达格列净、恩格列净及卡格列净在心肌梗死后预防心力衰竭患者的临床研究

Clinical trial of dapagliflozin,empagliflozin and canagliflozin in the prevention of patients with heart failure after myocardial infarction

目的观察达格列净、恩格列净及卡格列净对心肌梗死后预防心力衰竭(HF)患者的临床疗效及安全性。方法将接受达格列净治疗的心肌梗死患者作为达格列净组;将医院同期接受恩格列净治疗的心肌梗死患者作为恩格列净组,接受卡格列净治疗的心肌梗死患者作为卡格列净组。3组患者均接受常规抗心力衰竭治疗,达格列净组加服达格列净10 mg·d^(-1),恩格列净组加服恩格列净100 mg·d^(-1),卡格列净组加服卡格列净100 mg·d^(-1)。3组患者均治疗24周。比较3组患者的临床疗效、心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)]、炎性因子[超敏C反应蛋白(hs-CPR)、白细胞介素-6(IL-6)以及肿瘤坏死因子-α(TNF-α)]水平,观察治疗过程中药物不良反应的发生情况。结果达格列净组纳入57例、恩格列净组纳入45例、卡格列净组纳入48例。治疗后,达格列净组、恩格列净组和卡格列净组的总有效率分别为87.72%(50例/57例)、80.00%(36例/45例)和79.17%(38例/48例),差异均无统计学意义(均P>0.05)。治疗24周后,达格列净组、恩格列净组和卡格列净组的LVEF分别为(54.23±7.14)%、(52.36±7.25)%和(53.46±7.21)%,LVEDD分别为(47.93±6.68)、(48.56±5.89)和(48.63±5.26)mm,LVESD分别为(49.64±6.58)、(50.03±7.46)和(50.41±7.06)mm,hs-CPR分别为(3.24±1.56)、(3.45±2.03)和(3.06±1.84)mmol·L^(-1),IL-6分别为(112.24±20.47)、(110.56±21.46)和(111.45±19.67)mmol·L^(-1),TNF-α分别为(25.16±9.06)、(24.46±8.96)和(23.75±8.29)mmol·L^(-1),均较治疗前有所降低(均P<0.05)。达格列净组、恩格列净组和卡格列净组的药物不良反应有轻度低血糖、泌尿生殖道感染、胃肠道不适,总药物不良反应发生率分别为10.52%(6例/57例)和8.88%(4例/45例)和6.25%(3例/48例),差异均无统计学意义(均P>0.05)。结论达格列净、恩格列净以及卡格列净均具有心肌梗死后预防HF的疗效。

Objective To observe the clinical efficacy and safety of dapagliflozin,empagliflozin and canagliflozin in the prevention of heart failure(HF)after myocardial infarction.Methods Myocardial infarction patients treated with dapagliflozinwere taken as the dapagliflozin group;myocardial infarction patients treated with empagliflozin in the same period of time in the hospital were taken as the empagliflozin group;and myocardial infarction patients treated with canagliflozin were taken as the canagliflozin group.The patients in the three groups received conventional anti-heart failure therapy;dapagliflozin group was treated with dapagliflozin 10 mg·d^(-1);empagliflozin group was treated with empagliflozin 100 mg·d^(-1);canagliflozin group was treated with canagliflozin 100 mg·d^(-1);all treatment with for 24 weeks.Clinical efficacy of the two groups,the left ventricular ejection fraction(LVEF),left ventricular end-diastolic internal diameter(LVEDD),left ventricular end-systolic internal diameter(LVESD)],levels of inflammatory factors[hypersensitive C-reactive protein(hs-CPR),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)]and the incidence of adverse drug reactions in two groups were compared.Results There were 57 cases in dapagliflozin group,45 cases in empagliflozin group and 48 cases in canagliflozin group.After treatment,the overall effective rates in dapagliflozin group,empagliflozin group,and canagliflozin group were 87.72%(50 cases/57 cases),80.00%(36 cases/45 cases),and 79.17%(38 cases/48 cases),with no significant difference(P>0.05).After 24 weeks of treatment,the LVEF in dapagliflozin group,empagliflozin group,canagliflozin group were(54.23±7.14)%,(52.36±7.25)%and(53.46±7.21)%;LVEDD were(47.93±6.68),(48.56±5.89)and(48.63±5.26)mm;LVESD were(49.64±6.58),(50.03±7.46)and(50.41±7.06)mm;hs-CPR were(3.24±1.56),(3.45±2.03)and(3.06±1.84)mmol·L^(-1);IL-6 were(112.24±20.47),(110.56±21.46),(111.45±19.67)mmol·L^(-1);TNF-αwere(25.16±9.06),(24.46±8.96)and(23.75±8.29)mmol·L^(-1),with all reduced compared with before treatment(all P<0.05).The adverse drug reactions in dapagliflozin group,empagliflozin group and canagliflozin group included mild hypoglycemia,genitourinary tract infection,and gastrointestinal discomfort,and the total incidence rate of the adverse drug reactions were 10.52%(6 cases/57 cases)and 8.88%(4 cases/45 cases)and 6.25%(3 cases/48 cases),with no significant difference(P>0.05).Conclusion Dapagliflozin,empagliflozin,and canagliflozin had efficacy in preventing HF after myocardial infarction.