{"id":23214,"date":"2023-04-29T14:02:23","date_gmt":"2023-04-29T07:02:23","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=23214"},"modified":"2023-04-29T14:02:23","modified_gmt":"2023-04-29T07:02:23","slug":"sglt2","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/sglt2\/","title":{"rendered":"\u1ee8c ch\u1ebf SGLT2 v\u00e0 s\u1eaft t\u0129nh m\u1ea1ch trong suy tim – c\u00f3 t\u01b0\u01a1ng t\u00e1c ?"},"content":{"rendered":"

Vi\u1ec7c s\u1eed d\u1ee5ng SGLT2 inhibitors c\u00f9ng v\u1edbi s\u1eaft t\u0129nh m\u1ea1ch c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c s\u1eaft. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn m\u1ee9c s\u1eaft trong c\u01a1 th\u1ec3 gi\u1ea3m v\u00e0 g\u00e2y ra c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 s\u1ee9c kh\u1ecfe nh\u01b0 thi\u1ebfu m\u00e1u. Do \u0111\u00f3,\u00a0 trong b\u00e0i b\u00e1o “Potential Interactions When Prescribing SGLT2 Inhibitors and Intravenous Iron in Combination in Heart Failure<\/em>” \u0111\u01b0\u1ee3c \u0111\u0103ng tr\u00ean t\u1ea1p ch\u00ed JACC Heart Failure ng\u00e0y 11\/01\/2023 s\u1ebd tr\u00ecnh b\u00e0y r\u00f5 h\u01a1n.<\/strong><\/p>\n

1. T\u1ed5ng quan<\/strong><\/h1>\n

\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy tim, c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf \u0111\u1ed3ng v\u1eadn chuy\u1ec3n Natri-Glucose 2 (SGLT2) \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 l\u00e0m gi\u1ea3m Hepcidin v\u00e0 Ferritin v\u00e0 t\u0103ng th\u1ee5 th\u1ec3 Protein Transferrin, nh\u1eefng thay \u0111\u1ed5i th\u01b0\u1eddng l\u00e0m t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft tuy\u1ec7t \u0111\u1ed1i tr\u1ea7m tr\u1ecdng h\u01a1n, c\u00f3 th\u1ec3 th\u1ea5y \u1edf\u00a0 b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng k\u00e9m ho\u1eb7c b\u1ec7nh \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, ch\u1ea3y m\u00e1u, v\u00e0 c\u1ea3 hai \u0111\u1ec1u kh\u00f4ng b\u1ecb k\u00edch th\u00edch b\u1edfi thu\u1ed1c \u1ee9c ch\u1ebf SGLT2. Do \u0111\u00f3, 2 kh\u00e1i ni\u1ec7m kh\u00e1c nhau c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch t\u00ecnh tr\u1ea1ng thay \u0111\u1ed5i \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong c\u00e1c Protein c\u00e2n b\u1eb1ng n\u1ed9i m\u00f4i s\u1eaft. Theo \u201cgi\u1ea3 thuy\u1ebft suy gi\u1ea3m s\u1eaft t\u1ebf b\u00e0o\u201d, t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 l\u00e0m gi\u1ea3m Hepcidin v\u00e0 Ferritin v\u00e0 t\u0103ng th\u1ee5 th\u1ec3 transferrin c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 suy gi\u1ea3m Fe2+ t\u1ebf b\u00e0o x\u1ea3y ra sau khi t\u0103ng s\u1eed d\u1ee5ng s\u1eaft li\u00ean quan \u0111\u1ebfn Erythropoietin do thu\u1ed1c g\u00e2y ra.<\/p>\n

Thu\u1ed1c b\u1eaft ch\u01b0\u1edbc Erythropoietin (v\u00ed d\u1ee5, Darbepoietin) g\u1ee3i \u00fd thi\u1ebfu s\u1eaft, v\u00e0 n\u00f3 th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi t\u00ecnh tr\u1ea1ng kh\u00e1ng Erythropoietin \u0111\u01b0\u1ee3c gi\u1ea3m b\u1edbt b\u1eb1ng c\u00e1ch b\u1ed5 sung s\u1eaft qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Ng\u01b0\u1ee3c l\u1ea1i, theo \u201cgi\u1ea3 thuy\u1ebft b\u1ed5 sung s\u1eaft trong t\u1ebf b\u00e0o\u201d, t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 l\u00e0m gi\u1ea3m Hepcidin v\u00e0 Ferritin v\u00e0 t\u0103ng th\u1ee5 th\u1ec3 Transferrin th\u1ec3 hi\u1ec7n t\u00e1c d\u1ee5ng tr\u1ef1c ti\u1ebfp c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y:<\/p>\n

    \n
  • \u0110\u1ea3o ng\u01b0\u1ee3c s\u1ef1 gia t\u0103ng Hepcidin v\u00e0 Ferritin li\u00ean quan \u0111\u1ebfn vi\u00eam. Do \u0111\u00f3, gi\u1ea3m b\u1edbt c\u00e1c kh\u1ed1i ch\u1ee9c n\u0103ng s\u1eed d\u1ee5ng s\u1eaft.<\/li>\n
  • \u0110\u1ec3 t\u0103ng t\u00edn hi\u1ec7u Sirtuin-1, ch\u1ea5t \u1ee9c ch\u1ebf Hepcidin, \u0111\u1ea9y nhanh qu\u00e1 tr\u00ecnh ph\u00e2n h\u1ee7y Ferritin v\u00e0 \u0111i\u1ec1u ch\u1ec9nh t\u0103ng Protein th\u1ee5 th\u1ec3 Transferrin.<\/li>\n<\/ul>\n

    Th\u00f4ng qua m\u1ed9t trong hai ho\u1eb7c c\u1ea3 hai c\u01a1 ch\u1ebf, vi\u1ec7c \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp Hepcidin v\u00e0 Ferritin s\u1ebd l\u00e0m t\u0103ng Fe2+ t\u1ebf b\u00e0o, do \u0111\u00f3 vi\u1ec7c \u0111\u00e1p \u1ee9ng h\u1ed3ng c\u1ea7u kh\u00f4ng suy gi\u1ea3m \u0111\u1ed1i v\u1edbi Erythropoietin m\u00e0 kh\u00f4ng c\u1ea7n b\u1ed5 sung s\u1eaft qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch.<\/p>\n

    To\u00e0n b\u1ed9 b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng \u1ee7ng h\u1ed9 \u201cgi\u1ea3 thuy\u1ebft b\u1ed5 sung s\u1eaft trong t\u1ebf b\u00e0o\u201d b\u1edfi v\u00ec c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf SGLT2 l\u00e0m t\u0103ng h\u1ed3ng c\u1ea7u v\u00e0 \u0111\u00e1p \u1ee9ng b\u1ec1n v\u1eefng v\u1edbi Erythropoietin, ngay c\u1ea3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n thi\u1ebfu s\u1eaft qu\u00e1 m\u1ee9c v\u00e0 kh\u00f4ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng s\u1eaft ti\u00eam t\u0129nh m\u1ea1ch. Do \u0111\u00f3, s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a ki\u1ec3u ph\u1ea3n \u1ee9ng thi\u1ebfu s\u1eaft trong qu\u00e1 tr\u00ecnh d\u00f9ng \u1ee9c ch\u1ebf SGLT2 kh\u00f4ng ph\u1ea3n \u00e1nh t\u00ecnh tr\u1ea1ng d\u1ef1 tr\u1eef s\u1eaft ng\u00e0y c\u00e0ng x\u1ea5u \u0111i c\u1ea7n \u0111\u01b0\u1ee3c b\u1ed5 sung, m\u00e0 thay v\u00e0o \u0111\u00f3, th\u1ec3 hi\u1ec7n kh\u1ea3 n\u0103ng t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft ch\u1ee9c n\u0103ng li\u00ean quan \u0111\u1ebfn vi\u00eam nhi\u1ec5m th\u01b0\u1eddng th\u1ea5y \u1edf b\u1ec7nh nh\u00e2n. \u0110\u1ed1i v\u1edbi suy tim m\u00e3n t\u00ednh, \u0111i\u1ec1u tr\u1ecb b\u1eb1ng s\u1eaft ti\u00eam t\u0129nh m\u1ea1ch c\u00f3 th\u1ec3 kh\u00f4ng c\u1ea7n thi\u1ebft v\u00e0 c\u00f3 h\u1ea1i v\u1ec1 m\u1eb7t l\u00fd thuy\u1ebft.<\/p>\n

