沙库巴曲缬沙坦对慢性心力衰竭合并糖尿病患者心功能、血糖控制及预后的影响

Effects of Sakobactri Valsartan on Cardiac Function,Blood Glucose Control and Prognosis in Patients with Chronic Heart Failure Complicated with Diabetes Mellitus

目的:探讨沙库巴曲缬沙坦对慢性心力衰竭合并糖尿病患者心功能、血糖控制及预后的影响。方法:将2017年1月至2019年1月琼海市中医院心血管内科收治的慢性心力衰竭合并糖尿病患者120例根据随机数字表法分为常规组(n=60)和研究组(n=60)。常规组患者给予常规治疗方案,研究组患者在常规治疗方案的基础上加用沙库巴曲缬沙坦。比较两组患者治疗前和治疗12个月后的心功能指标、血糖指标水平,观察不良反应发生情况和主要心血管不良事件(major adverse cardiac events,MACE)发生情况。结果:两组患者治疗后的左心室射血分数、每博输出量和6 min步行试验距离明显高于治疗前,且研究组患者明显高于常规组,差异均有统计学意义(P<0.05)。两组患者治疗后的N末端B型利钠肽原、空腹血糖、餐后2 h血糖和糖化血红蛋白水平均明显低于治疗前,且研究组患者明显低于常规组,差异均有统计学意义(P<0.05)。常规组、研究组患者的不良反应发生率分别为12.28%(7/57)、15.52%(9/58),两组的差异无统计学意义(P=0.616)。研究组和常规组患者12个月累积MACE事件分别为18例和29例,研究组患者的MACE发生风险显著低于常规组,差异有统计学意义(P<0.05)。MACE组吸烟史、合并心房颤动、有心肌梗死病史和合并高脂血症患者所占比例,血清总胆固醇水平均明显高于非MACE组;服用沙库巴曲缬沙坦的患者所占比例明显低于非MACE组,上述差异均有统计学意义(P<0.05)。多因素Cox回归分析结果显示,合并心房颤动、合并高脂血症是慢性心力衰竭合并糖尿病患者发生MACE的独立危险因素,沙库巴曲缬沙坦是慢性心力衰竭合并糖尿病患者发生MACE的保护性因素。结论:沙库巴曲缬沙坦可有效改善慢性心力衰竭合并糖尿病患者的心功能、血糖指标水平及预后。

OBJECTIVE:To probe into the effects of sakobactri valsartan on cardiac function,blood glucose control and prognosis in patients with chronic Heart Failure complicated with diabetes mellitus.METHODS:Totally 120 patients with chronic Heart Failure complicated with diabetes mellitus admitted into Qionghai Hospital of Traditional Chinese Medicine from Jan.2017 to Jan.2019 were extracted to be divided into the conventional group(n=60)and the study group(n=60)via the random number table.The conventional group was given the conventional treatment regimen,while the study group received sakobactril valsartan on the basis of the conventional treatment.Cardiac function indicators and blood glucose indicators of two groups were compared before treatment and after treatment of 12 months,and the occurrence of adverse drug reactions and major adverse cardiac events(MACE)were observed.RESULTS:After treatment,the left ventricular ejection fraction,stroke volume and 6-min walk test of two groups were significantly higher than those before treatment,and the study group was significantly higher than the conventional group,the differences were statistically significant(P<0.05).After treatment,the N-terminal pro-B-type natriuretic peptide,fasting blood glucose,2 h postprandial blood glucose and glycosylated hemoglobin levels of two groups were significantly lower than those before treatment,and the study group was significantly lower than the conventional group,the differences were statistically significant(P<0.05).The incidence of adverse drug reactions in the conventional group and the study group was respectively 12.28%(7/57)and 15.52%(9/58),with no statistically significant difference(P=0.616).The 12-month cumulative MACE events of the study group and the conventional group were respectively 18 cases and 29 cases,the risk of MACE in the study group was significantly lower than that of the conventional group,and the difference was statistically significant(P<0.05).The proportion of smoking history,atrial fibrillation,history of myocardial infarction and hyperlipidemia in MACE group was significantly higher than that in non-MACE group,the proportion of patients taking sakobactril valsartan was significantly lower than that of non-MACE group,with statistically significant difference(P<0.05).Multivariate Cox regression analysis showed that atrial fibrillation,hyperlipidemia were independent risk factors for MACE in patients with chronic Heart Failure complicated with diabetes mellitus,and sakobactril valsartan was the protective factor for MACE in patients with chronic Heart Failure complicated with diabetes mellitus.CONCLUSIONS:Saurbactral valsartan can effectively improve the cardiac function,blood glucose levels and prognosis of patients with chronic Heart Failure complicated with diabetes mellitus.