达格列净治疗糖尿病合并心衰的疗效及其血管内皮功能和炎症因子的影响

Therapeutic effect of dapagliflozin on patients with diabetes mellitus complicated HF and its influence on vascular endothelial function and inflammatory factor levels

目的:探讨达格列净治疗糖尿病并心衰的疗效及其对血管内皮功能和炎性因子的影响。方法:我院的200例糖尿病合并心衰患者被随机均分为常规治疗组和达格列净组(在常规治疗组基础上接受达格列净),均治疗6个月。观察比较两组治疗前后的炎症因子水平和血管内皮功能,以及6个月的复合终点发生率。结果:治疗6个月后,与常规治疗组比较,达格列净组治疗后血清N基末端脑钠肽前体水平[(1562.63±331.00)pg/ml比(1098.16±256.26)pg/ml]、心衰恶化再入院与心源性死亡的复合终点事件发生率(25.53%比12.50%)显著降低,LVEF[(30.03±9.77)%比(37.64±9.78)%]显著升高,P<0.05或<0.01;血清内皮素-1[(67.69±10.14)μg/L比(61.28±8.90)μg/L]、白细胞介素(IL)-1β[(551.97±120.29)ng/ml比(316.11±102.06)ng/ml]、IL-6[(107.74±44.57)ng/L比(85.28±43.03)ng/L]、肿瘤坏死因子-α[(37.30±11.78)ng/L比(24.10±10.36)ng/L]水平降低更显著,血清一氧化氮水平[(130.39±35.30)μmol/L比(145.79±33.77)μmol/L]升高更显著,P均<0.01。结论:达格列净能显著改善糖尿病合并心衰患者心功能及血管内皮功能,降低炎性因子水平及心衰恶化再入院率。

Objective:To explore therapeutic effect of dapagliflozin on patients with diabetes mellitus(DM)complicated heart failure(HF)and its influence on vascular endothelial function and inflammatory factor levels.Methods:A total of 200 DM+HF patients treated in our hospital were randomly and equally divided into routine treatment group and dapagliflozin group(received dapagliflozin based on routine treatment group).Both groups were treated for six months.Vascular endothelial function and levels of inflammatory factors before and after treatment,and incidence rate of composite endpoint events after six months were observed and compared between two groups.Results:Compared with routine treatment group after treatment,there were significant reductions in serum level of N-terminal pro-brain natriuretic peptide[(1562.63±331.00)pg/ml vs.(1098.16±256.26)pg/ml],incidence rate of composite endpoint event including cardiogenic death and rehospitalization for worsening HF(25.53%vs.12.50%),and significant rise in LVEF[(30.03±9.77)%vs.(37.64±9.78)%]in dapagliflozin group,P<0.05 or<0.01;significant reductions in serum levels of endothelin-1[(67.69±10.14)μg/L vs.(61.28±8.90)μg/L],interleukin(IL)-1β[(551.97±120.29)ng/ml vs.(316.11±102.06)ng/ml],IL-6[(107.74±44.57)ng/L vs.(85.28±43.03)ng/L]and tumor necrosis factor-α[(37.30±11.78)ng/L vs.(24.10±10.36)ng/L],and significant rise in serum level of nitric oxide[(130.39±35.30)μmol/L vs.(145.79±33.77)μmol/L]in dapagliflozin group,P<0.01 all.Conclusion:Dapagliflozin can significantly improve cardiac function and vascular endothelial function,and reduce inflammatory factor levels and incidence rate of rehospitalization for worsening HF in DM+HF patients.