     <\/p>\n

    2. Gi\u1edbi thi\u1ec7u<\/strong><\/h2>\n

    Thu\u1ed1c \u1ee9c ch\u1ebf \u0111\u1ed3ng v\u1eadn chuy\u1ec3n Natri-Glucose 2 (SGLT2) l\u00e0m gi\u1ea3m nguy c\u01a1 t\u1eed vong do tim m\u1ea1ch v\u00e0 nh\u1eadp vi\u1ec7n v\u00ec suy tim \u1edf b\u1ec7nh nh\u00e2n suy tim, cho d\u00f9 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m hay \u0111\u01b0\u1ee3c b\u1ea3o t\u1ed3n. M\u1eb7c d\u00f9 c\u00e1c thu\u1ed1c n\u00e0y c\u00f3 nghi\u00ean c\u1ee9u ch\u1ee9ng minh an to\u00e0n cho b\u1ec7nh nh\u00e2n, m\u1ed9t ph\u00e2n t\u00edch g\u1ea7n \u0111\u00e2y t\u1eeb nghi\u00ean c\u1ee9 DAPA-HF \u0111\u00e3 b\u00e1o c\u00e1o r\u1eb1ng vi\u1ec7c s\u1eed d\u1ee5ng Dapagliflozin \u1edf b\u1ec7nh nh\u00e2n suy tim v\u1edbi ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m \u0111\u00e3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng tr\u1ea7m tr\u1ecdng h\u01a1n \u0111\u00e1ng k\u1ec3 c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc c\u1ee7a t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft.<\/p>\n

    Sau 12 th\u00e1ng \u0111i\u1ec1u tr\u1ecb, b\u1ec7nh nh\u00e2n \u1edf nh\u00f3m Dapagliflozin c\u00f3 kh\u1ea3 n\u0103ng bi\u1ec3u hi\u1ec7n t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft m\u1edbi kh\u1edfi ph\u00e1t cao h\u01a1n 70% so v\u1edbi nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c, \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1edfi n\u1ed3ng \u0111\u1ed9 Ferritin huy\u1ebft thanh <100 ng\/mL ho\u1eb7c \u0111\u1ed9 b\u00e3o h\u00f2a Transferrin <20% k\u1ebft h\u1ee3p v\u1edbi n\u1ed3ng \u0111\u1ed9 Ferritin huy\u1ebft thanh <300 ng\/mL. C\u00f3 l\u1ebd quan tr\u1ecdng h\u01a1n, nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau ch\u00ed n\u00e0y khi b\u1eaft \u0111\u1ea7u th\u1eed nghi\u1ec7m cho th\u1ea5y c\u00e1c ch\u1ec9 s\u1ed1 c\u00e2n b\u1eb1ng n\u1ed9i m\u00f4i s\u1eaft c\u1ee7a h\u1ecd ng\u00e0y c\u00e0ng x\u1ea5u \u0111i sau khi \u1ee9c ch\u1ebf SGLT2.<\/p>\n

    Tr\u01b0\u1edbc nh\u1eefng ph\u00e1t hi\u1ec7n n\u00e0y, c\u00e1c t\u00e1c gi\u1ea3 cho r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c h\u01b0\u1edfng l\u1ee3i t\u1eeb vi\u1ec7c b\u1ed5 sung s\u1eaft b\u1ed5 sung qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u1edbi hy v\u1ecdng r\u1eb1ng s\u1ef1 k\u1ebft h\u1ee3p c\u1ee7a 2 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 mang l\u1ea1i hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed5ng h\u1ee3p. Kh\u1ea3 n\u0103ng n\u00e0y d\u1ef1a tr\u00ean k\u1ebft qu\u1ea3 c\u1ee7a c\u00e1c nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c cho th\u1ea5y b\u1ed5 sung s\u1eaft qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (khi kh\u00f4ng c\u00f3 ch\u1ea5t \u1ee9c ch\u1ebf SGLT2) c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 suy tim n\u1eb7ng h\u01a1n v\u00e0 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng ho\u1ea1t \u0111\u1ed9ng \u1edf b\u1ec7nh nh\u00e2n suy tim v\u1edbi ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m \u0111\u00e1p \u1ee9ng c\u00e1c ti\u00eau ch\u00ed hi\u1ec7n t\u1ea1i v\u1ec1 \u0111i\u1ec1u tr\u1ecb suy tim.<\/p>\n

    \u0110\u00e1ng ch\u00fa \u00fd l\u00e0 g\u1ea7n 50% b\u1ec7nh nh\u00e2n trong th\u1eed nghi\u1ec7m DAPA-HF \u0111\u01b0\u1ee3c coi l\u00e0 thi\u1ebfu s\u1eaft khi b\u1eaft \u0111\u1ea7u th\u1eed nghi\u1ec7m, v\u00e0 th\u00eam 15% trong nh\u00f3m thu\u1ea7n t\u1eadp ban \u0111\u1ea7u tr\u1edf n\u00ean thi\u1ebfu s\u1eaft m\u1edbi khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Dapagliflozin. V\u00ec v\u1eady, n\u1ebfu s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft th\u00f4ng th\u01b0\u1eddng, g\u1ea7n 2\/3 b\u1ec7nh nh\u00e2n suy tim v\u1edbi ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m s\u1ebd \u0111\u01b0\u1ee3c coi l\u00e0 b\u1ecb thi\u1ebfu s\u1eaft v\u00e0 \u0111\u01b0\u1ee3c cho li\u1ec7u ph\u00e1p b\u1ed5 sung s\u1eaft sau v\u00e0i th\u00e1ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf SGLT2, g\u1ee3i \u00fd r\u1eb1ng li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p c\u00f3 th\u1ec3 tr\u1edf th\u00e0nh m\u1ed9t gi\u1ea3i ph\u00e1p h\u1eefu hi\u1ec7u.<\/p>\n

    3. \u0110i\u1ec1u g\u00ec l\u00e0m thay \u0111\u1ed5i t\u00ecnh tr\u1ea1ng c\u1ee7a d\u1ea5u \u1ea5n sinh h\u1ecdc trong t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft trong qu\u00e1 tr\u00ecnh s\u1eed d\u1ee5ng \u1ee9c ch\u1ebf SGLT2?<\/strong><\/h2>\n

    S\u1eaft c\u1ea7n thi\u1ebft cho qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p heme v\u00e0 c\u00e1c c\u1ee5m s\u1eaft-l\u01b0u hu\u1ef3nh trong ty th\u1ec3 c\u1ee7a ti\u1ec1n ch\u1ea5t h\u1ed3ng c\u1ea7u (d\u1eabn \u0111\u1ebfn t\u1ed5ng h\u1ee3p huy\u1ebft s\u1eafc t\u1ed1) v\u00e0 trong t\u1ebf b\u00e0o c\u01a1 tim (d\u1eabn \u0111\u1ebfn s\u1ea3n xu\u1ea5t adenosine triphosphate [ATP]). S\u1eaft ch\u1ecbu tr\u00e1ch nhi\u1ec7m tr\u1ef1c ti\u1ebfp cho c\u00e1c hi\u1ec7u \u1ee9ng n\u00e0y l\u00e0 nh\u00f3m t\u1ebf b\u00e0o ch\u1ee9a ion s\u1eaft c\u00f3 kh\u1ea3 n\u0103ng ph\u1ea3n \u1ee9ng cao (Fe2+) li\u00ean k\u1ebft y\u1ebfu, chi\u1ebfm 5% – 10% l\u01b0\u1ee3ng s\u1eaft d\u1ef1 tr\u1eef trong t\u1ebf b\u00e0o.<\/p>\n

