Therapeutic Research

Sodium glucose co‒transporter 2（SGLT2）inhibitor lowers blood pressure（BP）as well as blood glucose through suppression of kidney glucose reabsorption. We investigated whether the SGLT2 inhibitor dapagliflozin（DAPA）improves BP variability and whether DAPA with renin‒angiotensin system（RAS）inhibitor effectively decreases BP in Japanese patients with type 2 diabetes mellitus and hypertension. In Twenty‒four eligible patients treated with DAPA 5 mg/day for 12 weeks, 24‒hour BP was determined by ambulatory BP monitoring, visceral fat mass was assessed by a dual‒impedance method and glucose metabolism was monitored. After DAPA treatment, systolic BP（SBP）in 24‒hour and nighttime were significantly decreased and SBP in daytime showed marginally‒significant decrease, and BP variability was improved with reversal of the riser type （nighttime BP＞daytime BP）in three patients. In the RAS‒inhibitor‒treated group（n＝16）, the 24‒hour BP was decreased, but not in the untreated group（n＝8）. Fasting plasma glucose, HbA1c and visceral fat area were significantly decreased in both groups, and there was no difference in these parameters between the groups. Serum insulin level was reduced only in the RAS‒inhibitor‒treated group. Adverse drug reactions occurred in two patients. DAPA improved the 24‒hour BP, circadian variability of BP, body composition and metabolic parameters. These improvements were notable in those who underwent combined therapy with DAPA and RAS inhibitors. Combined therapy with SGLT2 and RAS inhibitors may be useful in Japanese patients with type 2 diabetes mellitus and hypertension.

2011 年6 月11 日から2014 年8 月5 日までに大阪府済生会中津病院（以下中津病院）にてliposomal amphotericin B（L‒AMB）が投与された，推定糸球体濾過量（eGFR）が30 mL/min/1.73 m2未満の高度腎機能低下の8 例（血液浄化療法施行中4 例，持続的腎代替療法施行中2 例，腎代替療法を用いなかった2 例）について，臨床背景と有効性，安全性について後方視的に検討を行った。第一選択薬としての投与は3 例，第二選択薬では5 例であった。L‒AMB が臨床的に有効であったのは2 例，無効が4 例，不明2 例であった。副作用により新たに血液浄化療法を施行した例はみられなかった。投与中止理由は血小板低下，肝機能障害であったが，電解質異常による中止症例はみられなかった。L‒AMB は併用薬や腎機能，電解質を慎重にモニタリングすることで，安全に使用できる可能性が示唆された。