卡格列净治疗女性糖尿病伴射血分数降低的心力衰竭患者的临床疗效及其作用机制研究

Clinical Effect and Mechanism of Canagliflozin in the Treatment of Female Patients with Diabetes Complicated with Heart Failure with Reduced Ejection Fraction

背景研究显示,达格列净能使糖尿病伴心力衰竭患者获益,但类似物卡格列净是否有此效应尚不得知。目的分析卡格列净治疗女性糖尿病伴射血分数降低的心力衰竭(HFrEF)患者的临床疗效,并探讨其作用机制。方法选取2019年9—10月于湖北医药学院附属太和医院心血管内科住院的女性糖尿病伴HFrEF患者102例,根据治疗方法分为对照组(n=54)与试验组(n=48)。对照组患者给予常规药物治疗,试验组患者在常规药物治疗的基础上给予卡格列净治疗;两组患者均治疗2个月。比较两组患者治疗前后心功能指标〔包括心率、6 min步行距离、N末端脑钠肽前体(NT-proBNP)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)〕、糖代谢指标〔包括空腹血糖(FBG)、餐后血糖(PBG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)〕、炎性因子〔包括肿瘤坏死因子α(TNF-α)、白介素1(IL-1)和白介素6(IL-6)〕及氧化应激指标〔包括丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)〕,记录两组患者住院时间及住院费用;观察治疗期间两组患者药物不良反应发生情况。结果试验组患者治疗后6 min步行距离长于对照组,NT-proBNP、FBG、HbA1c、HOMA-IR、TNF-α、IL-1、IL-6、MDA低于对照组,LVEF、SOD、GSH-Px高于对照组(P<0.05)。试验组患者住院时间短于对照组,住院费用、治疗期间低血糖发生率低于对照组(P<0.05);两组均无死亡病例。结论卡格列净可有效改善女性糖尿病伴HFrEF患者的心功能、糖代谢,缩短住院时间并降低住院费用,其作用机制可能与抗炎、抗氧化作用有关。

Background Studies have shown that dapagliflozin is benefit for the patients with diabetes complicated with heart failure.However,it is not known whether canagliflozin has this effect.Objective To investigate the clinical effect and mechanism of canagliflozin in the treatment of female patients with diabetes complicated with heart failure with reduced ejection fraction(HFrEF).Methods 102 female patients with diabetes complicated with HFrEF who were hospitalized in the Department of Cardiology Medicine,Affiliated Taihe Hospital of Hubei University of Medicine from September to October 2019 were selected,they were divided into control group(n=54)and experimental group(n=48)according to treatment method.Patients in control group were treated with conventional drugs,while patients in experimental group were treated with canagliflozin based on conventional drugs;both groups were treated for 2 months.Cardiac function indexes(including heart rate,6-minute walking distance,NT-proBNP,LVEDD,LVESD,LVEF),glycometabolism indexes(including FBG,PBG,HbA1c,HOMA-IR),inflammatory factors(including TNF-α,IL-1 and IL-6)and oxidative stress indexes(including MDA,SOD,GSH-Px)were compared between the two groups before and after treatment.Hospitalization time and cost of the two groups were recorded,and the adverse events of the two groups during treatment were observed.Results After treatment,6-min walking distance in experimental group was longer than that in control group,NT-proBNP,FBG,HbA1c,HOMA-IR,TNF-α,IL-1,IL-6 and MDA in experimental group were lower than those in control group,and LVEF,SOD,GSH-Px in experimental group were higher than those in control group(P<0.05).Hospitalization time in experimental group was shorter than that in control group,hospitalization cost and incidence of hypoglycemia during treatment in experimental group were lower than those in control group(P<0.05).No death happened in both groups.Conclusion Canagliflozin can effectively improve the cardiac function and glucose metabolism of female patients with diabetes complicated with HFrEF,shorten the hospitalization time and reduce the hospitalization cost.Its mechanism may be related to anti-inflammatory and anti-oxidantion.