    \u0110i\u1ec1u g\u00ec quy\u1ebft \u0111\u1ecbnh k\u00edch th\u01b0\u1edbc c\u1ee7a nh\u00f3m s\u1eaft Fe2+ tham gia ph\u1ea3n \u1ee9ng sinh h\u1ecdc?<\/em> \u00a0S\u1eaft \u0111i v\u00e0o m\u00e1u d\u01b0\u1edbi d\u1ea1ng\u00a0 s\u1eaft (Fe3+), m\u1ed9t qu\u00e1 tr\u00ecnh \u0111\u01b0\u1ee3c \u0111i\u1ec1u h\u00f2a b\u1edfi Hepcidin (ng\u0103n ch\u1eb7n s\u1ef1 h\u1ea5p thu s\u1eaft t\u1eeb \u0111\u01b0\u1eddng ti\u00eau h\u00f3a v\u00e0 gi\u1ea3i ph\u00f3ng s\u1eaft t\u1eeb c\u00e1c \u0111\u1ea1i th\u1ef1c b\u00e0o tham gia v\u00e0o qu\u00e1 tr\u00ecnh t\u00e1i t\u1ea1o h\u1ed3ng c\u1ea7u gi\u00e0). S\u1eaft Fe3+ l\u01b0u th\u00f4ng \u0111\u01b0\u1ee3c v\u1eadn chuy\u1ec3n v\u00e0o t\u1ebf b\u00e0o khi Protein v\u1eadn chuy\u1ec3n c\u1ee7a n\u00f3 (transferrin) g\u1eafn v\u1edbi Protein th\u1ee5 th\u1ec3 1 v\u1eadn chuy\u1ec3n , v\u00e0 ph\u1ee9c h\u1ee3p n\u00e0y \u0111\u01b0\u1ee3c n\u1ed9i h\u00f3a. Qu\u00e1 tr\u00ecnh kh\u1eed Fe3+ gi\u1ea3i ph\u00f3ng Fe2+ v\u00e0o nh\u00f3m t\u1ebf b\u00e0o ch\u1ea5t ph\u1ea3n \u1ee9ng sinh h\u1ecdc, nh\u01b0ng k\u00edch th\u01b0\u1edbc c\u1ee7a nh\u00f3m n\u00e0y \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh ch\u1eb7t ch\u1ebd, v\u00e0 h\u1ea7u h\u1ebft s\u1eaft n\u1ed9i b\u00e0o \u0111\u01b0\u1ee3c c\u00f4 l\u1eadp d\u01b0\u1edbi d\u1ea1ng Fe3+ kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng trong l\u1ed3ng nano Ferritin, gi\u00fap gi\u1ea3i ph\u00f3ng s\u1eaft v\u00e0o t\u1ebf b\u00e0o ch\u1ea5t khi c\u1ea7n thi\u1ebft. Khi d\u1ef1 tr\u1eef s\u1eaft trong c\u01a1 th\u1ec3 b\u1ecb c\u1ea1n ki\u1ec7t (nh\u01b0 trong t\u00ecnh tr\u1ea1ng thi\u1ebfu dinh d\u01b0\u1ee1ng ho\u1eb7c xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a), vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh gi\u1ea3m Hepcidin v\u00e0 \u0111i\u1ec1u ch\u1ec9nh t\u0103ng Protein th\u1ee5 th\u1ec3 transferrin 1 ph\u1ed1i h\u1ee3p v\u1edbi nhau \u0111\u1ec3 t\u1ea1o \u0111i\u1ec1u ki\u1ec7n thu\u1eadn l\u1ee3i cho vi\u1ec7c h\u1ea5p thu v\u00e0 \u0111\u01b0a s\u1eaft v\u00e0o c\u00e1c t\u1ebf b\u00e0o s\u1ea3n xu\u1ea5t Heme, v\u00e0, \u0111\u1ed3ng th\u1eddi\u00a0 Ferritin b\u1ecb ph\u00e2n h\u1ee7y, c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3i ph\u00f3ng s\u1eaft c\u00f4 l\u1eadp t\u1eeb c\u00e1c v\u1ecb tr\u00ed d\u1ef1 tr\u1eef n\u1ed9i b\u00e0o. N\u1ed3ng \u0111\u1ed9 Hepcidin v\u00e0 Ferritin th\u1ea5p v\u00e0 n\u1ed3ng \u0111\u1ed9 cao c\u1ee7a Protein th\u1ee5 th\u1ec3 Transferrin 1 (th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111o b\u1eb1ng th\u1ee5 th\u1ec3 Transferrin h\u00f2a tan) trong m\u00e1u l\u01b0u th\u00f4ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c coi l\u00e0 l\u00e0 d\u1ea5u hi\u1ec7u c\u1ee7a t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft. \u00a0Tuy nhi\u00ean, ki\u1ec3u thay \u0111\u1ed5i \u0111\u1eb7c bi\u1ec7t n\u00e0y trong c\u00e1c Protein c\u00e2n b\u1eb1ng n\u1ed9i m\u00f4i s\u1eaft kh\u00f4ng ph\u1ea3i l\u00e0 th\u01b0\u1edbc \u0111o k\u00edch th\u01b0\u1edbc c\u1ee7a nh\u00f3m Fe2+ trong t\u1ebf b\u00e0o ch\u1ea5t; thay v\u00e0o \u0111\u00f3, nh\u1eefng thay \u0111\u1ed5i n\u00e0y ph\u1ea3n \u00e1nh c\u00e1c ph\u1ea3n \u1ee9ng b\u00f9 tr\u1eeb\u00a0 khi Fe2+ trong t\u1ebf b\u00e0o c\u1ea1n ki\u1ec7t v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c b\u1ed5 sung.<\/p>\n

    \"\"<\/p>\n

    Ngu\u1ed3n<\/strong>: Milton Packer, Potential Interactions When Prescribing SGLT2 Inhibitors and Intravenous Iron in Combination in Heart Failure<\/em>, JACC Heart Failure, 2023.<\/p>\n

    4. Gi\u1ea3i th\u00edch t\u00ecnh tr\u1ea1ng x\u1ea5u \u0111i c\u1ee7a c\u00e1c d\u1ea5u \u1ea5n sin<\/strong>h h\u1ecdc s\u1eaft trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf SGLT2.<\/strong><\/h2>\n

    M\u1eb7c d\u00f9 s\u1ef1 thay \u0111\u1ed5i v\u1ec1 ch\u1ec9 d\u1ea5u sinh h\u1ecdc s\u1eaft n\u00e0y th\u01b0\u1eddng cho th\u1ea5y s\u1ef1 c\u1ea1n ki\u1ec7t ngu\u1ed3n d\u1ef1 tr\u1eef s\u1eaft c\u1ee7a c\u01a1 th\u1ec3 do thi\u1ebfu h\u1ee5t dinh d\u01b0\u1ee1ng ho\u1eb7c xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, tr\u1ea1ng th\u00e1i sinh l\u00fd b\u1ec7nh kh\u00e1c c\u0169ng d\u1eabn \u0111\u1ebfn m\u1ed9t t\u00ecnh tr\u1ea1ng \u0111\u1eb7c bi\u1ec7t l\u00e0 gi\u1ea3m Hepcidin v\u00e0 Ferritin c\u00f9ng v\u1edbi s\u1ef1 gia t\u0103ng th\u1ee5 th\u1ec3 Transferrin h\u00f2a tan.<\/p>\n

