黃建寧Chien-Ning Huang莊武龍Wu-Lung Chuang醫學研究所2026-10-299999-12-312022https://handle.ncl.edu.tw/11296/chm7akhttps://scholars.csmu.edu.tw/handle/123456789/36639研究目的：低血鈉是一個常見的住院急症。本研究的主要目的是要了解第二型糖尿病患者使用Sodium-glucose cotransporter-2 inhibitors (SGLT2i)藥物或者使用利尿劑合併使用SGLT2i藥物後的低血鈉風險。研究方法及資料：利用回顧性研究使用全民健康保險資料庫2016-2017 年的數據。使用傾向分數配對(Propensity Score Matching)篩選出有使用SGLT2i藥物的糖尿病患者，以及沒有使用SGLT2i藥物的糖尿病患者。有使用SGLT2i藥物的糖尿病患者，一共選出11399人，沒有使用SGLT2i藥物的糖尿病患者共11399人。接著使用調整風險比值(adjusted hazard ratios， aHR)以及使用 Cox 比例風險模型來預測低血鈉的相對風險。研究結果：糖尿病患者合併使用SGLT2i藥物及利尿劑與使用利尿劑相比，有較低的低血鈉風險。特別是60歲以上族群(aHR = 0.45, 95% CI = [0.23, 0.88])、高血壓(aHR = 0.47, 95% CI = [0.27, 0.82])以及高血脂異常(aHR = 0.53, 95% CI = [0.30, 0.94])的患者。而低血鈉的風險會隨著使用時間拉長而降低。(141-330天: aHR = 0.47, 95% CI = [0.27, 0.82]; 331+ 天: aHR = 0.13, 95% CI = [0.04, 0.41])。結論與建議：糖尿病患者使用SGLT2i藥物後的低血鈉風險，與使用利尿劑相比，會有較低的低血鈉風險。而糖尿病患者合併使用SGLT2i藥物及利尿劑與使用利尿劑相比，仍會有較低的低血鈉風險。Purpose: To evaluate the risk of hyponatremia in diabetic patient who receiving sodium glucose co- transporters 2 inhibitor (SGLT2i) or diuretics or combination therapy.Methods: We enrolled 11,399 diabetic patients treated with SGLT2is and 11,399 diabetic patients treated without SGLT2is from the Longitudinal Generation Tracking Database (LGTD) in the study after propensity score matching (PSM). Adjusted hazard ratios (aHR) and the corresponding 95% CI were estimated by multivariate Cox proportional hazards models with covariates of sex, age, diuretics, and comorbidities.Results: The diabetic patients treated with SGLT2is were at significantly lower risk of hyposmolality and hyponatremia in those aged more than or equal to 60 years (aHR = 0.45, 95% CI = [0.23, 0.88]) and those with hypertension (aHR = 0.47, 95% CI = [0.27, 0.82]) and hyperlipidemia (aHR = 0.53, 95% CI = [0.30, 0.94]) when compared to diabetic patients treated with diuretics only. The risk of hyposmolality and hyponatremia decreased along with the increase of days of supply of SGLT2is (141-330 days: aHR = 0.47, 95% CI = [0.27, 0.82]; 331+ days: aHR = 0.13, 95% CI = [0.04, 0.41]).Conclusion: The long time use may increase risk of hyponatremia in diabetic patients receiving diuretics but the risk of hyponatremia is lower if using SGLT2i alone or combination use of SGLT2i and diuretics.低血鈉第二型鈉葡萄糖共同運送受體抑制劑利尿劑糖尿病hyponatremiadiureticsSGLT2idiabetes mellitusthesis