达格列净对慢性肾脏病伴2型糖尿病合并心力衰竭患者心肾功能及预后的影响

Effect of dapagliflozin on cardiac and renal function and prognosis in patients with chronic kidney disease and type 2 diabetes complicated with heart failure

目的 观察达格列净对慢性肾脏病伴2型糖尿病合并心力衰竭患者心肾功能及预后的影响。方法 选取2020年3月—2021年3月保定市第一中心医院收治的慢性肾脏病伴2型糖尿病合并心力衰竭患者82例,按照随机数字表法分为观察组及对照组,每组41例。对照组给予常规治疗,观察组在对照组治疗的基础上给予达格列净治疗。2组均治疗12个月。比较2组治疗前后肾功能[血肌酐(SCr)、血尿酸(UA)]、心功能[左室舒张末压(LVEDD)、左室射血分数(LVEF)、6 min步行距离(6MWD)、N端脑钠肽前体(NT-proBNP)]、炎性因子[超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平、生活质量评分(MHFQL),以及预后与不良事件发生情况。结果 治疗12个月后,观察组SCr、UA水平低于治疗前及对照组(P<0.05或P<0.01),对照组治疗前后SCr、UA水平比较差异均无统计学意义(P>0.05);观察组LVEF、LVEDD均较治疗前及对照组改善(P<0.05或P<0.01),对照组治疗前后LVEF、LVEDD比较差异均无统计学意义(P>0.05),2组6MWD均长于治疗前,且观察组长于对照组(P<0.01);观察组NT-proBNP水平低于治疗前及对照组(P<0.05或P<0.01),对照组治疗前后NT-proBNP水平比较差异无统计学意义(P>0.05);2组hs-CRP、IL-6、TNF-α水平均低于治疗前,且观察组低于对照组(P<0.05或P<0.01);2组MHFQL评分均低于治疗前,且观察组低于对照组(P<0.05或P<0.01)。观察组与对照组病死率比较差异无统计学意义(9.76%vs. 12.20%,χ^(2)=0.125,P=0.724);观察组与对照组不良事件总发生率比较差异无统计学意义(24.39%vs. 9.76%,χ^(2)=3.101,P=0.078)。结论 达格列净对慢性肾脏病伴2型糖尿病合并心力衰竭患者心肾功能及预后均有一定的改善作用,值得临床应用。

Objective To observe the effect of dapagliflozin on cardiac and renal function and prognosis in patients with chronic kidney disease with type 2 diabetes mellitus and heart failure.Methods A total of 82 patients with chronic kidney disease with type 2 diabetes mellitus complicated with heart failure admitted to Baoding No.1 Central Hospital from March 2020 to March 2021 were selected.According to the random number table method,they were divided into observation group and control group,with 41 cases in each group.The control group was given conventional treatment,and the observation group was given dapagliflozin treatment on the basis of the control group.Both groups were treated for 12 months.The levels of renal function(SCr,UA),cardiac function(LVEDD,LVEF,6MWD,NT-proBNP),inflammatory factors(hs-CRP,IL-6,TNF-α),quality of life score(MHFQL)were compared between the two groups before and after treatment,and compared the prognosis and adverse events.Results After 12 months of treatment,the levels of SCr and UA in the observation group were lower than those before treatment and in the control group(P<0.05 or P<0.01),and there was no significant difference in the levels of SCr and UA in the control group before and after treatment(P>0.05).LVEF and LVEDD in the observation group were improved compared with those before treatment and those in the control group(P<0.05 or P<0.01),and there was no significant difference in LVEF and LVEDD in the control group before and after treatment(P>0.05).6MWD in both groups were longer than those before treatment,and the observation group was longer than that in the control group(P<0.01).The level of NT-proBNP in the observation group was lower than that before treatment and in the control group(P<0.05 or P<0.01),and there was no significant difference in the level of NT-proBNP in the control group before and after treatment(P>0.05).The levels of hs-CRP,IL-6 and TNF-αin the two groups were lower than those before treatment,and those in the observation group were lower than those in the control group(P<0.05 or P<0.01).The MHFQL scores of the two groups were lower than those before treatment,and the observation group was lower than that of the control group(P<0.05 or P<0.01).There was no significant difference in the mortality between the observation group and the control group(12.20%vs.9.76%,χ^(2)=0.125,P=0.724).There was no significant difference in the total incidence of adverse events between the observation group and the control group(24.39%vs.9.76%,χ^(2)=3.101,P=0.078).Conclusion Dapagliflozin can improve the cardiac and renal function and prognosis of patients with chronic kidney disease with type 2 diabetes mellitus complicated with heart failure,which is worthy of clinical application.