达格列净对慢性射血分数降低性心力衰竭合并2型糖尿病患者心功能的影响

Effect of Dapagliflozin on Cardiac Function in Patients with Chronic Heart Failure with Reduced Ejection Fraction Combined with Type 2 Diabetes Mellitus

目的观察达格列净对慢性射血分数降低性心力衰竭(HFrEF)合并2型糖尿病患者心功能的影响。方法回顾性入选2020年1—6月于郑州大学第一附属医院诊断为慢性HFrEF合并2型糖尿病的患者175例,其中采用达格列净和二甲双胍控制血糖者83例(A组),采用二甲双胍单药控制血糖者92例(B组)。记录入院时和治疗8周后两组患者的血压、心率(HR)、纽约心脏病学会(NYHA)心功能分级、6分钟步行距离、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、N末端B型利钠肽原(NT-proBNP)、24小时室性异位搏动数量、空腹血糖、糖化血红蛋白,并记录8周治疗期间两组患者的不良事件(低血压、肾功能异常、血钾水平异常、低血糖、再入院、死亡)。结果治疗期间,A组有3例患者再入院,B组有12例患者再入院(P<0.05)。经过治疗,两组患者血压、HR、NYHA心功能分级、LVEDD、NT-proBNP、空腹血糖、糖化血红蛋白均降低,24小时室性异位搏动数量均减少,6分钟步行距离均延长,LVEF均升高(P<0.05),与B组相比,A组NYHA心功能分级、LVEDD、NT-proBNP更低,24小时室性异位搏动数量更少,6分钟步行距离更长,LVEF更高(P<0.05)。结论达格列净能够改善慢性HFrEF合并2型糖尿病患者的心功能,降低再入院率,而不增加不良事件的风险。

Objective To observe the effect of dapagliflozin on cardiac function in patients with chronic heart failure with reduced ejection fraction(HFrEF) combined with type 2 diabetes mellitus.Methods One hundred and seventy-five patients diagnosed with chronic HFrEF combined with type 2 diabetes mellitus from January to June 2020 at the First Affiliated Hospital of Zhengzhou University were retrospectively enrolled,including 83 patients with glycemic control with dapagliflozin and metformin(group A),and 92 patients with glycemic control with metformin alone(group B).Blood pressure,heart rate(HR),New York Heart Association(NYHA) functional class,6-minutes walking distance,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),N-terminal pro-B-type natriuretic peptide(NT-proBNP),number of 24-hours ventricular ectopic beats,fasting glucose,and glycated hemoglobin were recorded at admission and after 8 weeks of treatment in both groups.Adverse events(hypotension,abnormal renal function,abnormal blood potassium level,hypoglycemia,readmission,death) were also recorded during the 8 weeks treatment period in both groups.Results During the treatment period,3 patients were readmitted in group A,and 12 patients were readmitted in group B(P<0.05).After treatment,patients in both groups had lower blood pressure,HR,NYHA functional class,LVEDD,NT-proBNP,fasting glucose,and glycated hemoglobin,fewer number of 24-hours ventricular ectopic beats,longer 6-minutes walking distance,and higher LVEF(P<0.05).Compared with group B,group A had lower NYHA functional class,LVEDD,and NT-proBNP,fewer number of 24-hours ventricular ectopic beats,longer 6-minutes walking distance,and higher LVEF(P<0.05).Conclusion Dapagliflozin can improve the cardiac function and reduce the readmission rate in patients with chronic HFrEF combined with type 2 diabetes mellitus without increasing the risks of adverse events.