2023 年第 6 期 第 18 卷

卡格列净对老年2型糖尿病合并射血分数保留型心力衰竭患者胰岛素抵抗和心脏舒张功能的影响及心血管结局

Effects of canagliflozin on insulin resistance and cardiac diastolic function in elderly patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction and cardiovascular outcome

作者：祖晓麟屈超叶明曾亚平高海

英文作者：Zu Xiaolin Qu Chao Ye Ming Zeng Yaping Gao Hai

单位：首都医科大学附属北京安贞医院心内急诊冠脉病房，北京100029

英文单位：Intracardiac Emergency Coronary Disease Ward Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：2型糖尿病；射血分数保留型心力衰竭；卡格列净；胰岛素抵抗；心脏舒张功能

英文关键词：Type2diabetesmellitus;Heartfailurewithpreservedejectionfraction;Canagliflozin;Insulinresistance;Cardiacdiastolicfunction

• 摘要：

• 目的  探讨卡格列净对老年2型糖尿病（T2DM）合并射血分数保留型心力衰竭（HFpEF）患者的胰岛素抵抗和心脏舒张功能的影响，并分析随访3年期间的心血管结局。方法  前瞻性选取2018年7月至2019年12月首都医科大学附属北京安贞医院收治的545例老年T2DM合并HFpEF患者，根据治疗方式将患者随机分为卡格列净组（272例）和格列美脲组（273例），2组患者均常规给予二甲双胍等降糖治疗。比较2组患者的一般资料、治疗前临床资料、治疗后心脏超声结果和治疗6个月及1、2和3年的胰岛素及心功能相关指标。比较2组患者随访3年期间主要不良心血管事件(MACE)发生情况。采用Kaplan-Meier法分析无MACE发生的存活率。采用多因素Cox回归模型分析影响MACE发生的危险因素。结果  卡格列净组患者应用二甲双胍比例、左心室质量指数、二尖瓣舒张早期峰值速度与瓣环舒张早期峰值速度的比值、MACE总发生率和心力衰竭加重再入院发生率低于格列美脲组［58.5%（159/272）比66.7%（182/273）、（122±19）g/m2 比（125±18）g/m2、（8.7±1.7）比（9.2±2.8）、19.5%（53/272）比27.5%（75/273）、9.6%（26/272）比13.9%（38/273）］，差异均有统计学意义（均P＜0.05）。多因素Cox回归分析结果表明，年龄、糖尿病病程、心力衰竭原因（缺血性）、稳态模型胰岛素抵抗指数、N末端B型脑钠肽前体、估算肾小球滤过率、左心室质量指数和卡格列净均是MACE发生的影响因素（均P＜0.05）。结论  卡格列净可能通过降低胰岛素抵抗，从而改善合并T2DM的老年HFpEF患者的心脏舒张功能，并降低心力衰竭加重再入院风险。

• Objective    To investigate the effects of canagliflozin on insulin resistance and cardiac diastolic function in elderly patients with type 2 diabetes mellitus (T2DM) and heart failure with preserved ejection fraction (HFpEF), and to analyze the cardiovascular outcomes during 3 years of follow-up. Methods  From July 2018 to December 2019, 545 elderly patients with T2DM and HFpEF admitted to Beijing Anzhen Hospital, Capital Medical University were prospectively selected. They were randomly divided into canagliflozin group (272 cases) and glimepiride group (273 cases) according to the treatment methods. The patients in both groups were routinely given metformin and other hypoglycemic treatments. The general data, clinical data before treatment, echocardiographic results after treatment, insulin and cardiac function related indicators at 6 months, 1 year, 2 years and 3 years after treatment were compared between the two groups. The incidence of major adverse cardiovascular events (MACE) was compared between the two groups during 3 years of follow-up. The Kaplan-Meier method was used to analyze the survival rate free from MACE. Multivariate Cox regression model was used to analyze the risk factors affecting the occurrence of MACE. Results  The proportion of patients using metformin, the left ventricular mass index, the ratio of early diastolic mitral velocity to early diastolic annular velocity, the total incidence of MACE and the incidence of readmission for aggravated heart failure in the canagliflozin group were lower than those in the glimepiride group ［58.5%（159/272） vs 66.7%（182/273）, (122±19) g/m2 vs (125±18) g/m2, (8.7±1.7) vs (9.2±2.8), 19.5%（53/272） vs 27.5%（75/273）, 9.6%（26/272） vs 13.9%（38/273）; all P<0.05］. Multivariate Cox regression analysis showed that age, duration of diabetes, cause of heart failure (ischemic), HOMA-IR, NT-proBNP, estimated glomerular filtration rate, left ventricular mass index and canagliflozin were influence factors for MACE (all P<0.05). Conclusions  Canagliflozin may improve cardiac diastolic function and reduce the risk of readmission for aggravated heart failure in elderly HFpEF patients with T2DM by reducing insulin resistance.