2022 年第 4 期 第 17 卷

达格列净对老年2型糖尿病合并射血分数保留型心力衰竭患者的治疗效果及对心功能的影响

Curative effect of dapagliflozin on elderly patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction and its impact on cardiac function

作者：刘姗姗1罗力亚1赵璨2

英文作者：Liu Shanshan1 Luo Liya1 Zhao Can2

单位：1河北省第八人民医院老年科，石家庄050000；2河北省第八人民医院心内科，石家庄050000

英文单位：1Department of Geriatric the Eighth People′s Hospital of Hebei Province Shijiazhuang 050000 China; 2Department of Cardiology the Eighth People′s Hospital of Hebei Province Shijiazhuang 050000 China

关键词：2型糖尿病；达格列净；射血分数保留型心力衰竭

英文关键词：Type2diabetesmellitus;Dapagliflozin;Heartfailurewithpreservedejectionfraction

• 摘要：

• 目的 分析达格列净对老年2型糖尿病（T2DM）合并射血分数保留型心力衰竭（HFpEF）患者的治疗效果及对心功能的影响。方法 选取2019年1月至2020年1月河北省第八人民医院收治的100例老年T2DM合并HFpEF患者。以抽签随机法将所有患者分为观察组和对照组，各50例。对照组予以常规抗心力衰竭、二甲双胍联合阿卡波糖控制血糖治疗，观察组予以常规抗心力衰竭、二甲双胍联合达格列净控制血糖治疗。比较2组治疗1、3、6、12个月后血糖指标、心功能指标、血清N末端B型脑钠肽前体（NT-proBNP）、血管紧张素Ⅱ（AngⅡ）水平和明尼苏达心力衰竭生活质量调查表（MLHFQ）评分。结果 观察组治疗1、3、6、12个月后空腹血糖、糖化血红蛋白、餐后2 h血糖、左心室舒张末期内径、左心室收缩末期内径、二尖瓣舒张晚期最大峰值流速均低于对照组，二尖瓣舒张早期最大峰值流速均高于对照组，差异均有统计学意义（均P＜0.05）。观察组治疗1、3、6、12个月后血清NT-proBNP、AngⅡ水平均低于对照组［治疗12个月后：（2 712±120）ng/L比（3 363±194）ng/L、（72.1±2.6）ng/L比（98.6±6.6）ng/L］，差异均有统计学意义（均P＜0.05）。2组治疗1、3、6、12个月后MLHFQ评分均低于治疗前，且观察组均低于对照组，差异均有统计学意义（均P＜0.05）。结论 达格列净在降低老年T2DM合并HFpEF患者血糖的同时，可改善心功能，抑制神经内分泌因子释放，提高生存质量。

• Objective To analyze the curative effect of dapagliflozin on elderly patients with type 2 diabetes mellitus (T2DM) and heart failure with preserved ejection fraction (HFpEF) and its effect on cardiac function. Methods Totally 100 elderly patients with T2DM combined with HFpEF in the Eighth People′s Hospital of Hebei Province from January 2019 to January 2020 were selected. They were randomly divided into observation group and control group, with 50 cases in each group. The control group was treated with conventional anti-heart failure, and metformin combined with acarbose to control blood glucose. The observation group was treated with conventional anti-heart failure, and metformin combined with dapagliflozin to control blood glucose. The levels of blood glucose indexes, cardiac function indexes, serum N-terminal pro-brain natriuretic peptide (NT-proBNP), angiotensin Ⅱ (AngⅡ), and Minnesota living heart failure questionnaire(MLHFQ) score were compared between the two groups. Results After 1, 3, 6 and 12 months of treatment, the values of fasting blood glucose, glycosylated hemoglobin, 2 h postprandial blood glucose, left ventricular end diastolic diameter, left ventricular end systolic diameter and maximum peak velocity of late mitral diastole in the observation group were lower than those in the control group, and the values of maximum peak velocity of early mitral diastole in the observation group was higher than that in the control group (all P＜0.05). After 1, 3, 6 and 12 months of treatment, serum levels of NT-proBNP and AngⅡ in the observation group were lower than those in the control group［12 months after treatment：（2 712±120）ng/L vs （3 363±194）ng/L,（72.1±2.6）ng/L vs （98.6±6.6）ng/L］(all P＜0.05). The MLHFQ scores of the two groups 1, 3, 6 and 12 months after treatment were lower than those before treatment, and those in the observation group were lower than those in the control group (all P＜0.05). Conclusion Dapagliflozin can improve heart function, inhibit the release of neuroendocrine factors, and improve the quality of life while reducing blood glucose in elderly patients with T2DM and HFpEF.