    4.1. T\u0103ng sinh h\u1ed3ng c\u1ea7u<\/strong><\/h3>\n

    K\u00edch th\u00edch t\u1ea1o h\u1ed3ng c\u1ea7u (b\u1ea5t k\u1ec3 nguy\u00ean nh\u00e2n n\u00e0o) ti\u00eau th\u1ee5 Fe2+ t\u1ebf b\u00e0o trong qu\u00e1 tr\u00ecnh h\u00ecnh th\u00e0nh heme, v\u00e0 k\u1ebft qu\u1ea3 l\u00e0 gi\u1ea3m Fe2+, t\u1ebf b\u00e0o k\u00edch ho\u1ea1t l\u00e0m gi\u1ea3m Hepcidin v\u00e0 Ferritin v\u00e0 t\u0103ng th\u1ee5 th\u1ec3 Transferrin h\u00f2a tan, nh\u01b0 m\u1ed9t ph\u1ea3n \u1ee9ng th\u00edch nghi \u0111\u1ec3 b\u1ed5 sung kh\u1ea3 n\u0103ng ch\u1ee9a s\u1eaft. Ho\u1ea1t \u0111\u1ed9ng ph\u1ed1i h\u1ee3p c\u1ee7a c\u00e1c protein n\u00e0y c\u00f3 t\u00e1c d\u1ee5ng duy tr\u00ec \u0111\u1ee7 l\u01b0\u1ee3ng Fe2+ trong t\u1ebf b\u00e0o \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o r\u1eb1ng qu\u00e1 tr\u00ecnh t\u1ea1o h\u1ed3ng c\u1ea7u hi\u1ec7u qu\u1ea3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c duy tr\u00ec. C\u00e1c ch\u1ea5t b\u1eaft ch\u01b0\u1edbc Erythropoietin (v\u00ed d\u1ee5, darbepoietin) g\u1ee3i ra m\u1ed9t ki\u1ec3u ph\u1ea3n \u1ee9ng thi\u1ebfu s\u1eaft, \u00a0c\u00f3 kh\u1ea3 n\u0103ng ph\u1ea3n \u00e1nh s\u1ef1 gi\u1ea3m \u0111\u00e1ng k\u1ec3 v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng c\u1ee7a Fe2+ trong t\u1ebf b\u00e0o v\u00ec:<\/p>\n

      \n
    • B\u1ec7nh nh\u00e2n v\u1edbi ki\u1ec3u n\u00e0y cho th\u1ea5y ph\u1ea3n \u1ee9ng k\u00e9m v\u1edbi Erythropoietin.<\/li>\n
    • B\u1ed5 sung Fe2+ trong t\u1ebf b\u00e0o b\u1eb1ng vi\u1ec7c b\u1ed5 sung s\u1eaft qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch gi\u00fap kh\u1eafc ph\u1ee5c t\u00ecnh tr\u1ea1ng kh\u00e1ng Erythropoietin.<\/li>\n<\/ul>\n

      4.2. Vi\u00eam h\u1ec7 th\u1ed1ng<\/strong><\/h3>\n

      \u1ede nh\u1eefng b\u1ec7nh \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng vi\u00eam m\u00e3n t\u00ednh, ho\u1ea1t h\u00f3a cytokine k\u00edch th\u00edch tr\u1ef1c ti\u1ebfp qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p Hepcidin v\u00e0 Ferritin. T\u00e1c \u0111\u1ed9ng c\u1ee7a vi\u00eam \u0111\u1ed1i v\u1edbi Hepcidin v\u00e0 Ferritin l\u00e0m ch\u1eadm l\u01b0\u1ee3ng s\u1eaft c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c h\u1ea5p th\u1ee5 t\u1eeb t\u00e1 tr\u00e0ng ho\u1eb7c gi\u1ea3i ph\u00f3ng t\u1eeb \u0111\u1ea1i th\u1ef1c b\u00e0o c\u0169ng nh\u01b0 l\u01b0\u1ee3ng s\u1eaft n\u1ed9i b\u00e0o c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i ph\u00f3ng kh\u1ecfi qu\u00e1 tr\u00ecnh c\u00f4 l\u1eadp Ferritin. K\u1ebft qu\u1ea3 l\u00e0 t\u00ecnh tr\u1ea1ng thi\u1ebfu Fe2+ t\u1ebf b\u00e0o, m\u1eb7c d\u00f9 l\u01b0\u1ee3ng d\u1ef1 tr\u1eef Fe3+ to\u00e0n th\u00e2n v\u00e0 n\u1ed9i b\u00e0o kh\u00f4ng b\u1ecb c\u1ea1n ki\u1ec7t, t\u1ee9c l\u00e0 t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft t\u1ebf b\u00e0o mang t\u00ednh ch\u1ee9c n\u0103ng, ch\u1ee9 kh\u00f4ng ph\u1ea3i tuy\u1ec7t \u0111\u1ed1i.<\/p>\n

      T\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft ch\u1ee9c n\u0103ng c\u00f3 th\u1ec3 \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi vi\u1ec7c cung c\u1ea5p s\u1eaft qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch (ch\u1ee9 kh\u00f4ng ph\u1ea3i \u0111\u01b0\u1eddng u\u1ed1ng). Tuy nhi\u00ean, n\u1ebfu t\u00ecnh tr\u1ea1ng vi\u00eam m\u00e3n t\u00ednh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n, k\u00edch th\u00edch sinh h\u1ecdc \u0111\u1ed1i v\u1edbi qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p Hepcidin v\u00e0 Ferritin gi\u1ea3m xu\u1ed1ng, d\u1eabn \u0111\u1ebfn s\u1ef1 gia t\u0103ng ph\u1ea3n \u1ee9ng sinh h\u1ecdc trong t\u1ebf b\u00e0o. Fe2+, m\u1eb7c d\u00f9 n\u1ed3ng \u0111\u1ed9 Hepcidin v\u00e0 Ferritin trong tu\u1ea7n ho\u00e0n \u0111ang gi\u1ea3m. Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y, s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a ki\u1ec3u ph\u1ea3n \u1ee9ng thi\u1ebfu s\u1eaft kh\u00f4ng ph\u1ea3n \u00e1nh s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft, m\u00e0 thay v\u00e0o \u0111\u00f3, ph\u1ea3n \u00e1nh s\u1ef1 thuy\u00ean gi\u1ea3m c\u1ee7a t\u00ecnh tr\u1ea1ng vi\u00eam nhi\u1ec5m li\u00ean quan \u0111\u1ebfn kh\u1ed1i ch\u1ee9c n\u0103ng v\u1ec1 s\u1eed d\u1ee5ng s\u1eaft. S\u1ef1 \u0111\u1ea3o ng\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft ch\u1ee9c n\u0103ng qua trung gian vi\u00eam t\u1ea1o ra nh\u1eefng thay \u0111\u1ed5i trong c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc s\u1eaft l\u01b0u h\u00e0nh g\u1ea7n gi\u1ed1ng v\u1edbi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft tuy\u1ec7t \u0111\u1ed1i. Tuy nhi\u00ean, do n\u1ed3ng \u0111\u1ed9 Fe2+ trong t\u1ebf b\u00e0o \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 v\u00e0 t\u0103ng c\u01b0\u1eddng, n\u00ean vi\u1ec7c \u00a0thi\u1ebfu s\u1eaft ch\u1ee9c n\u0103ng kh\u00f4ng \u0111i k\u00e8m v\u1edbi kh\u00e1ng Erythropoietin v\u00e0 kh\u00f4ng c\u1ea7n b\u1ed5 sung s\u1eaft \u0111\u1ec3 duy tr\u00ec h\u1ed3ng c\u1ea7u.<\/p>\n

