达格列净对冠心病合并心力衰竭患者PCI术后支架内再狭窄的影响

Effects of dapagliflozin on in-stent restenosis in patients with coronary atherosclerotic heart disease and heart failure after PCI

目的 探讨达格列净对冠心病(CAD)合并心力衰竭(HF)患者行经皮冠状动脉支架植入术(PCI)后患者中间型单核细胞亚群(IMs)和支架内再狭窄(ISR)的影响。方法 选取2019年9月—2021年3月邯郸市中心医院收治CAD合并HF行PCI治疗的126例患者作为研究对象,按照随机数字表法将其分为达格列净组与常规治疗组,每组63例。最终完成1年随访及复查冠脉造影者共116例,其中达格列净组59例,常规治疗组57例。记录两组患者年龄、性别、肝功能、肾功能、血糖、血脂、心功能、IMs、血浆脂蛋白相关性磷脂酶A2(Lp-PLA2)、植入支架的长度及支架内最小管腔直径(MLD)等相关指标,并于1年后复查冠脉造影及上述指标。依据复查冠脉造影结果,将所有患者分为再狭窄组及非再狭窄组,分析ISR的危险因素。结果 干预前达格列净组与常规治疗组相比,所观察的指标均无统计学差异(P>0.05)。干预后达格列净组与对照组相比,N末端B型利钠肽原(NT-proBNP)明显下降(P<0.01),左室射血分数(LVEF)明显升高(P<0.05);IMs及Lp-PLA2均明显降低(P<0.01);ISR的发生率明显降低(P<0.05)。二元Logistic回归分析显示IMs、Lp-PLA2及MLD均为ISR的危险因素。结论 达格列净不但能改善冠心病合并心力衰竭患者的心功能,而且与降低PCI术后ISR发生率存在相关性,这可能与降低IMs比例、Lp-PLA2的活性及改善心功能相关。

Objective To investigate the effects of dapagliflozin on intermediate monocytes(IMs) and in-stent restenosis(ISR) in patients with coronary atherosclerotic heart disease(CAD) and heart failure(HF) after percutaneous coronary intervention(PCI).Methods Patients with CAD and HF treated by PCI in Handan Central Hospital from September 2019 to March 2021 were selected as the research objects,and they were divided into dapagliflozin group and conventional treatment group according to the random number table.The patients age,sex,liver function,kidney function,blood glucose,blood lipid,heart function,plasma lipoprotein-associated phospholipase A2(Lp-PLA2),IMs,number of stents,stent length and in-stent minimum lumen diameter(MLD) were recorded.Furthermore coronary angiography and above indexes were reviewed 1 year later.According to the results of coronary angiography,all patients were divided into restenosis group and non-restenosis group,and analyze the risk factors of ISR.Results Before medication,there was no statistical difference in the indexes between dapagliflozin group and conventional treatment group(P>0.05).After 1 year of treatment,compared with the conventional treatment group,N-terminal pro-brain natriuretic peptide(NT-proBNP) was significantly decreased(P<0.01),left ventricular ejection fraction(LVEF) was significantly increased(P<0.05),IMs and LP-PLA2 were significantly decreased(P<0.01),and the incidence of ISR was significantly decreased(P<0.05).Binary logistic regression analysis showed that both IMs、Lp-PLA2 and MLD were risk factors for ISR.Conclusion Dapagliflozin can not only improve the cardiac function of patients with CAD and HF,but also was correlated with the decrease of the incidence of ISR after PCI,which may be related to reducing the proportion of IMs,the activity of LP-PLA2 and improved heart function.