恩格列净对急性心力衰竭合并2型糖尿病患者心力衰竭再入院风险、心功能和生活质量的影响

Effects of empagliflozin on rehospitalization rate,cardiac function and quality of life in patients with acute heart failure and type 2 diabetes

目的探讨恩格列净治疗对急性心力衰竭合并2型糖尿病患者心力衰竭再入院风险、心功能和生活质量的影响。方法前瞻性选取2021年1月至2022年6月在广西科技大学第一附属医院诊治的急性心力衰竭合并2型糖尿病患者为观察对象,根据随机数字表法分组,分为观察组(126例)和对照组(127例)。2组均常规给予强心、利尿等抗心力衰竭及降糖治疗,观察组在此基础上还给予每日一次10 mg恩格列净,持续6个月。比较2组心力衰竭再入院率、心功能、6 min步行试验(6MWT)距离和生活质量(KCCQ评分)。安全性指标是肾功能和血钾水平。比较2组的一般临床资料,分析治疗前后的观察指标情况,Cox回归分析评估影响心力衰竭再入院的相关因素。结果2组患者的一般临床资料、治疗前的心功能、6WMT、KCCQ评分、N末端B型利钠肽原(NT-proBNP)水平、肾功能和血钾水平相似,差异均无统计学意义(均为P>0.05);治疗6个月后,Kaplan-meier生存分析结果显示,观察组的心力衰竭再入院率显著低于对照组(11.9%比17.3%,HR=0.692,95%CI:0.504~0.951,P=0.023)。较对照组,观察组的6WMT更长,NT-proBNP更低,左室射血分数更大,左室收缩末期容积更小(均为P<0.05)。生活质量评分方面,观察组的躯体受限得分、症状得分、心理得分、社会功能得分、临床得分和总得分均高于对照组(均为P<0.05)。校正各影响因素后,多因素Cox回归分析证实恩格列净与心力衰竭再入院率降低显著相关(P<0.05)。结论应用恩格列净治疗可显著降低急性心力衰竭合并2型糖尿病患者的心力衰竭再入院率,改善心功能,增加6MWD,提高生活质量。

Objective To investigate the effects of empagliflozin on the rate of rehospitalization and quality of life in acute heart failure patients with type 2 diabetes(T2DM).Methods The patients with T2DM complicated with acute heart failure who were diagnosed and treated in The First Affiliated Hospital of Guangxi University of Science and Technology from January 2021 to June 2022 were prospectively selected.They were randomly divided into the observation group(n=126)and the control group(n=127)according to whether they were treated with empagliflozin.Both groups were given anti heart failure treatment such as cardiotonic and diuretic therapy,and the observation group was also given 10 mg empagliflozin once a day for 6 months.The primary outcome was readmission of heart failure,and the secondary outcomes were 6-minute walk test(6MWT),cardiac function(cardiac ultrasound,NT-proBNP level),quality of life(KCCQ score).The safety indexes were renal function and blood potassium level.The general clinical data of the two groups were compared,and the observation indexes before and after treatment were analyzed.Cox regression analysis was used to evaluate and calculate the relevant factors affecting readmission of heart failure.Results There were no significant differences in general clinical data,KCCQ score,pulmonary ultrasound score,NT-proBNP level,renal function and blood potassium level between the two groups were similar(all P>0.05);After 6 months of treatment,Kaplan-meier survival analysis showed that the readmission rate of heart failure in the observation group was significantly lower than that in the control group(11.9%vs.17.3%,HR=0.692,95%CI:0.504-0.951,P=0.023).In addition,compared with the control group,the observation group had longer 6WMT,increased level of LVEF,and decreased levels of NT-proBNP,LVESD,E/e’and lung ultrasound scores(all P<0.05).In terms of KCCQ score,the scores of physical limitation,symptoms,psychology,social function,clinical score and total score in the observation group were higher than those in the control group(all P<0.05).After adjusting the influencing factors,Cox regression analysis showed that empagliflozin was still significantly related to the reduction of readmission rate of heart failure(P<0.05).Conclusions Empagliflozin treatment of acute heart failure with can reduce the risk of readmission of patients with heart failure,improve cardiac function and dyspnea,increase 6MWT and improve the quality of life.