达格列净对老年2型糖尿病合并射血分数保留型心力衰竭的疗效观察

Efficacy of Dagliazine in Elderly Patients with type 2 Diabetes Mellitus Complicated with Ejection Fraction Retention Heart Failure

目的 探讨达格列净对老年2型糖尿病(T_(2)DM)合并射血分数保留型心力衰竭(HFpEF)的临床疗效以及患者生命质量的影响。方法 选取锦州医科大学附属第一医院自2021年12月—2022年05月入院的200例老年T_(2)DM合并HFpEF患者作为样本,按照“随机抽样法”分为观察组(n=100)和对照组(n=100),两组均实施常规抗心衰治疗,同时对照组进行糖尿病常规治疗,观察组在对照组基础上加用达格列净治疗,对比2组治疗6个月后的心功能指标及相关临床资料、再住院率及不良反应发生率。监测两组患者指标:(1)超声心动图(改良Simpson法)指标包括:二尖瓣舒张早期最大峰值流速、左心室射血分数(LVEF)、左室舒张末期直径(LVEDD)、左室收缩末期直径(LVESD)、二尖瓣舒张晚期最大峰值流速;(2)化验指标包括:N末端B型利钠肽前体(NT-proBNP),空腹血糖(FPG)、餐后2小时血糖(2hPG)、糖化血红蛋白(HbA1c);(3)6分钟步行距离(6MWD);(4)采用明尼苏达心功能不全生命质量量表(MLHFQ)评价患者生命质量。监测不良反应情况:(1)主要的心血管不良事件(MACE)(心源性死亡、因心梗再住院率、因心衰再入院率等);(2)一般不良反应(泌尿系感染、低血糖、胃肠道反应情况等)。结果 (1)2组治疗6个月后LVEDD、LVESD、二尖瓣舒张晚期最大峰值流速、NT-proBNP及MLHFQ评分均较前明显降低(P<0.05),二尖瓣舒张早期最大峰值流速及6分钟步行距离(6MWD)较治疗前均明显升高(P<0.05),且观察组明显优于对照组(P<0.05)。(2)观察组治疗后6个月总有效率(97.00%)明显高于对照组(88.00%)(P<0.05)。(3)不良反应:(1)观察组MACE发生率(5.00%)低于对照组(15.00%),差异有显著统计学意义(P<0.01);(2)一般不良反应发生率观察组(4.00%)较对照(12.00%)发生较少,差异有统计学意义(P<0.05)。结论 达格列净可以改善老年T_(2)DM合并HFpEF患者心脏舒张功能及生活质量,延长6分钟步行距离(6MWD),同时具有良好的安全性。

Objective To investigate the effects of daglipzin on the clinical efficacy and quality of life of elderly patients with type 2 diabetes mellitus(T_(2)DM)combined with ejection fraction preserving heart failure(HFpEF).Methods A total of 200 elderly T_(2)DM patients with HFpEF admitted to the First Affiliated Hospital of Jinzhou Medical University from December 2021 to May 2022 were selected as samples and divided into observation group(n=100)and control group(n=100)according to the“random sampling method”.Both groups received conventional anti-heart failure treatment,while the control group received conventional diabetes treatment.The observation group was treated with daglipzine on the basis of the control group,and the cardiac function indexes,related clinical data,re-hospitalization rate and incidence of adverse reactions were compared between the two groups after 6 months of treatment.Indicators of the two groups were monitored:(1)Echocardiographic indicators(modified Simpson method)included:LVEF,LVEDD,left ventricular end-systolic diameter(LVESD),mitral valve maximum peak velocity at early diastolic stage,mitral valve maximum peak velocity at late diastolic stage;(2)Laboratory indicators include:N-terminal B-type natriuretic peptide precursor(NT-proBNP),fasting blood glucose(FPG),2 hours postprandial blood glucose(2hPG),and HbA1c;(3)6-minute walking distance(6MWD);(4)The quality of life of the patients was evaluated by the Minnesota Heart Dysfunction Quality of Life Scale(MLHFQ).Adverse events were monitored:(1)major cardiovascular adverse events(MACE)(cardiac death,re-hospitalization due to myocardial infarction,readmission due to heart failure,etc.);(2)General adverse reactions(urinary tract infection,hypoglycemia,gastrointestinal reactions,etc.).Results(1)After 6 months of treatment,LVEDD,LVESD,maximum mitral valve diastolic late peak flow rate,NT-proBNP and MLHFQ scores in 2 groups were significantly decreased compared with before(P<0.05),and maximum mitral valve diastolic early peak flow rate and 6-minute walking distance(6MWD)were significantly increased compared with before treatment(P<0.05).The observation group was significantly better than the control group(P<0.05).(2)After 6 months of treatment,the total effective rate of the not use dagliazine group(97.00%)was significantly higher than that of Daglizine group(88.00%)(P<0.05).(3)Adverse reactions:(1)The incidence of MACE in observation group(5.00%)was lower than that in control group(15.00%),and the difference was statistically significant(P<0.01).(2)The incidence of adverse reactions in the observation group(4.00%)was less than that use Daglizine group(12.00%),and the difference was statistically significant(P<0.05).Conclusions Daglipzine can improve the diastolic function and quality of life in elderly patients with T_(2)DM combined with HFpEF,prolong the 6-minute walking distance(6MWD),and has good safety.