达格列净治疗2型糖尿病合并慢性心力衰竭的疗效

The clinical effect of Dapagliflozin on type 2 diabetes combined with chronic heart failure

目的探讨达格列净治疗2型糖尿病(T2DM)合并慢性心力衰竭(CHF)患者的临床疗效。方法选择尚未接受达格列净或其他钠-葡萄糖共转运蛋白2抑制剂治疗的T2DM合并CHF患者120例为研究对象,按照随机数字表法分为达格列净组60例和对照组60例,达格列净组予以积极生活方式干预并加用达格列净(5 mg/d)治疗,根据血糖水平酌情减量或停用原有降糖药;对照组予以积极生活方式干预并继续口服原有降糖药。比较两组患者治疗6个月后的空腹血糖(FBG)、糖化血红蛋白(HbA1c)、N末端B型利钠肽前体(NT-proBNP)、6 min步行距离(6MWD)、血压(BP)、左心室射血分数(LVEF)及左心室舒张末期内径(LVEDd)的变化、再住院率、药物不良反应发生率,以及治疗后1、3、6个月内主要心血管不良事件(MACE)的发生情况。结果治疗前,两组BP、FBG、HbA1c、NT-proBNP、LVEDd、LVEF、6MWD等指标比较,差异无统计学意义(P>0.05)。与治疗前比较,两组患者治疗后的HbA1c、NT-proBNP水平明显下降,LVEF、6MWD明显增加,差异均有统计学意义(P<0.05);两组患者治疗前后的LVEDd无明显变化,差异无统计学意义(P>0.05)。治疗后,达格列净组HbA1c、NT-proBNP水平明显低于对照组,LVEF、6MWD明显大于对照组,差异均有统计学意义(P<0.05)。达格列净组患者的再住院率低于对照组,差异有统计学意义(P<0.05)。两组消瘦、低血糖、低血压发生率比较,差异无统计学意义(P>0.05)。达格列净组治疗后1、3、6个月的MACE发生率分别为1.7%、3.3%和5.0%,对照组分别为6.7%、11.7%和18.3%,对照组治疗后6个月的MACE发生率明显高于达格列净组,差异有统计学意义(P<0.05)。结论达格列净可改善T2DM合并CHF患者的症状和预后。

Objective To investigate the clinical efficacy of Dapagliflozin in the treatment of type 2 diabetes mellitus(T2DM)complicated with chronic heart failure(CHF).Methods A total of 120 T2DM patients with CHF who had not received Dapagliflozin or other sodium-glucose cotransporter 2 inhabitor treatment were selected as the study subjects.According to random number table method,120 patients were divided into Dapagliflozin group and control group,60 cases in each group.Dapagliflozin group was given active lifestyle intervention and additional treatment with Dapagliflozin(5 mg/d),the original hypoglycemic drugs were reduced or discontinued as appropriate.Control group received active lifestyle intervention and continued oral administration of original hypoglycemic drugs.Fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),N-terminal B-type natriuretic peptide precursor(NT-proBNP),6 min walking distance(6MWD),blood pressure(BP),left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDd),readmission rate,incidence of adverse drug reactions at 6 months after treatment,incidence of major adverse cardiovascular events(MACE)at 1,3,6 months after treatment in two groups were compared.Results Before treatment,there was no statistical significance on BP,FBG,HbA1c,NT-proBNP,LVEDd,LVEF and 6MWD between the two groups(P>0.05).Compared with those before treatment,the levels of HbA1c and NT-proBNP in the two groups decreased significantly after treatment,while LVEF and 6MWD increased significantly,the differences were statistically significant(P<0.05).There was no significant change on LVEDd before and after treatment in the two groups(P>0.05).After treatment,the levels of HbA1c and NT-proBNP in Dapagliflozin group were significantly lower than those in control group,while LVEF and 6MWD were significantly higher than those in control group,with statistical significance(P<0.05).The readmission rate of patients in Dapagliflozin group was lower than that in control group,the difference was statistically significant(P<0.05).There was no significant difference on the incidence of emaciation,hypoglycemia and hypotension between the two groups(P>0.05).The incidence of MACE at 1,3 and 6 months after treatment were 1.7%,3.3% and 5.0% in Dapagliflozin group and 6.7%,11.7% and 18.3% in control group respectively,the incidence of MACE in control group at 6 months after treatment was significantly higher than that in Dapagliflozin group,with statistical significance(P<0.05).Conclusion Dapagliflozin could improve the symptoms and prognosis of patients with T2DM complicated with CHF.