达格列净治疗老年2型糖尿病并心力衰竭患者的临床疗效及其对心功能的影响

Clinical Efficacy of Dapagliflozin in the Treatment of Elderly Type 2 Diabetes Mellitus Patients Complicated with Heart Failure and Its Impact on Cardiac Function

背景老年2型糖尿病(T2DM)并心力衰竭患者病情复杂、预后较差,是老年医学领域研究的重、难点。目前,老年T2DM并心力衰竭患者的降糖用药方案较多,效果不一,且具体的用药方案尚无统一标准。达格列净的降糖效果明显,且能有效防治心力衰竭,具有较高的研究价值。目的探讨达格列净治疗老年T2DM并心力衰竭患者的临床疗效及其对心功能的影响。方法选取2019年8月至2020年9月河北省第八人民医院心内科和老年科收治的老年T2DM并心力衰竭患者100例,采用随机数字表法分为常规组和研究组,各50例。常规组患者采用常规药物治疗,研究组患者在常规组基础上采用达格列净治疗,两组患者均持续治疗12个月。比较两组患者治疗前及治疗后血糖指标〔空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA_(1c))、胰岛素抵抗指数(HOMA-IR)〕、心功能指标〔左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)及E/A值〕、心肌损伤标志物〔N末端脑钠肽前体(NT-proBNP)、血管紧张素Ⅱ(AngⅡ)〕、6 min步行距离(6MWD)、明尼苏达心力衰竭生活质量调查表(MLHFQ)评分,并观察两组患者治疗期间不良反应发生情况。结果治疗后,两组患者FBG、2 h PBG、HbA_(1c)及HOMA-IR分别低于本组治疗前,且研究组患者低于常规组(P<0.05)。治疗后,两组患者LVEF分别高于本组治疗前,LVESD、LVEDD分别小于本组治疗前,E/A值分别大于本组治疗前,且研究组患者LVEF高于常规组,LVESD、LVEDD小于常规组,E/A值大于常规组(P<0.05)。治疗后,两组患者血清NT-proBNP、AngⅡ水平分别低于本组治疗前,且研究组患者低于常规组(P<0.05)。治疗后,两组患者6MWD分别长于本组治疗前,MLHFQ评分分别低于本组治疗前,且研究组患者6MWD长于常规组,MLHFQ评分低于常规组(P<0.05)。两组患者治疗期间均未出现肾功能损伤、低血压、皮疹等不良反应。结论达格列净可有效改善老年T2DM并心力衰竭患者的血糖水平及心功能,减轻心肌损伤,提高运动耐量及生活质量,且安全性较高。

Background Elderly type 2 diabetes mellitus(T2DM)patients complicated with heart failure have complex disease and poor prognosis,which is a major difficulty in the field of geriatrics research.However,there are many hypoglycemic drug regimens for elderly T2DM patients complicated with heart failure,but with different effects,and the specific drug regimen has not yet formed a standard.Dapagliflozin has obvious hypoglycemic effect and can effectively prevent and treat heart failure,which has high research value.Objective To investigate clinical efficacy of dapagliflozin in the treatment of elderly T2DM patients complicated with heart failure and its impact on cardiac function.Methods From August 2019 to September 2020,100 elderly T2DM patients complicated with heart failure who were admitted to the Department of Cardiology and Geriatrics,the Eighth People's Hospital of Hebei Province were selected,and they were divided into routine group and study group by random number table method,with 50 cases in each group.The patients in the routine group were treated with routine drugs,while the patients in the study group were treated with dapagliflozin on the basis of the routine group,both groups were continuously treated for 12 months.The blood glucose indexes[fasting blood glucose(FBG),2 h postprandial blood glucose(2 h PBG),glycosylated hemoglobin(HbA_(1c)),homeostasis model assessment of insulin resistance(HOMA-IR)],cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD)and E/A ratio],myocardial injury markers[N-terminal pro-brain natriuretic peptide(NT-proBNP),angiotensinⅡ(AngⅡ)],6 min walking distance(6MWD)and Minnesota Living with Heart Failure Questionnaire(MLHFQ)score were compared between the two groups before and after treatment.Incidence of adverse reactions during the treatment of the two groups were observed.Results After treatment,FBG,2 h PBG,HbA_(1c) and HOMA-IR of the two groups were lower than those before treatment,respectively(P<0.05);and FBG,2 h PBG,HbA_(1c) and HOMA-IR in the study group were lower than those of the routine group(P<0.05).After treatment,LVEF of the two groups was higher than that before treatment,LVESD,LVEDD were smaller than those before treatment,E/A ratio was bigger than that before treatment,respectively(P<0.05);and LVEF in the study group was higher than that of the routine group,LVESD,LVEDD were smaller than those of the routine group,E/A ratio was bigger than that of the routine group(P<0.05).After treatment,serum levels of NT-proBNP,AngⅡof the two groups were lower than those before treatment,respectively(P<0.05);and serum levels of NT-proBNP,AngⅡin the study group were lower than those of the routine group(P<0.05).After treatment,6MWD of the two groups was longer than that before treatment,MLHFQ score was lower than that before treatment,respectively(P<0.05);and 6MWD in the study group was longer than that of the routine group,MLHFQ score was lower than that of the routine group(P<0.05).There were no adverse reactions such as renal function injury,hypotension,allergic rash and so on during the treatment in the two groups.Conclusion Dapagliflozin can effectively improve the blood glucose level and cardiac function of elderly T2DM patients complicated with heart failure,and reduce myocardial injury,improve exercise tolerance and quality of life,and with high safety.