达格列净对老年射血分数保留型心力衰竭合并2型糖尿病患者炎症细胞因子及心功能的影响

Effects of dapagliflozin on inflammatory cytokines and cardiac function in elderly patients with preserved ejection fraction heart failure complicated with type 2 diabetes mellitus

目的探讨达格列净对老年射血分数保留型心力衰竭(HFpEF)合并2型糖尿病患者炎症细胞因子、血糖控制情况及心功能的影响。方法选取80例老年HFpEF合并2型糖尿病患者,随机分为对照组(n=40)和研究组(n=40)。对照组接受降糖及抗心力衰竭标准治疗,研究组接受降糖及抗心力衰竭标准治疗和达格列净治疗,2组均治疗6个月。比较2组患者炎症因子水平、血糖控制情况、心肌标志物水平、运动耐力[6 min步行距离(6MWD)]、心脏超声相关指标及药物不良反应发生情况。结果治疗6个月后,研究组的血清白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF)-α低于对照组,差异有统计学意义(P<0.05);研究组的糖化血红蛋白(HbA1c)、空腹血糖(FPG)、氨基末端B型脑钠肽前体(NT-proBNP)、超敏肌钙蛋白(hs-TNT)低于对照组,差异有统计学意义(P<0.05);研究组的6MWD、左室射血分数(LVEF)大于对照组,左室舒张末期内径(LVEDD)及右房和右室内径、左房和左室内径、右室室壁厚度、肺动脉压力水平小于对照组,差异有统计学意义(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论采用达格列净治疗老年HFpEF合并2型糖尿病患者,可有效控制其血糖水平,减轻炎症反应,提升运动耐力,改善患者心功能,且不会增加药物不良反应。

Objective To investigate the effects of dapagliflozin on inflammatory cytokines,blood glucose control and cardiac function in elderly with preserved ejection fraction heart failure(HFpEF)combined with type 2 diabetes.Methods A total of 80 elderly HFpEF patients with type 2 diabetes mellitus were randomly divided into control group(40 cases)and study group(40 cases).The control group received hypoglycemic and anti-heart failure standard therapy,and the study group received hypoglycemic and anti-heart failure standard therapy and dapagliflozin therapy.Both groups were treated for 6 months.The levels of inflammatory factors,blood glucose control,myocardial markers,exercise endurance[6 min walking distance(6MWD)],cardiac ultrasound related indexes and adverse drug reactions were compared between the two groups.Results After 6 months of treatment,serum interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP)and tumor necrosis factor(TNF)-αin the study group were significantly lower than those in the control group(P<0.05);the glycated hemoglobin(HbA1c),fasting blood glucose(FPG),amino terminal B-type brain natriuretic peptide precursor(NT-proBNP)and hypersensitive troponin(hs-TNT)of the study group were significantly lower than those of the control group(P<0.05);the 6MWD and left ventricular ejection fraction(LVEF)of the study group were higher than those of the control group,and the left ventricular end-diastolic diameter(LVEDD),right atrial and right ventricular diameter,left atrial and left ventricular diameter,right ventricular wall thickness and pulmonary artery pressure of the study group were significantly lower than those of the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The use of dapagliflozin in the treatment of elderly HFpE patients complicated with type 2diabetes can effectively control their blood sugar level,reduce inflammation,improve exercise endurance,and improve patients′heart function without increasing adverse drug reactions.