达格列净联合沙库巴曲缬沙坦治疗老年HFpEF患者的临床观察

Clinical observation of dapagliflozin combined with sacubitril-valsartan in treatment of elderly patients with HFpEF

目的研究达格列净联合沙库巴曲缬沙坦治疗射血分数保留的心力衰竭(HFpEF)的临床疗效和安全性。方法选取2022年3-12月在本院心血管内科住院的HFpEF患者128例作为研究对象,采用随机数字表法分为观察组与对照组,每组64例。对照组给予常规抗心力衰竭治疗并口服沙库巴曲缬沙坦,观察组在对照组基础上联合应用达格列净,连续治疗12个月。患者于治疗后3、6、12个月完成心脏彩色多普勒超声测定左心室舒张末内径(LVEDd)、左心室射血分数(LVEF),抽血检查氨基末端脑钠肽前体(NT-proBNP)水平,完成6 min步行距离(6MWD)检测。每个月门诊随访,随访内容包括有无不良反应及主要心脏不良事件(MACE)。结果治疗后3个月,两组患者NT-proBNP水平均较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。与治疗前比较,治疗后3个月后,两组的LVEDd较治疗前降低,LVEF较治疗前升高,差异均有统计学意义(P<0.05);治疗后6、12个月,观察组LVEDd均低于对照组,LVEF均高于对照组,差异有统计学意义(P<0.05)。治疗后3个月,两组的6MWD均较治疗前增加,差异有统计学意义(P<0.05);治疗后6、12个月,观察组6MWD均高于对照组,差异有统计学意义(P<0.05)。观察组心力衰竭再入院率、总MACE发生率低于对照组(9.38%vs.23.44%,12.50%vs.26.50%,P<0.05),两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论达格列净联合沙库巴曲缬沙坦能够明显改善老年HFpEF患者的心功能,降低MACE发生率,且具有较好的安全性。

Objective To study the clinical efficacy and safety of dapagliflozin combined with sacubitril-valsartan in the treatment of heart failure with preserved ejection fraction(HFpEF).Methods A total of 128 patients with HFpEF hospitalized in the cardiovascular medicine department of this hospital from March to December 2022 were selected as the study subjects and divided into the observation group and control group by the random number table method,64 cases in each group.The control group was given the conventional anti-heart failure therapy and orally took sacubitril-valsartan,and the observation group took the combined application of dapagliflozin on the basis of the control group.The continuous treatment lasted for 12 months.The left ventricular end diastolic diameter(LVEDd)and left ventricular ejection fraction(LVEF)were completed by the cardiac color Doppler ultrasound determination in 3,6,12 months after treatment,the blood was collected for detecting NT-poBNP and 6 min walking distance(6MWD)determination was completed.The outpatient follow up was conducted monthly,the follow up contents contained the adverse reactions and major adverse cardio vascular event(MACE)events.Results After 3-month treatment,the NT-proBNP level in the two groups was decreased compared with before treatment,moreover the observation group was lower than the control group,and the differences were statistically significant(P<0.05).Compared with before treatment,LVEDd after 3-month treatment in the two groups was decreased compared with before treatment,LVEF was increased compared with before treatment,and the differences were statistically significant(P<0.05).LVEDd after 6-,12-month treatment in the observation group was lower than that in the control group,LVEF was higher than that in the control group,and the differences were statistically significant(P<0.05).6MWD after 3-month treatment in the two groups was increased compared with before treatment,and the difference was statistically significant(P<0.05).6MWD after 6-,12-month treatment in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).The re-admission rate due to heart failure and MACE total occurrence rate in the observation group were lower than those in the control group(9.38%vs.23.44%,12.50%vs.26.50%,P<0.05),and the adverse reactions occurrence rates had no statistical difference between the two groups(P>0.05).Conclusion Dapagliflozin combined with sacubitril-valsartan could significantly improve the cardiac function in elderly patients with HFpEF,reduce the occurrence rate of MACE,moreover has good safety.