恩格列净对不合并2型糖尿病的射血分数保留的心力衰竭患者疗效观察

Curative effect of empagliflozin in patients with heart failure with preserved ejection fraction without complicated by type 2 diabetes mellitus

目的探讨恩格列净对不合并2型糖尿病的射血分数保留的心力衰竭(HFpEF)患者临床效果。方法选取2021年1月至2022年6月就诊于郑州市第七人民医院心血管内科的118例不合并2型糖尿病的HFpEF患者为研究对象,以随机数表法分为研究组(61例)和对照组(57例)。两组患者均予以包括沙库巴曲缬沙坦、美托洛尔、螺内酯等在内的常规抗心力衰竭治疗。研究组在对照组的基础上加用恩格列净(10 mg/d)。随访6个月,测定两组患者治疗6月后临床疗效,以及治疗前、治疗1月、3月、6月后由美国GE公司的Vivid7全数字彩色多普勒超声诊断仪采集左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左室射血分数(LVEF)、二尖瓣舒张早期最大峰值流速(Ea)、二尖瓣舒张晚期最大峰值流速(Aa),以免疫比浊法测定血浆超敏C反应蛋白(hs-CRP),以酶联免疫吸附法检测N末端脑钠肽前体(NT-proBNP),以荧光测定法测定血管紧张素Ⅱ(AngⅡ),测定明尼苏达心力衰竭生活质量量表(MLHFQ)评分、6 min步行距离(6MWD)与治疗6月后心力衰竭再住院率、不良反应发生率,分析恩格列净对不合并2型糖尿病的射血分数保留的心力衰竭患者临床疗效。结果治疗6月后研究组总有效率高于对照组(P<0.05),心力衰竭再住院率低于对照组(P<0.05),两组不良反应发生率相当(P>0.05)。随着治疗时间的延长,两组LVEF、Ea、6MWD均较前升高(P<0.05),且研究组Ea、6MWD均高于对照组(P<0.05);两组LVEDD、LVESD、Aa、hs-CRP、NT-proBNP、AngⅡ、MLHFQ评分均较前降低,且研究组均低于对照组(P<0.05)。结论恩格列净可改善不合并2型糖尿病的HFpEF患者的心脏功能,降低其hs-CRP、NT-proBNP、AngⅡ水平,改善其临床症状、生活质量和运动耐力,降低其心力衰竭再住院率,具有良好的有效性及安全性。

Objective To discuss the clinical efficacy of empagliflozin in patients with heart failure with preserved ejection fraction(HFpEF)without complicated by type 2 diabetes mellitus(T2DM).Methods HFpEF patients without complicated by T2DM(n=118)were chosen from Department of Cardiovascular Medicine in the Seventh People’s Hospital of ZhengzhouCity,and divided,according to digital table,into study group(n=61)and control group(n=57).Both groups were treated with routine anti-heart failure therapy including sacubitrilvalsartan,metoprolol and spironolactone,and study group was additionally given empagliflozin(10 mg/d).The patients were followed up for 6 months.The clinical efficacy was detected after treatment for 6 months.The values of left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF),maximum peak flow rate of early mitral valve diastole(Ea),and maximum peak flow rate of late mitral valve diastole(Aa)were collected from 2 groups by using Vivid7 fully digital color Doppler ultrasound diagnostic instrument before and after treatment for 1 month,3 month and 6 months.The level of high sensitivity C-reactive protein(hs-CRP)was detected by using immunoturbidimetry,N-terminal pro-brain natriuretic peptide(NT-proBNP)was detected by using ELISA,level of angiotensinⅡ(AngⅡ)was detected by using fluorometry,scores of Minnesota Living with Heart Failure Questionnaire(MLHFQ)and 6-minute walk distance(6MWD)were detected,and re-hospitalization rate due to HF and incidence of adverse reactions were observed after treatment for 6 months.The clinical efficacy of empagliflozin was analyzed in HFpEF patients without complicated by T2DM.Results After treatment for 6 months,the total effective rate was higher(P<0.05),re-hospitalization rate due to HF was lower(P<0.05)in study group than those in control group,and incidence of adverse reactions were similar in 2 groups(P>0.05).As treatment time prolonged,LVEF,Ea and 6MWD increased(P<0.05),and Ea and 6MWD were higher in study group than those in control group(P<0.05).LVEDD,LVESD,Aa,hs-CRP,NT-proBNP,AngⅡand MLHFQ scores decreased in 2 groups,and were lower in study group than those in control group(P<0.05).Conclusion Empagliflozin can improve heart function,reduce levels of hs-CRP,NT-proBNP and AngⅡ,relieve clinical symptoms,improve life quality and exercise tolerance and reduce re-hospitalization rate due to HF with higher efficacy and safety in HFpEF patients without complicated by T2DM.