      C\u01a1 ch\u1ebf n\u00e0o trong 2 c\u01a1 ch\u1ebf n\u00e0y c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch nh\u1eefng thay \u0111\u1ed5i t\u00ecm th\u1ea5y \u0111\u01b0\u1ee3c trong d\u1ea5u \u1ea5n sinh h\u1ecdc thi\u1ebfu s\u1eaft trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 \u1edf b\u1ec7nh nh\u00e2n suy tim? Trong c\u00e1c th\u1eed nghi\u1ec7m \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c, ch\u1ea5t \u1ee9c ch\u1ebf SGLT2 \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 l\u00e0m t\u0103ng th\u1ee5 th\u1ec3 Erythropoietin v\u00e0 Transferrin h\u00f2a tan trong khi l\u00e0m gi\u1ea3m Hepcidin v\u00e0 Ferritin. Nh\u1eefng thay \u0111\u1ed5i nh\u01b0 v\u1eady t\u01b0\u01a1ng \u1ee9ng v\u1edbi m\u1ed9t trong 2 kh\u00e1i ni\u1ec7m \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3. Tuy nhi\u00ean, kh\u00e1i ni\u1ec7m th\u1ee9 nh\u1ea5t \u0111\u01b0\u1ee3c kh\u1eb3ng \u0111\u1ecbnh d\u1ef1a tr\u00ean gi\u1ea3 \u0111\u1ecbnh r\u1eb1ng n\u1ed3ng \u0111\u1ed9 Fe2+ trong t\u1ebf b\u00e0o b\u1ecb c\u1ea1n ki\u1ec7t do qu\u00e1 tr\u00ecnh t\u1ea1o h\u1ed3ng c\u1ea7u t\u0103ng c\u01b0\u1eddng, trong khi kh\u00e1i ni\u1ec7m th\u1ee9 hai gi\u1ea3 \u0111\u1ecbnh r\u1eb1ng n\u1ed3ng \u0111\u1ed9 Fe2+ trong t\u1ebf b\u00e0o \u0111ang \u0111\u01b0\u1ee3c b\u1ed5 sung do gi\u1ea3m vi\u00eam ho\u1eb7c b\u1edfi c\u00e1c t\u00e1c \u0111\u1ed9ng kh\u00e1c gi\u1ea3m Stress t\u1ebf b\u00e0o. Kh\u00e1i ni\u1ec7m \u0111\u1ea7u ti\u00ean d\u1eabn \u0111\u1ebfn k\u1ebft lu\u1eadn r\u1eb1ng vi\u1ec7c b\u1ed5 sung s\u1eaft l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 mang l\u1ea1i k\u1ebft qu\u1ea3 t\u1ed1i \u01b0u cho b\u1ec7nh nh\u00e2n, trong khi kh\u00e1i ni\u1ec7m th\u1ee9 hai g\u1ee3i \u00fd r\u1eb1ng vi\u1ec7c b\u1ed5 sung s\u1eaft l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft. Kh\u00e1i ni\u1ec7m n\u00e0o gi\u1ea3i th\u00edch t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf SGLT2?<\/p>\n

      4.3. C\u00e1c c\u01a1 ch\u1ebf t\u1ebf b\u00e0o \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn c\u00e2n b\u1eb1ng n\u1ed9i m\u00f4i s\u1eaft trong qu\u00e1 tr\u00ecnh \u1ee9c ch\u1ebf SGLT2.<\/strong><\/h3>\n

      Theo \u201cgi\u1ea3 thuy\u1ebft suy gi\u1ea3m s\u1eaft t\u1ebf b\u00e0o\u201d, ch\u1ea5t \u1ee9c ch\u1ebf SGLT2 tr\u1ef1c ti\u1ebfp k\u00edch th\u00edch s\u1ea3n xu\u1ea5t Erythropoietin, c\u00f3 l\u1ebd th\u00f4ng qua kh\u1ea3 n\u0103ng \u0111i\u1ec1u ch\u1ec9nh t\u0103ng t\u00edn hi\u1ec7u sirtuin-1 (SIRT1) \u0111\u00e3 \u0111\u01b0\u1ee3c thi\u1ebft l\u1eadp c\u1ee7a ch\u00fang. SIRT1 t\u0103ng c\u01b0\u1eddng s\u1ea3n xu\u1ea5t Erythropoietin th\u00f4ng qua t\u00e1c d\u1ee5ng c\u1ee7a n\u00f3 \u0111\u1ec3 k\u00edch ho\u1ea1t y\u1ebfu t\u1ed1 c\u1ea3m \u1ee9ng thi\u1ebfu oxy-2\u03b1. Ho\u1ea1t \u0111\u1ed9ng c\u1ee7a Erythropoietin \u0111\u1ec3 k\u00edch th\u00edch qu\u00e1 tr\u00ecnh t\u1ea1o h\u1ed3ng c\u1ea7u l\u00e0m c\u1ea1n ki\u1ec7t nh\u00f3m Fe2+ trong t\u1ebf b\u00e0o, do \u0111\u00f3 k\u00edch ho\u1ea1t s\u1ef1 \u1ee9c ch\u1ebf Hepcidin v\u00e0 Ferritin v\u00e0 \u0111i\u1ec1u ch\u1ec9nh t\u0103ng Protein th\u1ee5 th\u1ec3 transferrin nh\u01b0 m\u1ed9t ph\u1ea3n \u1ee9ng b\u00f9 tr\u1eeb. Tuy nhi\u00ean, nh\u1eefng thay \u0111\u1ed5i mang t\u00ednh ph\u1ea3n \u1ee9ng n\u00e0y kh\u00f4ng th\u1ec3 ph\u1ee5c h\u1ed3i Fe2+ trong t\u1ebf b\u00e0o n\u1ebfu ngu\u1ed3n th\u1ef1c ph\u1ea9m v\u00e0\/ho\u1eb7c d\u1ef1 tr\u1eef s\u1eaft \u1edf \u0111\u1ea1i th\u1ef1c b\u00e0o v\u00e0 gan l\u00e0 qu\u00e1 \u00edt. S\u1ef1 c\u1ea1n ki\u1ec7t Fe2+ trong t\u1ebf b\u00e0o l\u00e0m suy y\u1ebfu \u0111\u00e1p \u1ee9ng c\u1ee7a h\u1ed3ng c\u1ea7u v\u1edbi Erythropoietin, d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng kh\u00e1ng Erythropoietin ph\u1ee5 thu\u1ed9c s\u1eaft, gi\u1ed1ng nh\u01b0 t\u00ecnh tr\u1ea1ng \u0111\u00e3 th\u1ea5y khi s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t k\u00edch th\u00edch t\u1ea1o Erythropoietin.<\/p>\n

