达格列净对老年HFpEF急性失代偿期左室舒张功能的影响研究

Effects of dapagliflozin on left ventricular diastolic function in elderly patients with HFpEF during acute decompensation

目的:研究达格列净对老年射血分数保留型心力衰竭(HFpEF)急性失代偿期左室舒张功能的影响。方法:回顾性选择福建省老年医院老年医学科于2021年1月至2024年1月接收的160例老年HFpEF急性失代偿期患者,按照治疗方案的不同分为常规治疗组(n=80,常规抗心衰药物治疗)和联合达格列净治疗组(n=80,常规抗心衰药物联合达格列净治疗),两组均持续治疗3个月。对比两组临床疗效,左室舒张功能指标[舒张早期二尖瓣环运动峰值速度(e')、左室舒张早期充盈峰速度(E)与e'比值(E/e')、三尖瓣反流速度(TRV)、左房内径(LAD)],炎症因子[血清淀粉样蛋白A(SAA)、高敏C反应蛋白(hsCRP)、白细胞介素6(IL-6)],心肌酶[乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH)],氨基末端脑利钠肽前体(NT-proBNP)变化及不良反应发生情况。结果:与常规治疗组相比,联合达格列净治疗组治疗总有效率显著提高(85.00%比95.00%,P=0.035);且治疗后联合达格列净治疗组E/e'、TRV、LAD、SAA、hsCRP、IL-6、LDH、CK、CK-MB、α-HBDH、NT-proBNP均显著低于常规治疗组(P均<0.01);两组不良反应发生率无显著差异(P=0.718)。结论:应用达格列净治疗老年HFpEF急性失代偿期患者,可显著改善左室舒张功能,并有效缓解心衰进展,具有一定临床意义。

Objective:To study the effects of dapagliflozin on left ventricular diastolic function in elderly patients with heart failure with preserved ejection fraction(HFpEF)during acute decompensation.Methods:A total of 160 elderly patients with HFpEF during acute decompensation treated in Department of Geriatrics,Fujian Provincial Geriatric Hospital were retrospectively enrolled between January 2021 and January 2024.According to different therapeutic regimens,they were divided into routine treatment group(n=80,routine anti-heart failure drug therapy)and combined dapagliflozin treatment group(n=80,dapagliflozin on basis of routine anti-heart failure drug therapy).All patients were treated for 3 months.The clinical curative effect,changes of left ventricular diastolic function indexes[early diastolic mitral annular peak velocity(e'),ratio of left ventricular early diastolic filling peak velocity(E)to e'(E/e'),tricuspid regurgitation velocity(TRV),left atrial diameter(LAD)],inflammatory factors[serum amyloid A(SAA),high sensitive C-reactive protein(hsCRP),interleukin-6(IL-6)],myocardial enzymes[lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),α-hydroxybutyrate dehydrogenase(α-HBDH)]and N-terminal pro brain natriuretic peptide(NT-proBNP),and the occurrence of adverse reactions were compared between the two groups.Results:Compared with routine treatment group,total effective rate was significantly higher in combined dapagliflozin treatment group(85.00%vs.95.00%,P=0.035).After treatment,E/e',TRV,LAD,levels of SAA,hsCRP,IL-6,LDH,CK,CK-MB,α-HBDH and NT-proBNP in combined dapagliflozin treatment group were significantly lower than those in routine treatment group(P<0.01 all).There was no significant difference in the incidence rate of adverse reactions between the two groups(P=0.718).Conclusion:Dapagliflozin can significantly improve left ventricular diastolic function and effectively alleviate the progression of heart failure in elderly patients with HFpEF during acute decompensation,which has certain clinical significance.