达格列净治疗2型糖尿病合并Ⅰ~Ⅲ级心力衰竭患者的疗效

Efficacy of dapagliflozin in the treatment of patients with type 2 diabetes mellitus complicated with grade Ⅰ~Ⅲ heart failure

目的探讨达格列净在2型糖尿病合并Ⅰ~Ⅲ级心力衰竭患者中的疗效和安全性及对患者抗氧化能力和心功能的影响。方法收集2020年1月至2022年12月济南市第二人民医院收治的120例2型糖尿病合并Ⅰ~Ⅲ级心力衰竭级患者,以随机数字表法分为对照组和观察组各60例。观察组中,男女比例为33/27;年龄52~73(59.27±4.33)岁;病程3~14(7.57±1.42)年;纽约心脏病协会(NYHA)分级:Ⅰ级13例,Ⅱ级30例,Ⅲ级17例。对照组中,男女比例为32/28;年龄50~74(59.34±4.38)岁;病程3~15(7.58±1.44)年;NYHA分级:Ⅰ级12例,Ⅱ级31例,Ⅲ级17例。对照组采取二甲双胍及常规治疗,观察组在对照组基础上采取达格列净治疗。比较两组患者的总有效率、心功能指标[心输出量(CO)、每搏输出量(SV)和左心室射血分数(LVEF)]、抗氧化能力[丙二醛(MDA)、超氧化物歧化酶(SOD)和总抗氧化能力(TAC)]、不良反应发生率、生命质量。行χ^(2)检验、t检验。结果观察组治疗后的总有效率[98.33%(59/60)]高于对照组[88.33%(53/60)](χ^(2)=4.820,P=0.028)。治疗后,观察组的CO(4.38±0.78)L/min、SV(59.38±5.27)ml、LVEF(59.33±4.85)%均高于对照组(3.81±0.73)L/min、(55.37±5.31)ml、(57.18±4.32)%(t=4.133,P<0.001;t=4.152,P<0.001;t=2.564,P=0.012);观察组的MDA水平(4.67±1.21)nmol/ml低于对照组(6.25±1.37)nmol/ml,SOD(83.26±11.83)U/ml、TAC(8.32±1.11)nmol/ml高于对照组(73.51±10.25)U/ml、(7.79±1.03)nmol/ml(t=6.696,P<0.001;t=4.825,P<0.001;t=2.771,P=0.008)。观察组患者治疗后的不良反应发生率[6.67%(4/60)]与对照组[3.33%(2/60)]比较差异无统计学意义(χ^(2)=0.700,P=0.402)。观察组治疗后的生命质量评分低于对照组[(52.58±3.39)分比(62.47±4.45)分](t=13.694,P<0.001)。结论在2型糖尿病合并Ⅰ~Ⅲ级心力衰竭患者中应用达格列净的用药有效性和安全性均较高,能够明显改善患者的心功能,提高抗氧化能力和生命质量。

Objective To investigate the efficacy and safety of dapagliflozin in patients with type 2 diabetes mellitus complicated with grade I-III heart failure and its effects on antioxidant capacity and cardiac function.Methods A total of 120 patients with type 2 diabetes mellitus complicated with grade I-III heart failure admitted to Jinan Second People's Hospital from January 2020 to December 2022 were collected and were divided into a control group and an observation group with 60 cases in each group by the random number table method.In the observation group,the ratio of male to female was 33/27,the age was 52-73(59.27±4.33)years old,the course of disease was 3-14(7.57±1.42)years,and the New York Heart Association(NYHA)grade showed that there were 13 patients with grade I,30 patients with grade II,and 17 patients with grade III.In the control group,the ratio of male to female was 32/28,the age was 50-74(59.34±4.38)years old,the course of disease was 3-15(7.58±1.44)years,and the NYHA grade showed that there were 12 cases with grade I,31 cases with grade II,and 17 cases with grade III.The control group was treated with metformin and conventional treatment,and the observation group was treated with dapagliflozin on the basis of the control group.The total effective rate,cardiac function indexes[cardiac output(CO),stroke volume(SV),and left ventricular ejection fraction(LVEF)],antioxidant capacity[malondialdehyde(MDA),superoxide dismutase(SOD),and total antioxidant capacity(TAC)],incidence of adverse reactions,and quality of life of the two groups were compared.χ^(2) test and t test were used.Results The total effective rate of the observation group[98.33%(59/60)]was higher than that of the control group[88.33%(53/60)](χ^(2)=4.820,P=0.028).After treatment,the levels of CO[(4.38±0.78)L/min],SV[(59.38±5.27)ml],and LVEF[(59.33±4.85)%]in the observation group were higher than those in the control group[(3.81±0.73)L/min,(55.37±5.31)ml,and(57.18±4.32)%](t=4.133,P<0.001;t=4.152,P<0.001;t=2.564,P=0.012);the level of MDA in the observation group[(4.67±1.21)nmol/ml]was lower than that in the control group[(6.25±1.37)nmol/ml],but the levels of SOD[(83.26±11.83)U/ml]and TAC[(8.32±1.11)nmol/ml]were higher than those in the control group[(73.51±10.25)U/ml and(7.79±1.03)nmol/ml](t=6.696,P<0.001;t=4.825,P<0.001;t=2.771,P=0.008).There was no statistically significant difference in the incidence of adverse reactions between the observation group[6.67%(4/60)]and the control group[3.33%(2/60)](χ^(2)=0.700,P=0.402).The quality of life score of the observation group after treatment was lower than that of the control group[(52.58±3.39)points vs.(62.47±4.45)points](t=13.694,P<0.001).Conclusion Dapagliflozin has high efficacy and safety in patients with type 2 diabetes mellitus complicated with grade I-III heart failure,which can significantly improve their cardiac function,antioxidant capacity,and quality of life.