      Theo \u201cgi\u1ea3 thuy\u1ebft b\u1ed5 sung s\u1eaft trong t\u1ebf b\u00e0o\u201d , vi\u1ec7c \u0111i\u1ec1u ch\u1ec9nh t\u0103ng t\u00edn hi\u1ec7u SIRT1 kh\u00f4ng ch\u1ec9 th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p Erythropoietin m\u00e0 c\u00f2n tr\u1ef1c ti\u1ebfp l\u00e0m gi\u1ea3m Hepcidin v\u00e0 Ferritin v\u00e0 t\u0103ng protein th\u1ee5 th\u1ec3 transferrin, kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o qu\u00e1 tr\u00ecnh t\u1ea1o h\u1ed3ng c\u1ea7u. C\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf SGLT2 ph\u00e1t huy t\u00e1c d\u1ee5ng ch\u1ed1ng vi\u00eam quan tr\u1ecdng (c\u00f3 th\u1ec3 qua trung gian SIRT1) do \u0111\u00f3 \u0111\u1ea3o ng\u01b0\u1ee3c t\u00e1c d\u1ee5ng k\u00edch th\u00edch \u0111\u1ed1i v\u1edbi c\u1ea3 Hepcidin v\u00e0 Ferritin. SIRT1 \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh t\u1ed5ng h\u1ee3p Hepcidin \u1edf c\u1ea3 t\u1ebf b\u00e0o gan v\u00e0 \u0111\u1ea1i th\u1ef1c b\u00e0o; SIRT1 k\u00edch ho\u1ea1t h\u1ec7 s\u1ed1 \u0111i\u1ec1u h\u00f2a Gamma-1 Alpha \u0111\u01b0\u1ee3c k\u00edch ho\u1ea1t b\u1edfi ch\u1ea5t t\u0103ng sinh Peroxisome, ho\u1ea1t \u0111\u1ed9ng \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh t\u0103ng protein th\u1ee5 th\u1ec3 transferrin; v\u00e0 k\u00edch th\u00edch y\u1ebfu t\u1ed1 g\u00e2y thi\u1ebfu Oxy-2 alpha b\u1edfi SIRT1 l\u00e0m t\u0103ng bi\u1ec3u hi\u1ec7n c\u1ee7a ch\u1ea5t \u0111\u1ed3ng ho\u1ea1t h\u00f3a th\u1ee5 th\u1ec3 h\u1ea1t nh\u00e2n, th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh \u0103n Ferritino, do \u0111\u00f3 l\u00e0m tho\u00e1i h\u00f3a Ferritin. Do \u0111\u00f3, th\u00f4ng qua t\u00e1c d\u1ee5ng ch\u1ed1ng vi\u00eam v\u00e0 c\u00e1c ho\u1ea1t \u0111\u1ed9ng t\u1ebf b\u00e0o kh\u00e1c \u1ee9c ch\u1ebf Hepcidin v\u00e0 Ferritin (kh\u00f4ng ph\u1ee5 thu\u1ed9c v\u00e0o qu\u00e1 tr\u00ecnh t\u1ea1o h\u1ed3ng c\u1ea7u), c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf SGLT2 c\u00f3 th\u1ec3 tr\u1ef1c ti\u1ebfp v\u01b0\u1ee3t qua c\u00e1c kh\u1ed1i ch\u1ee9c n\u0103ng b\u00ean trong do s\u1eed d\u1ee5ng s\u1eaft g\u00e2y ra do vi\u00eam h\u1ec7 th\u1ed1ng. B\u1edfi v\u00ec d\u1ef1 tr\u1eef s\u1eaft trong t\u1ebf b\u00e0o kh\u00f4ng b\u1ecb c\u1ea1n ki\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb thi\u1ebfu s\u1eaft ch\u1ee9c n\u0103ng, n\u00ean vi\u1ec7c \u0111\u1ea3o ng\u01b0\u1ee3c c\u00e1c kh\u1ed1i ch\u1ee9c n\u0103ng khi s\u1eed d\u1ee5ng s\u1eaft v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng ch\u1ea5t \u1ee9c ch\u1ebf SGLT2 c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m t\u0103ng Fe2+ t\u1ebf b\u00e0o, do \u0111\u00f3 cho ph\u00e9p \u0111\u00e1p \u1ee9ng h\u1ed3ng c\u1ea7u kh\u00f4ng b\u1ecb suy gi\u1ea3m, trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng b\u1ed5 sung s\u1eaft.<\/p>\n

      4.4. B\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng \u1ee7ng h\u1ed9 gi\u1ea3 thuy\u1ebft b\u1ed5 sung s\u1eaft t\u1ebf b\u00e0o<\/strong><\/h3>\n

      \u0110\u1ec3 x\u00e1c \u0111\u1ecbnh kh\u00e1i ni\u1ec7m n\u00e0o c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng \u0111\u01b0\u1ee3c trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf SGLT2, s\u1ebd l\u00e0 l\u00fd t\u01b0\u1edfng n\u1ebfu c\u00e1c nh\u00e0 l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 \u0111o l\u01b0\u1ee3ng Fe2+ trong t\u1ebf b\u00e0o, nh\u01b0ng \u0111i\u1ec1u \u0111\u00f3 l\u00e0 kh\u00f4ng th\u1ec3 trong m\u00f4i tr\u01b0\u1eddng l\u00e2m s\u00e0ng. Tuy nhi\u00ean, 2 b\u1eb1ng ch\u1ee9ng t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng \u1ee7ng h\u1ed9 gi\u00e1 tr\u1ecb c\u1ee7a \u201cgi\u1ea3 thuy\u1ebft b\u1ed5 sung s\u1eaft trong t\u1ebf b\u00e0o\u201d.<\/p>\n

      \u0110\u1ea7u ti\u00ean, t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft g\u1eb7p \u1edf 50% b\u1ec7nh nh\u00e2n suy tim v\u1edbi ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m kh\u00f4ng ph\u1ea3i do t\u00ecnh tr\u1ea1ng thi\u1ebfu h\u1ee5t tuy\u1ec7t \u0111\u1ed1i li\u00ean quan \u0111\u1ebfn ch\u1ebf \u0111\u1ed9 \u0103n u\u1ed1ng k\u00e9m ho\u1eb7c xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a. Thay v\u00e0o \u0111\u00f3, t\u1ef7 l\u1ec7 thi\u1ebfu s\u1eaft cao l\u00e0 do s\u1ef1 c\u1ea3n tr\u1edf ch\u1ee9c n\u0103ng gi\u1ea3i ph\u00f3ng s\u1eaft t\u1eeb c\u00e1c kho d\u1ef1 tr\u1eef hi\u1ec7n c\u00f3. B\u1ec7nh nh\u00e2n suy tim c\u00f3 t\u00ecnh tr\u1ea1ng vi\u00eam k\u00edch th\u00edch s\u1ea3n xu\u1ea5t c\u1ea3 Hepcidin v\u00e0 Ferritin, gi\u1ea3i th\u00edch t\u1ea1i sao n\u1ed3ng \u0111\u1ed9 Hepcidin trong huy\u1ebft thanh l\u1ea1i cao t\u0103ng trong suy tim song song v\u1edbi vi\u1ec7c k\u00edch ho\u1ea1t c\u00e1c con \u0111\u01b0\u1eddng ti\u1ec1n vi\u00eam. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1eady, b\u1ec7nh nh\u00e2n suy tim c\u00f3 n\u1ed3ng \u0111\u1ed9 Ferritin t\u0103ng l\u00ean v\u00e0 m\u1ee9c \u0111\u1ed9 gia t\u0103ng n\u00e0y r\u00f5 r\u1ec7t \u0111\u1ebfn m\u1ee9c s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a suy tim l\u00e0m thay \u0111\u1ed5i ng\u01b0\u1ee1ng c\u1ee7a Ferritin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft. S\u1ef1 suy gi\u1ea3m s\u1eaft \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng b\u1ecb suy tim th\u01b0\u1eddng \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi Ferritin huy\u1ebft thanh gi\u1ea3m xu\u1ed1ng <30 ng\/mL. Tuy nhi\u00ean, ng\u01b0\u1ee1ng n\u00e0y t\u0103ng g\u1ea5p 10 l\u1ea7n \u1edf b\u1ec7nh nh\u00e2n suy tim, nh\u1eefng ng\u01b0\u1eddi c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n l\u00e0 thi\u1ebfu s\u1eaft v\u1edbi n\u1ed3ng \u0111\u1ed9 ferritin cao t\u1edbi 299 ng\/mL (ho\u1eb7c th\u1eadm ch\u00ed cao h\u01a1n). M\u1eb7c d\u00f9 m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 b\u00e1o c\u00e1o t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft tuy\u1ec7t \u0111\u1ed1i \u1edf b\u1ec7nh nh\u00e2n suy tim, nh\u1eefng nghi\u00ean c\u1ee9u n\u00e0y \u0111\u00e3 \u0111\u00e1nh gi\u00e1 c\u00e1c \u0111o\u00e0n h\u1ec7 nh\u1ecf \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn k\u1ef9 c\u00e0ng \u0111\u00e3 \u0111\u01b0\u1ee3c ki\u1ec3m tra t\u1ee7y x\u01b0\u01a1ng, \u0111i\u1ec1u n\u00e0y r\u1ea5t kh\u00f3 gi\u1ea3i th\u00edch. M\u1eb7c d\u00f9 c\u00f3 th\u1ec3 m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n b\u1ecb suy tim ti\u1ebfn tri\u1ec3n \u0111\u00e3 c\u1ea1n ki\u1ec7t ngu\u1ed3n d\u1ef1 tr\u1eef s\u1eaft, nh\u01b0ng h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n b\u1ecb suy tim c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng t\u1eeb nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh (nh\u01b0 tr\u01b0\u1eddng h\u1ee3p trong nghi\u00ean c\u1ee9u DAPA-HF) v\u00e0 c\u00f3 t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft ch\u1ee9c n\u0103ng.<\/p>\n

