达格列净联合沙库巴曲缬沙坦治疗老年糖尿病合并射血分数保留心衰的效果

Efficacy of dapagliflozin combined with sacubitril/valsartan in elderly patients with diabetes mellitus and heart failure with preserved ejection fraction

目的探讨达格列净联合沙库巴曲缬沙坦对老年糖尿病合并射血分数保留心衰(HFpEF)病人的临床疗效。方法收集老年HFpEF合并糖尿病病人180例,分别应用达格列净+沙库巴曲缬沙坦治疗(C组)、沙库巴曲缬沙坦治疗(B组)、常规心衰治疗(对照组,A组),各60例,治疗时间6个月。检测并比较各组治疗前后心功能指标左室舒张末径(LVEDD)、左房内径(LAD)、左心室射血分数(LVEF)、左心室舒张早期二尖瓣血流最大速度/舒张早期二尖瓣环峰值速度(E/e’)、血压、N端前体脑利钠肽(NT-ProBNP)及治疗效果。结果治疗前各组基线资料差异无显著性(P>0.05)。治疗后各组血压、NT-proBNP、LVEDD、LAD、E/e’均较治疗前明显降低(t=5.82~26.31,P<0.05);C组治疗后血压、NT-proBNP下降较A组、B组更明显(F=11.53、33.14,H=42.48,P<0.01),LVEDD、LAD、E/e’下降较A组更明显(F=10.53~14.07,P<0.01),C组LVEDD、LAD、E/e’下降与B组比较差异无显著性(P>0.05)。C组治疗后总体有效率较其他两组明显升高(χ2=22.047,P<0.05)。随访6个月,心血管原因再入院病人C组5例(8.3%),B组8例(13.3%),A组18例(30.0%),B组、C组再入院率较A组明显降低(χ2=11.446、6.730,P<0.05),但B组与C组差异无显著性(P>0.05)。各组均无明显药物不良反应。结论达格列净联合沙库巴曲缬沙坦治疗老年糖尿病并HFpEF病人短期内即可起到降压、降低NT-proBNP水平的作用,二者在改善病人心功能方面发挥协同作用,且安全性高。

Objective To investigate the clinical efficacy of dapagliflozin combined with sacubitril/valsartan in elderly patients with diabetes mellitus and heart failure with preserved ejection fraction(HFpEF).Methods Elderly patients with HFpEF and diabetes mellitus(n=180)were treated for 6 months with dapagliflozin+sacubitril/valsartan(group C,n=60),sacubitril/valsartan(group B,n=60),and conventional heart failure therapy(group A,n=60).The efficacy was compared based on the cardiac function indicators such as left ventricular end-diastolic dimension(LVEDD),left atrial diameter(LAD),left ventricular ejection fraction(LVEF),ratio of the early diastolic velocity of mitral inflow to the early diastolic velocity of mitral annular motion(E/e’),blood pressure,and N-terminal prohormone of brain natriuretic peptide(NT-ProBNP)before and after treatment.Results There were no significant differences between the groups at baseline before treatment(P>0.05).Blood pressure,NT-pro-BNP,LVEDD,LAD,and E/e’were significantly lower after treatment(t=5.82-26.31,P<0.05).Blood pressure and NT-pro-BNP decreased more significantly in group C than in the other two groups(F=11.53,33.14;H=42.48,P<0.01).LVEDD,LAD,and E/e’decreased more significantly in group C than in group A(F=10.53-14.07,P<0.01).The decreases in LVEDD,LAD,and E/e’were not significantly different between groups C and B(P>0.05),The overall efficiency was significantly higher in group C compared to the other two groups(χ2=22.047,P<0.05).Readmission for cardiovascular reasons at 6 months of follow-up occurred in 5 patients(8.3%)in group C,8 patients(13.3%)in group B,and 18 patients(30.0%)in group A,with a significantly lower rate of cardiovascular readmission in groups B and C compared to group A(χ2=11.446,6.730;P<0.05).There was no significant difference between groups B and C(P>0.05).There were no significant adverse reactions in groups.Conclusion Dapagliflozin combined with sacubitril/valsartan can rapidly lower blood pressure and NT-proBNP levels in the treatment of elderly patients with diabetes mellitus and HFpEF,and play a synergistic role in improving patients’cardiac function with a high safety profile.