钠⁃葡萄糖协同转运蛋白2抑制剂结合新型血管紧张素受体脑啡肽酶抑制剂对2型糖尿病合并心力衰竭患者N末端脑钠肽前体、炎症因子及心肌能量代谢的影响

Effects of SGLT2i combined with novel ARNI on NT⁃proBNP,inflammatory factors and myocardial energy metabolism in patients with type 2 diabetes mellitus complicated by heart failure

目的探讨SGLT2i结合新型血管紧张素受体脑啡肽酶抑制剂(ARNI)对T2DM合并心力衰竭(HF)患者N末端脑钠肽前体(NT⁃proBNP)、炎症因子及心肌能量代谢的影响。方法选取2019年2月至2020年2月于我院心内科诊治的T2DM合并HF患者144例,随机分为沙库巴曲缬沙坦钠组(Sak,n=71)和沙库巴曲缬沙坦钠+达格列净组(Sak+Dap,n=73)。在常规治疗和对症治疗基础上,Sak组予沙库巴曲缬沙坦钠片,Sak+Dap组加用达格列净片。比较两组有效率、治疗后血糖控制水平、心功能、心肌能量代谢、NT⁃proBNP、炎症因子及不良反应发生率等。结果Sak+Dap组有效率、左室射血分数、心排血量、每搏量高于Sak组(P<0.05),左室舒张末期内径、左室收缩末期内径、超敏C反应蛋白、NT⁃proBNP、TNF⁃α、心肌能量消耗及FFA低于Sak组(P<0.05)。结论SGLT2i结合新型ARNI治疗T2DM合并HF患者的疗效确切,安全性好,值得临床推广。

Objective To investigate the effects of sodium⁃glucose co⁃transporter 2 inhibitor(SGLT2i)binding to novel angiotesin receptor neprilysin inhibitor(ARNI)on plasma N⁃terminal pro brain natriuretic peptide(NT⁃proBNP),inflammatory factors and myocardial energy metabolism in patients with type 2 diabetes mellitus(T2DM)and heart failure(HF).Methods 144 T2DM patients complicated with HF who were treated in our hospital from February 2019 to February 2020 were selected and randomly divided into Sak group(n=71)and Sak+Dap group(n=73).The patients in Sak group was treated with Sakubatra/valsartan sodium.The patients in Sak+Dap group received Dapagliflozin tablets combined with Sakubatra/valsartan sodium.The clinical efficiency,blood glucose status,cardiac function,myocardial energy metabolism,NT⁃proBNP,inflammatory factors and adverse reactions between the two groups were compared.Results The effective rate of the treatment in Sak+Dap group was significantly higher than that in Sak group(P<0.05).After treatment,the levels of left ventricular end diastolic diameter(LVEDD),left ventricular end contractile diameter(LVESD),hypersensitive⁃C reactive protein(hs⁃CRP),amino terminal brain natriuretic peptide precursor(NT⁃proBNP),tumor necrosis factor⁃α(TNF⁃α),myocardial energy expenditure(MEE)and free fatty acid(FFA)in Sak+Dap group were significantly lower than those in Sak group(P<0.05).The levels of left ventricular ejection fraction(LVEF),cardiac outpu(t CO)and(stroke volume)SV in Sak+Dap group were significantly higher than those in Sak group(P<0.05).Conclusion The combination of SGLT2i and novel ARNI in the treatment of T2DM patients with HF is effective and safe,which is worthy of clinical promotion.