达格列净对慢性心力衰竭合并2型糖尿病患者左心室舒张功能的影响

Influence of dapagliflozin on left ventricular diastolic function in patients with chronic heart failure complicated by type 2 diabetes mellitus

目的调查钠-葡萄糖协同转运蛋白2(SGLT2,达格列净)抑制剂对慢性心力衰竭合并2型糖尿病患者左心室舒张功能的影响。方法选自2016年11月至2017年2月于菏泽市立医院心血管内科52例慢性心力衰竭合并2型糖尿病患者,所有患者试验前均未服用SGLT2抑制剂,并已服用其他降糖药至少1年,而后应用达格列净治疗6个月。患者在试验前和治疗6个月行实验室及心脏超声检查。主要终点是治疗初和治疗6个月后舒张早期二尖瓣血流速度与舒张早期二尖瓣环运动速度的比值(E/e')。次要终点包括治疗前后左室质量指数(LVMI)和左房容积指数(LAVI)。结果治疗6个月后,E/e’从8.9降到7.8(P=0.018),LAVI和LVMI分别从30.8 ml/m^2降至24.8 ml/m^2(P=0.015),74.2 g/m^2降到66.1 g/m^2(P=0.012)。结论SGLT2抑制剂达格列净可改善慢性心力衰竭合并2型糖尿病患者左室舒张功能,为临床治疗提供新的方向。

Objective To investigate the influence of inhibitors of sodium-glucose cotransporter 2(SGLT2,dapagliflozin)on left ventricular diastolic function in patients with chronic heart failure(CHF)complicated by type 2 diabetes mellitus(T2DM).Methods The patients with CHF complicated by T2DM(n=52)were chosen from Department of Cardiovascular Medicine of Municipal Hospital of Heze City from Nov.2016 to Feb.2017.All patients did not take SGLT2 inhibitors ever before and they had taken other antidiabetic drugs for at least 1y,then they were treated with dapagliflozin for 6 months.The patients were given examinations of laboratory and chocardiography before the study and after treatment for 6 months.The primary endpoint was the ratio of left ventricular peak early diastolic mitral flow velocity to diastolic mitral annular velocity(E/e’)at the beginning of treatment and 6 months after treatment,and the secondary endpoints included left ventricular mass index(LVMI)and left atrial volume index(LAVI)before and after treatment.Results After treatment for 6 months,E/e’decreased from 8.9 to 7.8(P=0.018).LAVI decreased from 30.8 ml/m^2 to 24.8 ml/m^2(P=0.015),and LVMI decreased from 74.2 g/m^2 to 66.1 g/m^2(P=0.012).Conclusion SGLT2 inhibitor-dapagliflozin can improve left ventricular diastolic function in patients with CHF complicated by T2DM,which can be a new direction for clinical practice.