达格列净治疗老年2型糖尿病合并射血分数下降心力衰竭患者的效果

Effect of dapagliflozin in the treatment of elderly patients with type 2 diabetes mellitus combined with heart failure with reduced ejection fraction

目的探讨达格列净治疗老年2型糖尿病合并射血分数下降心力衰竭(HFrEF)患者的效果。方法选取80例老年2型糖尿病合并HFrEF患者作为研究对象,随机将其分为达格列净组和对照组,每组40例。对照组行标准化常规治疗,达格列净组在对照组的基础上加用达格列净,两组均治疗6个月。比较两组患者疗效,治疗前和治疗6个月后实验室指标、心脏彩超指标、6 min步行试验距离、健康调查简表(SF-36)评分,以及治疗期间再住院率和不良反应发生情况。结果达格列净组患者治疗总有效率高于对照组(95.00%比80.00%,P<0.05)。治疗前两组患者空腹血糖(FBG)水平、餐后2 h血糖(2hPBG)水平、糖化血红蛋白(HbA1c)水平、氨基末端脑利钠肽前体(NT-proBNP)水平、左室收缩末期内径(LVESd)、左室舒张末期内径(LVEDd)、左室射血分数(LVEF)、6 min步行试验距离、SF-36评分差异均无统计学意义(均P>0.05),治疗6个月后两组患者FBG、2hPBG、HbA1c、NT-proBNP水平、LVEDd、LVESd均下降,且达格列净组患者上述指标水平均低于对照组;两组LVEF、6 min步行试验距离、SF-36评分均提高/延长,且达格列净组患者LVEF、6 min步行试验距离、SF-36评分均长/高于对照组(均P<0.05)。治疗过程中,达格列净组再住院率(7.50%)低于对照组(30.00%)(χ^(2)=6.646,P=0.010);两组均未出现严重的不良反应。结论在标准化治疗的基础上给予老年2型糖尿病合并HFrEF患者达格列净治疗可显著改善心力衰竭,控制血糖水平,降低再住院率,促进患者生活质量的提高。

Objective To investigate the effect of dapagliflozin in the treatment of elderly patients with type 2 diabetes mellitus combined with heart failure with reduced ejection fraction(HFrEF).Methods A total of 80 elderly patients with type 2 diabetes mellitus combined with HFrEF were selected as the study subjects and randomly divided into a dapagliflozin group or a control group,with 40 cases in each group.The control group was treated with standardized conventional treatment,based on which the dapagliflozin group was treated with dapagliflozin additionally,and both groups were treated for 6 months.The efficacy;laboratory indexes,cardiac color ultrasound indexes,6-minute walk test distance,and the MOS 36-item short-form health survey(SF-36)score before and after the 6-month treatment;and rehospitalization rate and occurrence of adverse reactions during the treatment were compared between the two groups.Results The total therapeutic effective rate of the dapagliflozin group was higher than that of the control group(95.00%vs.80.00%,P<0.05).Before the treatment,there was no statistically significant difference in the fasting blood glucose(FBG)level,2-hour postprandial blood glucose(2hPBG)level,glycosylated hemoglobin(HbA1c)level,N-terminal probrain natriuretic peptide(NT-proBNP)level,left ventricular end-systolic diameter(LVESd),left ventricular end-diastolic diameter(LVEDd),left ventricular ejection fraction(LVEF),6-minute walk test distance,or SF-36 score between the two groups(all P>0.05).After 6 months of treatment,the levels of FBG,2hPBG,HbA1c,and NT-proBNP;LVEDd;and LVESd were decreased in the two groups,and the above indexes levels in the dapagliflozin group were lower than those in the control group(all P<0.05).The LVEF,6-minute walk test distance,and SF-36 score were increased/prolonged in both groups,and the LVEF,6-minute walk test distance,and SF-36 score in the dapagliflozin group were longer/higher than those in the control group(all P<0.05).During the treatment,the rehospitalization rate of the dapagliflozin group(7.50%)was lower than that of the control group(30.00%)(χ^(2)=6.646,P=0.010);there was no serious adverse reaction in the two groups.Conclusion On the basis of standardized treatment,dapagliflozin treatment in elderly patients with type 2 diabetes mellitus combined with HFrEF can significantly improve heart failure,control blood glucose levels,reduce the rehospitalization rate,and promote the improvement of patients'quality of life.