达格列净治疗糖尿病合并慢性心力衰竭的疗效及对血清微小RNA水平的影响

Efficacy of Dapagliflozin in the treatment of diabetes mellitus combined with chronic heart failure and the effect on serum microRNA levels

目的评估达格列净治疗对2型糖尿病(T2DM)合并慢性心力衰竭(CHF)患者血清微小RNA(miR)-92a、miR-16、miR-765水平的影响。方法将2019年1月至2022年1月该院收治的T2DM合并CHF的患者166例纳入研究,随机分为对照组和观察组各83例。对照组根据患者的情况个体化给予降糖药物和抗心力衰竭药物治疗,观察组在此基础上口服达格列净。两组患者均持续治疗6个月。比较两组患者治疗前后空腹血糖(FBS)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、N末端脑钠肽前体(NT-proBNP)和血管紧张素Ⅱ(AngⅡ)、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)、miR-92a、miR-16和miR-765水平,以及治疗期间不良反应、心力衰竭再住院和不良心血管事件的发生情况。结果与治疗前比较,治疗6个月后两组患者的FBG、2hPG、HbA1c、LVEDD和LVESD均明显降低(P<0.05),而LVEF明显升高(P<0.05)。治疗6个月后,与对照组相比,观察组FBG、2hPG、HbA1c、LVEDD和LVESD明显较低(P<0.05),而LVEF明显较高(P<0.05)。治疗6个月后,两组患者血清miR-92a水平均较治疗前降低(P<0.05),而miR-16和miR-765水平均较治疗前升高(P<0.05)。治疗6个月后,观察组血清miR-92a水平显著低于对照组(P<0.05),而miR-16和miR-765水平均显著高于对照组(P<0.05)。治疗6个月后,观察组患者治疗的总有效率明显高于对照组(P<0.05),观察组患者的心力衰竭再住院率和不良心血管事件发生率明显低于对照组(P<0.05)。结论达格列净治疗能够降低T2DM合并心力衰竭患者的血糖水平、改善心功能、降低心脏不良事件的发生率,这可能与其对miR-92a、miR-765和miR-16的调节作用有关。

Objective To evaluate the effect of Dapagliflozin treatment on serum microRNA(miR)-92a,miR-16,and miR-765 levels in patients with type 2 diabetes mellitus(T2DM)combined with chronic heart failure(CHF).Methods A total of 166 T2DM patients with CHF admitted to our hospital from January 2019 to January 2022 were enrolled in the study,and were randomly divided into control group and observation group,83 cases in each group.The control group was individually treated with hypoglycemic drugs and anti-heart failure drugs according to the patients′conditions,and the observation group was orally treated with daglipzin on this basis.Both groups were treated for 6 months.Fasting blood glucose(FBS),2-hour postprandial glucose(2hPG),glycated hemoglobin(HbA1c),N-terminal brain natriuretic peptide precursor(NT-proBNP)and angiotensinⅡ(AngⅡ),left ventricular ejection fraction(LVEF),left ventricular end-systolic internal diameter(LVESD),left ventricular end-diastolic internal diameter(LVEDD),serum miR-92a,miR-16,and miR-765 levels before and after treatment and the occurrence of adverse events,heart failure rehospitalization,and adverse cardiovascular events during treatment were compared between the two groups.Results Compared with before treatment,the FBG,2hPG,HbA1c,LVEDD and LVESD of the two groups were significantly decreased(P<0.05),while LVEF was significantly increased after 6 months of treatment(P<0.05).After 6 months of treatment,compared with the control group,the FBG,2hPG,HbA1c,LVEDD and LVESD in the observation group were significantly lower,while LVEF was significantly higher(P<0.05).After 6 months of treatment,the levels of serum miR-92a in the two groups were lower than those before treatment,while the levels of miR-16 and miR-765 were higher than those before treatment(P<0.05).After 6 months of treatment,the level of serum miR-92a in the observation group was significantly lower than that in the control group,while the levels of miR-16 and miR-765 were significantly higher than those in the control group(P<0.05).After 6 months of treatment,the total effective rate of the observation group was significantly higher than that of the control group(P<0.05),and the rehospitalization rate of heart failure and the incidence of adverse cardiovascular events in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Dapagliflozin treatment can reduce blood glucose level,improve cardiac function and reduce the incidence of adverse cardiac events in patients with T2DM combined with CHF,which may be related to its modulating effects on miR-92a,miR-765 and miR-16.