达格列净结合标准抗心衰及降糖方案治疗老年慢性心力衰竭合并T2DM及高尿酸血症的临床分析

Clinical Analysis of Dapagliflozin Combined with Standard Anti-heart Failure and Glucose-lowering Regimen for the Treatment of Chronic Heart Failure Combined with T2DM and Hyperuricemia in Elderly People

目的探究对老年慢性心力衰竭合并2型糖尿病(Diabetes Mellitus Type 2,T2DM)及高尿酸血症患者采用达格列净和标准抗心衰及降糖方案结合治疗后效果。方法随机选取2021年6月—2022年6月广州市花都区人民医院收治的心力衰竭合并T2DM及高尿酸血症患者120例为研究对象,采用随机数表法分成对照组(60例)、观察组(60例)。对照组采取标准抗心衰及降糖方案,观察组在对照组基础上采取达格列净,对比临床效果。结果观察组氨基末端脑钠肽前体(N Terminal Pro B Type Natriuretic Peptide,NT-proBNP)为(519.36±107.52)ng/L、血尿酸为(346.17±42.15)μmol/L低于对照组,差异有统计学意义(t=2.020、4.245,P<0.05)。观察组血脂改善更好,左室舒张末容积、左室收缩末容积、舒张早期二尖瓣血流速度/二尖瓣环运动速度(the Ratio of Early Diastolic Transmitral Flow Velocity to Mitral Annular Velocity,E/e’)低于对照组,左室射血分数高于对照组,差异有统计学意义(P<0.05)。观察组主要终点事件、次要终点事件、痛风发作率低于对照组,差异有统计学意义(P<0.05)。两组药物不良反应率对比,差异无统计学意义(P>0.05)。结论针对老年慢性心力衰竭合并T2DM及高尿酸血症患者,采用达格列净联合标准抗心衰及降糖方案,能改善血脂、心功能等指标水平,预后效果以及安全性较高。

Objective To investigate the effect of the combination of dapagliflozin and standard anti-heart failure and glucose-lowering regimens in the treatment of elderly patients with chronic heart failure combined with diabetes melli⁃tus type 2(T2DM)and hyperuricemia.Methods 120 cases of patients with chronic heart failure combined with T2DM and hyperuricemia admitted to Guangzhou Huadu District People's Hospital from June 2021 to June 2022 were se⁃lected and divided into the control group(60 cases)and the observation group(60 cases)by using the method of ran⁃dom number table method.The control group adopted the standard anti-heart failure and glucose-lowering regimen,and the observation group adopted dapagliflozin on the basis of the control group to compare the clinical effects.Results In the observation group,the N terminal pro B type natriuretic peptide(NT-proBNP)was(519.36±107.52)ng/L and blood uric acid was(346.17±42.15)μmol/L,which were lower than the control group,and the differences were statisti⁃cally significant(t=2.020,4.245,P<0.05).Lipids improved better in the observation group.In the observation group,left ventricular end-diastolic volume,left ventricular end-systolic volume,and the ratio of early diastolic transmitral flow velocity to mitral annular velocity(E/e')were lower,left ventricular ejection fraction was higher than those in the control group,and the difference was statistically significant(P<0.05).The primary endpoint event,secondary end⁃point event,and gout attack rate in the observation group were lower than those in the control group,and the differ⁃ence was statistically significant(P<0.05).There was no statistically significant difference in the comparison of ad⁃verse drug reaction rates between the two groups(P>0.05).Conclusion For elderly patients with chronic heart failure combined with T2DM and hyperuricemia,the use of dapagliflozin combined with standard anti-heart failure and glucose-lowering regimen can improve the levels of lipids,cardiac function and other indexes,with high prognostic ef⁃fect as well as safety.