lower than those in the control group, while SOD was higher than that in the control group, with statistical significance (all P<0.05). Among all patients included, 34 cases experienced CIAKI (9.8%), and the incidence of CIAKI in the SGLT2i group was lower than that in the control group [4.8% (6/124) vs 11.6% (28/242),P=0.037]. Multivariate logistic regression analysis showed that the use of dapagliflozin was a protective factor for CIAKI in T2DM patients receiving PCI treatment (OR=0.321, 95%CI: 0.127-0.816, P=0.017). After a follow-up of 14.0 (12.0, 16.2) months, the incidence of MACE in SGLT2i group was lower than that in the control group (7.3% vs 12.8%, P=0.048). Conclusions: Dapagliflozin may reduce the risk of CIAKI and MACE in T2DM patients after PCI treatment. Its mechanism may be related to the anti-inflammatory and antioxidant effects of SGLT2i.
目的： 探讨钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）达格列净对2型糖尿病（T2DM）患者行经皮冠状动脉介入治疗（PCI）后对比剂诱导急性肾损伤（CIAKI）的影响。 方法： 队列研究。回顾性分析366例天津大学胸科医院心内科2021年6月至2022年6月行PCI的冠心病合并T2DM患者的临床资料，其中男218例，女148例，年龄（64.6±11.0）岁。根据患者是否应用达格列净，将纳入患者分为SGLT2i组（n=124）和对照组（n=242）。分析比较2组患者心脏指标、PCI前及术后72 h肾功能及炎症反应指标变化。分析2组患者CIAKI发生率，应用多因素logistic回归分析CIAKI发生的影响因素。记录2组患者随访期间主要心脏不良事件（MACE）发生情况，采用Kaplan-Meier生存分析和log-rank检验比较2组MACE发生率差异。 结果： SGLT2i组左心室射血分数（LVEF）低于对照组，LVEF<45%患者入选比例及CIAKI危险评分高于对照组，差异均有统计学意义（均P<0.05）。PCI后72 h，2组β-2微球蛋白（β-2MG）、胱抑素-C（Cys-C）、血中性粒细胞明胶酶相关载脂蛋白（NGAL）水平均较PCI前升高，差异均有统计学意义（均P<0.05）；而SGLT2i组β-2MG、Cys-C和NGAL水平均低于对照组，差异均有统计学意义（均P<0.05）；2组患者血白细胞介素-6（IL-6）、超敏C-反应蛋白（hs-CRP）和丙二醛均较术前升高，而超氧化物歧化酶（SOD）较术前下降，差异均有统计学意义（均P<0.05）；SGLT2i组IL-6、hs-CRP和丙二醛水平均低于对照组，而SOD高于对照组，差异均有统计学意义（均P<0.05）。纳入所有患者中34例发生CIAKI（9.8%），SGLT2i组CIAKI发生率低于对照组［4.8%（6/124）比11.6%（28/242），P=0.037］。多因素logistic回归分析显示，使用达格列净是接受PCI的T2DM患者发生CIAKI的保护因素（OR=0.321，95%CI：0.127~0.816，P=0.017）。随访14.0（12.0，16.2）个月，SGLT2i组患者MACE发生率低于对照组（7.3%比12.8%，P=0.048）。 结论： 达格列净可能能够减少T2DM患者PCI后CIAKI及MACE的发生，其机制可能与其抗炎症反应和抗氧化应激作用有关。.