钠-葡萄糖协同转运蛋白2抑制剂联合沙库巴曲缬沙坦治疗慢性心力衰竭合并2型糖尿病的效果

Effect of sodium-glucose cotransporter 2 inhibitor combined with sacubitril/valsartan on chronic heart failure with type 2 diabetes

目的 观察钠-葡萄糖协同转运蛋白2(sodium-glucose cotransporter 2,SGLT2)抑制剂联合沙库巴曲缬沙坦治疗慢性心力衰竭(chronic heart failure,CHF)合并2型糖尿病(type 2 diabetes mellitus,T2DM)的疗效及对血管内皮功能及心血管不良事件(major adverse cardiovascular events,MACE)的影响。方法 选取CHF合并T2DM患者156例作为研究对象,以随机数字表法分为联合组与对照组,每组78例。在常规治疗的基础上,对照组给予沙库巴曲缬沙坦治疗,联合组在对照组治疗的基础上联合SGLT2抑制剂治疗。比较2组的临床疗效,治疗前后血管内皮功能、血糖水平、心功能指标以及治疗期间MACE的发生情况。结果 治疗后,联合组的临床疗效(89.74%)优于对照组(75.64%),P<0.05;降钙素基因相关肽(calcitoningene related peptide,CGRP)、射血分数(left ventricular ejection fraction,LVEF)水平和每搏输出量(stroke volume,SV)均显著高于对照组,抵抗素、内皮素-1(endothelin-1,ET-1)、空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(glucosylated hemoglobin,HbAlc)、左心室收缩内径(left ventricular end-systolic dimension,LVESD)、左心室舒张内径(left ventricular end-diastolic dimension,LVEDD)及MACE的总发生率均低于对照组(P<0.05)。结论 SGLT2抑制剂联合沙库巴曲缬沙坦治疗CHF合并T2DM疗效显著,能显著改善患者的血管内皮功能、血糖水平以及心功能,降低MACE的发生率。

Objective To observe the effect of sodium glucose cotransporter 2(SGLT2)inhibitor combined with sacubitril/valsartan on vascular endothelial function and major adverse cardiovascular events(MACE)in patients with chronic heart failure(CHF)and type 2 diabetes mellitus(T2DM).Methods A total of 156 patients with CHF and T2DM who were admitted to the hospital were selected,and divided into combination group and control group by random number table method,78 cases in each group.On the basis of conventional treatment,the control group was treated with sacubitril/valsartan,while the combination group was treated with SGLT2 inhibitor combined with sacubitril/valsartan.The clinical effect,vascular endothelial function indicators,blood glucose,cardiac function indicators,and the incidence of MACE during treatment were compared between the groups.Results After treatment,the clinical efficacy of the combined group was 89.74%,higher than 75.64%of the control group(P<0.05),and the calcitoningene related peptide(CGRP),left ventricular ejection fraction(LVEF)and stroke volume(SV)levels in the combined group were significantly higher than those in the control group,while resistin,endothelin-1(ET-1),fasting plasma glucose(FPG),glucosylated hemoglobin(HbAlc),left ventricular end-systolic dimension(LVESD),left ventricular end-diastolic dimension(LVEDD)levels and the total incidence of MACE in the combined group were lower than those in the control group(P<0.05).Conclusion SGLT2 inhibitor combined with sacubitril/valsartan is effective in the treatment of CHF complicated with T2DM,which can significantly improve the patients’vascular endothelial function,blood glucose and cardiac function,and reduce the incidence of MACE.