      Th\u1ee9 hai, n\u1ebfu nh\u1eefng thay \u0111\u1ed5i v\u1ec1 d\u1ea5u \u1ea5n sinh h\u1ecdc s\u1eaft trong qu\u00e1 tr\u00ecnh s\u1eed d\u1ee5ng \u1ee9c ch\u1ebf SGLT2 th\u1ec3 hi\u1ec7n t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft ng\u00e0y c\u00e0ng tr\u1ea7m tr\u1ecdng h\u01a1n, th\u00ec nh\u1eefng b\u1ec7nh nh\u00e2n v\u1ed1n \u0111\u00e3 thi\u1ebfu s\u1eaft tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb s\u1ebd c\u00f3 ph\u1ea3n \u1ee9ng suy gi\u1ea3m \u0111\u1ed1i v\u1edbi c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y, li\u00ean quan \u0111\u1ebfn t\u00e1c d\u1ee5ng c\u1ee7a ch\u00fang \u0111\u1ed1i v\u1edbi c\u1ea3 x\u01b0\u01a1ng, tu\u1ef7 v\u00e0 tim. C\u1ee5 th\u1ec3, nh\u1eefng b\u1ec7nh nh\u00e2n thi\u1ebfu s\u1eaft s\u1ebd cho th\u1ea5y t\u1ea1o h\u1ed3ng c\u1ea7u k\u00e9m v\u00ec s\u1ef1 c\u1ea1n ki\u1ec7t Fe2+ trong t\u1ebf b\u00e0o d\u1eabn \u0111\u1ebfn kh\u00e1ng Erythropoietin. H\u01a1n n\u1eefa, ATP b\u1ecb c\u1ea1n ki\u1ec7t \u1edf b\u1ec7nh nh\u00e2n suy tim, \u0111\u1eb7c bi\u1ec7t khi b\u1ec7nh nh\u00e2n thi\u1ebfu s\u1eaft, ph\u1ee5c h\u1ed3i ATP l\u00e0 c\u01a1 s\u1edf cho vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t b\u1ed5 sung s\u1eaft \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 c\u00e1c bi\u1ebfn c\u1ed1 suy tim nghi\u00eam tr\u1ecdng. Do \u0111\u00f3, n\u1ebfu c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf SGLT2 l\u00e0m gi\u1ea3m Fe2+ t\u1ebf b\u00e0o, ch\u00fang s\u1ebd l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam s\u1ef1 suy gi\u1ea3m ATP li\u00ean quan \u0111\u1ebfn thi\u1ebfu s\u1eaft trong c\u01a1 tim, d\u1eabn \u0111\u1ebfn t\u0103ng nguy c\u01a1 bi\u1ebfn c\u1ed1 suy tim v\u00e0 h\u1ea1n ch\u1ebf kh\u1ea3 n\u0103ng gi\u1ea3m nh\u1eadp vi\u1ec7n do suy tim c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf SGLT2. Tuy nhi\u00ean, trong nghi\u00ean c\u1ee9u DAPA-HF, khi so s\u00e1nh v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 \u0111\u1ee7 s\u1eaft, nh\u1eefng b\u1ec7nh nh\u00e2n thi\u1ebfu s\u1eaft l\u00fac ban \u0111\u1ea7u cho th\u1ea5y l\u01b0\u1ee3ng huy\u1ebft s\u1eafc t\u1ed1 t\u0103ng t\u01b0\u01a1ng t\u1ef1 v\u00e0 gi\u1ea3m t\u01b0\u01a1ng t\u1ef1 nguy c\u01a1 bi\u1ebfn c\u1ed1 suy tim khi \u0111\u00e1p \u1ee9ng v\u1edbi Dapagliflozin, m\u1eb7c d\u00f9 c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc c\u1ee7a t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft tr\u1edf n\u00ean x\u1ea5u \u0111i \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 m\u1ee9c \u0111\u1ed9 t\u0103ng h\u1ed3ng c\u1ea7u \u0111\u01b0\u1ee3c t\u1ea1o ra b\u1edfi c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf SGLT2 kh\u00f4ng suy gi\u1ea3m theo th\u1eddi gian, ph\u00e1t hi\u1ec7n s\u1ebd kh\u00f3 gi\u1ea3i th\u00edch n\u1ebfu b\u1ec7nh nh\u00e2n th\u1ef1c s\u1ef1 tr\u1edf n\u00ean thi\u1ebfu s\u1eaft ng\u00e0y c\u00e0ng nhi\u1ec1u h\u01a1n.<\/p>\n

      C\u1ea7n l\u01b0u \u00fd r\u1eb1ng\u2014tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf SGLT2\u2014nhi\u1ec1u b\u1ec7nh nh\u00e2n trong nghi\u00ean c\u1ee9u DAPA-HF \u0111\u01b0\u1ee3c coi l\u00e0 thi\u1ebfu s\u1eaft c\u0169ng b\u1ecb thi\u1ebfu m\u00e1u, ng\u1ee5 \u00fd r\u1eb1ng m\u1ee9c Fe2+ t\u1ebf b\u00e0o trong ti\u1ec1n ch\u1ea5t h\u1ed3ng c\u1ea7u kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 duy tr\u00ec \u0111\u1ee7 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u. Tuy nhi\u00ean, sau khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf SGLT2, nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb thi\u1ebfu m\u00e1u do thi\u1ebfu s\u1eaft c\u00f3 kh\u1ea3 n\u0103ng \u0111i\u1ec1u ch\u1ec9nh t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u, m\u1eb7c d\u00f9 <1% \u0111\u01b0\u1ee3c b\u1ed5 sung s\u1eaft qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Chu\u1ed7i s\u1ef1 ki\u1ec7n n\u00e0y ch\u1ec9 c\u00f3 th\u1ec3 x\u1ea3y ra n\u1ebfu vi\u1ec7c \u1ee9c ch\u1ebf SGLT2 c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m b\u1edbt\u00a0 m\u00e0 kh\u00f4ng l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam t\u00ecnh tr\u1ea1ng n\u1ed3ng \u0111\u1ed9 Fe2+ trong t\u1ebf b\u00e0o th\u1ea5p c\u00f3 t\u00e1c d\u1ee5ng h\u1ea1n ch\u1ebf t\u1ea1o h\u1ed3ng c\u1ea7u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n thi\u1ebfu m\u00e1u n\u00e0y. S\u1ef1 gi\u1ea3m thi\u1ec3u nh\u01b0 v\u1eady ph\u00f9 h\u1ee3p v\u1edbi \u201cgi\u1ea3 thuy\u1ebft b\u1ed5 sung s\u1eaft t\u1ebf b\u00e0o\u201d, nh\u01b0ng n\u00f3 kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi \u0111\u1ecbnh ngh\u0129a c\u1ee7a \u201cgi\u1ea3 thuy\u1ebft suy gi\u1ea3m s\u1eaft t\u1ebf b\u00e0o\u201d.<\/p>\n

