倾向性评分匹配法分析达格列净和沙库巴曲缬沙坦对心力衰竭预后的影响

Influence of dapagliflozin and sacubitril/valsartan on prognosis of heart failure by propensity score matching

目的基于倾向性评分匹配法分析达格列净和沙库巴曲缬沙坦对心力衰竭患者预后的影响。方法回顾性分析2018年6月至2021年12月山西医科大学第一医院收治的369例心力衰竭患者的临床资料,根据治疗方法不同将患者分为达格列净组和沙库巴曲缬沙坦组。倾向性评分匹配后比较2组患者的预后并分析其影响因素。采用SPSS 26.0和R Studio(4.1.2版本)进行数据分析。根据数据类型,组间比较分别采用t检验、秩和检验、χ^(2)或Fisher精确概率法。采用Cox回归模型分析2组患者预后的影响因素并绘制Kaplan-Meier曲线。结果倾向性评分匹配后每组70例,Kaplan-Meier曲线示2组患者出院后首次心力衰竭再住院情况差异无统计学意义(P=0.190)。Cox多因素分析显示,达格列净组纽约心脏病学会(NYHA)分级(HR=6.923,95%CI=1.032~46.426;P=0.046)、左室舒张末期内径(LVEDD)(HR=1.139,95%CI=1.004~1.293;P=0.044)、标准化Z值的N端-B型钠尿肽前体(NT-proBNP)(HR=1.825,95%CI=1.075~3.097;P=0.026)是影响心力衰竭患者预后的危险因素;饮酒(HR=0.086,95%CI=0.018~0.413;P=0.002)和HDL-C(HR=0.012,95%CI=0.000~0.642;P=0.029)是保护因素。沙库巴曲缬沙坦组吸烟(HR=14.376,95%CI=1.657~124.748;P=0.016)是影响心力衰竭患者预后的危险因素;饮酒(HR=0.082,95%CI=0.012~0.578;P=0.012)和血红蛋白(HR=0.953,95%CI=0.912~0.995;P=0.030)是保护因素。结论倾向性评分匹配后,达格列净组NYHA分级、LVEDD、标准化Z值的NT-proBNP、HDL-C和饮酒是患者预后的影响因素;沙库巴曲缬沙坦组吸烟、Hb和饮酒是患者预后的影响因素。达格列净和沙库巴曲缬沙坦对患者预后的影响无显著差异。

Objective To determine the effect of dapagliflozin and sacubitril/valsartan on prognosis of patients with heart failure based on propensity score matching.Methods Clinical data of 369 patients with heart failure diagnosed in the First Hospital of Shanxi Medical University from June 2018 to December 2021 were collected and analyzed retrospectively in this study.According to the treatment they received,the subjects were divided into dapagliflozin group and sacubitril/valsartan group.After propensity score matching,the prognosis of the two groups was compared and the influencing factors were analyzed.SPSS statistics 26.0 and R Studio(version 4.1.2)were used for data analysis.Data comparison between two groups was conducted using student′s t test,rank sum test,Chi-square test or Fisher exact probability method depending on data type.Cox regression models were used to analyze the influencing factors for prognosis in two groups of patients,and Kaplan-Meier curves were plotted.Results There were 70 patients in each group after propensity score matching.Kaplan-Meier survival analysis showed no statistical difference in first heart failure rehospitalization after discharge between the two groups(P=0.190).Cox multivariate analysis showed that the New York Heart Association(NYHA)classification(HR=6.923,95%CI=1.032-46.426;P=0.046),left ventricular end diastolic diameter(LVEDD)(HR=1.139,95%CI=1.004-1.293;P=0.044)and Z score of N-terminal pro-B-type natriuretic peptide(NT-proBNP)(HR=1.825,95%CI=1.075-3.097;P=0.026)were prognostic risk factors for patients with heart failure.Alcohol drinking(HR=0.086,95%CI=0.018-0.413;P=0.002)and high-density lipoprotein cholesterol(HDL-C)(HR=0.012,95%CI=0.000-0.642;P=0.029)were prognostic protective factors in the dapagliflozin group.For the sakubatril/valsartan group,smoking(HR=14.376,95%CI=1.657-124.748;P=0.016)was a risk factor,while drinking(HR=0.082,95%CI=0.012-0.578;P=0.012)and hemoglobin(Hb,HR=0.953,95%CI=0.912-0.995;P=0.030)were protective factors.Conclusion After propensity score matching,NYHA classification,LVEDD,Z score of NT-proBNP,HDL-C and alcohol drinking are factors influencing the prognosis of patients with heart failure in the dapagliflozin group.Smoking,Hb and alcohol drinking are prognostic factors in the sakubatril/valsartan group.There is no significant difference in prognosis for heart failure in comparison of dapagliflozin and sakubatril/valsartan.