达格列净对心力衰竭患者生活质量及预后的影响

Effect of Dapagliflozin on Quality of Life and Prognosis in Patients with Heart Failure

目的:探讨达格列净治疗对心力衰竭患者心功能、生活质量及预后的影响。方法:将250例心力衰竭患者随机分为治疗组及对照组,其中对照组157例给予心脏康复运动及常规抗心力衰竭治疗,治疗组93例在对照组基础上给予达格列净10mg日一次治疗,比较两组患者治疗前及治疗后血清N末端前体脑利钠肽(NT-proBNP)、中性粒细胞百分比(N%)、血红蛋白(Hb)、肌酐(Cr)左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室壁相对厚度(RWT)、6min行实验(6MWD)、明尼苏达慢性心力衰竭生活质量问卷(MLHFQ),并监测6个月内再入院率及死亡率,比较不同指标差异并分析。结果:对比干预前治疗组及对照组中NT-proBNP、N%、Hb、Cr、LVEF、LVEDD、RWT、6MWD及MLHFQ,差异无统计学意义(P>0.05)。干预后治疗组血清NT-proBNP水平、血清Cr水平、LVEDD、6MWD评分降低(P<0.05),LVEF值、MLHFQ升高(P<0.05),干预后各项指标优于对照组(P<0.05)。所有患者均获得随访,治疗组及对照组6个月内再入院率分别为16.13%和22.93%,经过统计学分析,组间差异具有统计学意义(P<0.05);两组患者心源性死亡率分别为2.2%和8.2%,经过统计学分析,组间差异具有统计学意义(P<0.05);两组患者心肌梗死及肾功能减低的发生率,经过统计学分析,组间差异无统计学意义(P>0.05)。结论:通过心脏康复及达格列净联合治疗,可明显改善患者的心肺功能及生活质量,这对于提高心衰患者远期预后有较大助益。

Objective:To investigate the effect of dapagliflozin treatment on cardiac function,quality of life and prognosis of patients with heart failure.Methods:A total of 250 patients with heart failure were randomly divided into experimental group and control group,of which 157 patients in the control group were treated with cardiac rehabilitation exercise and conventional anti-heart failure therapy,and 93 patients in the experimental group were treated with dapagliflozin 10mg once a day on the basis of the control group.Two groups were compared before and after treatment with serum N-terminal precursor brain natriuretic peptide(NT-proBNP),percentage of neutrophils(N%),hemoglobin(Hb),creatinine(Cr),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),Left ventricular wall relative thickness(RWT),6-minute walk experiment(6MWD),Minnesota Chronic Heart Failure Quality of Life Questionnaire(MLHFQ),and follow-up readmission rate and mortality within 6 months,and the differences of various indicators were compared and analyzed.Results:There were no significant differences between in NT-proBNP,N%,Hb,Cr,LVEF,LVEDD,RWT,6MWD and MLHFQ in the pre-intervention experimental group and control group(P>0.05).After the intervention,the serum NT-proBNP level,serum Cr level,LVEDD and 6MWD scores decreased(P<0.05),LVEF value and MLHFQ increased(P<0.05),all indicators after intervention in the experimental group were better than those in the control group.All patients were followed up.The readmission rates within six months in the experimental group and the control group were 16.13%and 22.93%,respectively.The difference was statistically significant between the two groups(P<0.05).The cardiogenic mortality rates of the two groups were 2.2%and 8.2%,respectively,and the difference between the two groups was statistically significant(P<0.05).There was no significant difference in the incidence of myocardial infarction and renal dysfunction between the two groups(P>0.05).Conclusion:Cardiac rehabilitation and dapagliflozin combination therapy can significantly improve the cardiopulmonary function and quality of life of patients,and is of great help to improve the long-term prognosis of patients with heart failure.