达格列净对老年射血分数保留的心力衰竭的疗效观察

Efficacy of dapagliflozin in treatment of heart failure with preserved ejection fraction in the elderly

目的观察达格列净对老年射血分数保留的心力衰竭(HFpEF)患者的临床疗效。方法选择老年HFpEF患者123例,按照随机数表法分为观察组62和对照组61例。对照组给予常规抗心力衰竭药物治疗,观察组在此基础上加用达格列净,10 mg 1次/d。观察2组治疗前、治疗6个月和12个月后左心房容积指数(LAVI)、左心室质量指数(LVMI)、左心室舒张早期二尖瓣血流最大速度(E)/舒张早期二尖瓣环峰值速度(e′)、N末端B型钠尿肽前体(NT-proBNP)、可溶性生长刺激表达基因2蛋白(sST2)、明尼苏达心力衰竭生活质量量表(MLHFQ)评分、6 min步行距离(6MWD)变化,以及临床疗效、心力衰竭再住院率以及不良反应发生情况。结果2组治疗后6、12个月LAVI、LVMI、E/e′、NT-proBNP、sST2及MLHFQ评分较治疗前明显降低,6MWD较治疗前明显升高(P<0.05)。观察组LAVI、LVMI、E/e′、NT-proBNP、sST2、MLHFQ评分及6MWD改善情况明显优于对照组(P<0.05)。观察组治疗后12个月总有效率明显高于对照组(90.2%vs 72.9%,P<0.05),心力衰竭再次住院率明显低于对照组(11.5%vs 28.8%,P<0.05)。观察组泌尿系统感染发生率明显高于对照组(14.8%vs 1.7%,P<0.05)。结论达格列净可以改善老年HFpEF患者心脏舒张功能,降低NT-proBNP、sST2水平,改善生活质量、运动耐力、临床症状及心力衰竭再住院率,具有良好的安全性。

Objective To observe the clinical efficacy of dapagliflozin in elderly patients with heart failure with preserved ejection fraction(HFpEF).Methods A total of 123 elderly HFpEF patients were randomly divided into observation group(n=62)and control group(n=61).The patients of the control group were given conventional drug treatment for heart failure,and those from the observation group were given dapagliflozin,10 mg,once per day additionally.Left atrial volume index(LAVI),left ventricular mass index(LVMI),early left ventricular diastole maximum mitral flow velocity(E)/peak mitral annular velocity in early diastole(e′),and serum levels of N-terminal-pro hormone b-type natriuretic peptide(NT-proBNP)and soluble growth-stimulating gene 2 protein(sST2),Minnesota Heart Failure Quality of Life Scale(MLHFQ)score,6-min walking distance(6 MWD),and clinical efficacy,rehospitalization rate due to heart failure and incidences of adverse reactions were observed in the two groups before and 6 and 12 months after treatment.Results After 6 and 12 months of treatment,LAVI,LVMI,E/e′,NT-proBNP and sST2 levels and MLHFQ score were significantly decreased,and 6 MWD was enlonged in the two groups(P<0.05).The observation group achieved better improvements of above indicators than the control group(P<0.05).In 12 months after treatment,the total effective rate(90.2%vs 72.9%,P<0.05)was obviously higher,and the rehospitalization rate due to heart failure(11.5%vs 28.8%,P<0.05)was statistically lower in the observation group than the control group.The incidence of urinary tract infection was significantly higher in the observation group than the control group(14.8%vs 1.7%,P<0.05).Conclusion Dapagliflozin can promote the diastolic function,reduce the serum NT-proBNP and sST2 levels,improve the quality of life,exercise tolerance and clinical signs and symptoms,and decrease heart failure rehospitalization rate in the elderly HFpEF patients,with good safety.