摘要
目的 观察达格列净治疗老年2型糖尿病(T2DM)合并射血分数保留的心力衰竭(HFpEF)患者的疗效及安全性。方法 前瞻性连续纳入2020年3月~2022年8月新疆维吾尔自治区人民医院收治的老年T2DM合并HFpEF患者130例。随机数表法分为对照组和达格列净组,每组各65例。两组患者均接受标准的心力衰竭治疗。对照组口服盐酸二甲双胍,降糖效果不佳则使用胰岛素;在对照组基础上达格列净组每日晨服达格列净10 mg。比较两组治疗前和治疗12个月后NT-ProBNP水平、左室射血分数(LVEF)、左心房容积指数(LAVI)、左心室舒张早期二尖瓣血流最大速度/舒张早期二尖瓣环峰值速度(E/e′)。比较两组明尼苏达心力衰竭生活质量调查表(MLHFQ)评分、12个月期间两组心血管死亡率、因HF再住院率及不良反应。结果 对照组64例、达格列净组63例完成研究。治疗后,两组患者NT-ProBNP水平和MLHFQ得分均下降,达格列净组NT-ProBNP(652.9±114.6)pg/ml、MLHFQ(48.4±8.1)分低于对照组的(943.1±101.7)pg/ml、(52.6±8.9)分,组间差异有统计学意义(t=15.099、2.780,P<0.05),达格列净组LAVI(31.3±3.8)ml/m2、E/e′(11.9±2.9)虽低于对照组的(32.6±3.7)ml/m2、(12.7±2.3),但组间差异无统计学意义(t=1.953、1.723,P> 0.05)。达格列净组心力衰竭再住院率为12.69%,低于对照组的26.56%,差异有统计学意义(χ^(2)=3.859,P=0.049)。两组心血管死亡率和不良反应发生率(0.02%vs. 0%、9.52%vs. 6.25%)比较,差异无统计学意义(χ^(2)=0.001、0.469,P> 0.05)。结论 对于合并2型糖尿病的老年HFpEF患者,在常规治疗方案基础上应用达格列净可提高患者的生活质量,降低因心力衰竭再住院风险,且不良反应可接受。
Objective To observe the therapeutic value and safety of daggligin in elderly patients with type 2 diabetes complicated with heart failure with preserved ejection fraction(HFpEF).Methods A total of 130 elderly patients with HFpEF from March 2020 to August 2022 were included and were randomly divided into a control group and a daggliflozin group,with 65 cases in each group.Both groups received standard heart failure treatment.The control group received oral metformin with insulin added if blood sugar control was poor;while the Daggliflozin group received Daggliflozin at an increased dosage of 10 mg day on top of the control group treatment.NT ProBNP levels,Minnesota heart failure quality of life questionnaire(MLHFQ)scores,left ventricular ejection fraction(LVEF),left atrial volume index(LAVI),and left ventricular early diastolic mitral flow maximum velocity early diastolic mitral ring peak velocity(E e′)between the two groups before and 12 months after treatment were compared.Compare the cardiovascular mortality rate,readmission rate due to HF,and adverse reactions between the two groups during the 12 month period.Results 64 cases in the control group and 3 cases in the daggliflozin group were unable to complete the study.After treatment,the NT ProBNP levels and MLHFQ scores in both groups decreased.The NT ProBNP levels and MLHFQ scores in the dapagliflozin group were(652.9±114.6)pg ml and(48.4±8.1),respectively,lower than the control group′s(943.1±101.7)pg ml and(52.6±8.9),with statistically significant differences between the groups(t=15.099,2.780,P<0.05),and LAVI in the dapagliflozin group was(31.3±3.8)ml m 2,Although E e′(11.9±2.9)was lower than the control group′s(32.6±3.7)ml m 2 and(12.7±2.3),there was no statistically significant difference between the groups(t=1.953,1.723,P>0.05).The readmission rate for heart failure in the dapagliflozin group was 12.69%,lower than the control group′s 26.56%(χ^(2)=3.859,P=0.049).The cardiovascular mortality rate and incidence of adverse reactions in the two groups were 0.02%vs.0%,9.52%vs.6.25%(χ^(2)=0.001,0.469,P>0.05).Conclusion In elderly HFpEF patients with type 2 diabetes,adding daggligin to conventional treatment can improve quality of life,reduce the risk of HF readmission,and exhibit acceptable adverse reactions.
作者
姬佳妮
崔帅
陈菲
朱佳
成娜
Ji Jiani;Cui Shuai;Chen Fei(Cadre Health Center,Xinjiang Uygur Autonomous Region People′s Hospital,Urmqi 830000,China)
出处
《中华保健医学杂志》
2024年第3期282-285,共4页
Chinese Journal of Health Care and Medicine
基金
新疆维吾尔自治区自然科学基金资助项目(2021D01C176)。
关键词
心力衰竭
射血分数保留的心力衰竭
达格列净
老年
Heart failure
Heart failure with preserved ejection fraction
Dapagliptin
Elderly