      \"\"<\/p>\n

      Ngu\u1ed3n<\/strong>: Milton Packer, Potential Interactions When Prescribing SGLT2 Inhibitors and Intravenous Iron in Combination in Heart Failure<\/em>, JACC Heart Failure, 2023.<\/p>\n

      C\u1ea7n l\u01b0u \u00fd r\u1eb1ng s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 v\u00e0 thu\u1ed1c b\u1ed5 sung s\u1eaft ti\u00eam t\u0129nh m\u1ea1ch cho b\u1ec7nh suy tim \u0111\u00e3 di\u1ec5n ra song song v\u00e0 c\u00e1c nghi\u00ean c\u1ee9u quy m\u00f4 l\u1edbn v\u1edbi m\u1ed9t lo\u1ea1i thu\u1ed1c th\u01b0\u1eddng kh\u00f4ng thu nh\u1eadn b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c kia. Do \u0111\u00f3, c\u00e1c b\u00e1c s\u0129 kh\u00f4ng bi\u1ebft li\u1ec7u thu\u1ed1c \u1ee9c ch\u1ebf s\u1eaft v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 ti\u00eam t\u0129nh m\u1ea1ch c\u00f3 t\u01b0\u01a1ng t\u00e1c v\u1edbi nhau hay kh\u00f4ng n\u1ebfu \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n c\u00f9ng nhau. Vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi c\u00e1c lo\u1ea1i thu\u1ed1c n\u00e0y trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng \u0111\u1eb7c bi\u1ec7t c\u00f3 kh\u1ea3 n\u0103ng x\u1ea3y ra v\u00ec thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 l\u00e0m gi\u1ea3m \u0111\u1ed9 b\u00e3o h\u00f2a ferritin v\u00e0 transferrin huy\u1ebft thanh, v\u00e0 do \u0111\u00f3, ch\u00fang l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng b\u1ec7nh nh\u00e2n b\u1ecb ch\u1ea9n \u0111o\u00e1n l\u00e0 thi\u1ebfu s\u1eaft, v\u00e0 do \u0111\u00f3, \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb b\u1eb1ng s\u1eaft ti\u00eam t\u0129nh m\u1ea1ch.<\/p>\n

      5. T\u1ed5ng k\u1ebft<\/strong><\/h2>\n

      B\u1eb1ng ch\u1ee9ng s\u1eb5n c\u00f3 cho th\u1ea5y r\u1eb1ng:<\/p>\n

        \n
      • H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n suy tim nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh \u0111\u1ec1u c\u00f3 t\u00ecnh tr\u1ea1ng vi\u00eam th\u00fac \u0111\u1ea9y s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft ch\u1ee9c n\u0103ng.<\/li>\n
      • Vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf SGLT2 d\u01b0\u1eddng nh\u01b0 l\u00e0m gi\u1ea3m b\u1edbt t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft ch\u1ee9c n\u0103ng song song v\u1edbi t\u00e1c d\u1ee5ng ch\u1ed1ng vi\u00eam c\u1ee7a ch\u00fang m\u00e0 kh\u00f4ng c\u1ea7n s\u1eed d\u1ee5ng s\u1eaft ti\u00eam t\u0129nh m\u1ea1ch.<\/li>\n
      • Thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc tu\u1ea7n ho\u00e0n th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng s\u1eaft \u1edf b\u1ec7nh nh\u00e2n suy tim, nh\u01b0ng nh\u1eefng thay \u0111\u1ed5i n\u00e0y c\u1ee7a c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc s\u1eaft kh\u00f4ng x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft n\u1ed9i b\u00e0o l\u00e0m h\u1ea1n ch\u1ebf t\u00e1c d\u1ee5ng c\u00f3 l\u1ee3i c\u1ee7a c\u00e1c thu\u1ed1c n\u00e0y trong c\u01a1 th\u1ec3.<\/li>\n<\/ul>\n

        Tr\u00ean th\u1ef1c t\u1ebf, vi\u1ec7c l\u00e0m gi\u1ea3m t\u00ecnh tr\u1ea1ng thi\u1ebfu s\u1eaft ch\u1ee9c n\u0103ng trong qu\u00e1 tr\u00ecnh s\u1eed d\u1ee5ng \u00a0\u1ee9c ch\u1ebf SGLT2 s\u1ebd l\u00e0m gi\u1ea3m b\u1edbt, thay v\u00ec t\u0103ng th\u00eam, nhu c\u1ea7u b\u1ed5 sung s\u1eaft qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y. Do \u0111\u00f3, tr\u01b0\u1edbc khi s\u1eaft ti\u00eam t\u0129nh m\u1ea1ch \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n r\u1ed9ng r\u00e3i cho b\u1ec7nh nh\u00e2n suy tim c\u00f3 bi\u1ec3u hi\u1ec7n thi\u1ebfu s\u1eaft trong khi d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf SGLT2, c\u1ea7n c\u00e1c nghi\u00ean c\u1ee9u t\u00ednh h\u1eefu \u00edch c\u1ee7a li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh xem \u201cgi\u1ea3 thuy\u1ebft b\u1ed5 sung s\u1eaft trong t\u1ebf b\u00e0o\u201d hay \u201cgi\u1ea3 thuy\u1ebft v\u1ec1 c\u1ea1n ki\u1ec7t s\u1eaft trong t\u1ebf b\u00e0o\u201d. Hi\u1ec7u qu\u1ea3 v\u00e0 \u0111\u1ed9 an to\u00e0n c\u1ee7a vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi thu\u1ed1c \u1ee9c ch\u1ebf SGLT2 v\u00e0 s\u1eaft ti\u00eam t\u0129nh m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n suy tim n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra tr\u01b0\u1edbc khi khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p.<\/p>\n

        Ngu\u1ed3n<\/strong>: Milton Packer, Potential Interactions When Prescribing SGLT2 Inhibitors and Intravenous Iron in Combination in Heart Failure<\/em>, JACC Heart Failure, 2023 Jan,\u00a011 (1) 106\u2013114.<\/p>\n","protected":false},"excerpt":{"rendered":"

        Vi\u1ec7c s\u1eed d\u1ee5ng SGLT2 inhibitors c\u00f9ng v\u1edbi s\u1eaft t\u0129nh m\u1ea1ch c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c s\u1eaft. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn m\u1ee9c s\u1eaft trong c\u01a1 th\u1ec3 gi\u1ea3m v\u00e0 g\u00e2y ra c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 s\u1ee9c kh\u1ecfe nh\u01b0 thi\u1ebfu m\u00e1u. Do \u0111\u00f3,\u00a0 trong b\u00e0i b\u00e1o “Potential Interactions When Prescribing SGLT2 Inhibitors and […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\n\u1ee8c ch\u1ebf SGLT2 v\u00e0 s\u1eaft t\u0129nh m\u1ea1ch trong suy tim - c\u00f3 t\u01b0\u01a1ng t\u00e1c ?<\/title>\n<meta name=\"description\" content=\"Trong b\u00e0i b\u00e1o "Potential Interactions When Prescribing SGLT2 Inhibitors and Intravenous Iron in Combination in Heart Failure" \u0111\u01b0\u1ee3c \u0111\u0103ng tr\u00ean\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u1ee8c ch\u1ebf SGLT2 v\u00e0 s\u1eaft t\u0129nh m\u1ea1ch trong suy tim - 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