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目的：观察达格列净治疗2型糖尿病（T2DM）合并射血分数轻度下降（HFmrEF,40%≤LVEF<50%）的心力衰竭患者的临床疗效。方法：选取2019年10月～2021年10月入住本院的T2DM合并HFmrEF患者共84例，采用随机数字表法分为对照组和研究组各42例。两组均使用基础降糖及规范抗心衰治疗，同时研究组加用达格列净治疗。治疗9个月后，比较两组治疗前后心功能指标：左室射血分数（LVEF）、血清N末端脑钠肽前体（NT-proBNP），运动耐力指标：6 min步行距离（6MWD）,NYHA心功能分级，明尼苏达心力衰竭生活质量调查表（MLHFQ）评分及主要不良心脏事件（MACE）。结果：治疗后，两组患者的NT-proBNP水平降低、LVEF升高，6MWD延长，NYHA心功能分级提升，MLHFQ评分降低，各指标在治疗后相比，两组内均优于本组治疗前，两组间研究组均优于对照组，差异均具有统计学意义（P<0.05）。与对照组相比，研究组发生MACE事件及药物不良反应的患者例数更少。结论：达格列净治疗T2DM合并HFmrEF患者，可改善心功能指标、提高运动耐力、提升NYHA心功能分级、改善患者生活质量，减少MACE事件的发生，安全性好。
Abstract：Objective: To observe the clinical efficacy of dapagliflozin in the treatment of type 2 diabetes mellitus(T2DM) complicated with heart failure with mildly reduced ejection fraction(HFmrEF, 40%≤LVEF<50%). Methods: A total of 84 patients with T2DM complicated with HFmrEF hospitalized in our hospital from October 2019 to October 2021 were selected, and random number table method was used to divide the control group and the study group into 42 cases. Both groups used basal hypoglycemic and standardized anti-heart failure therapy, and the study group was treated simultaneously with dapagliflozin. Nine months later, the following indexes were compared between the two groups before and after treatment: the cardiac function indicators: N-terminal pro brain natriuretic peptide(NT-proBNP), left ventricular ejection fraction(LVEF); exercise endurance: 6-minute walk distance(6MWD), NYHA cardiac function class, the score of the Minnesota living with heart failure questionnaire(MLHFQ) and the incidence of major adverse cardiovascular events(MACE). Results: Nine months later, the two groups showed decreased NT-proBNP level, increased LVEF, prolonged 6MWD, improved NYHA cardiac function grade, decreased MLHFQ score, and statistically significant differences within both groups compared with before treatment(P<0.05), after treatment, significant differences were displayed between the two groups(P<0.05). Less patients had MACE events and adverse drug reactions in the study group compared with the control group. Conclusion: Dapagliflozin in the treatment of T2DM patients with HFmrEF can improve cardiac function indicators, improve exercise endurance, improve NYHA cardiac function class, improve patient's quality of life, and reduce the incidence of MACE events, with no obvious side effects.
1 GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence,prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories,1990-2017:A systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2018, 392(10159):1789-1858.
2 中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2020概要[J].中国循环杂志，2021,36(6):521-545.
3 中华医学会心血管病学分会心力衰竭学组.中国心力衰竭诊断和治疗指南2018[J].中华心血管病杂志，2018,46(10):760-789.
4 中国心衰中心联盟，苏州工业园区心血管健康研究院，中国心血管健康联盟.中国心衰中心工作报告（2021）-心力衰竭患者的诊疗现况[J].中国介入心脏病学志，2022, 30(5):328-336.
5 Pop-Busui R, Januzzi JL, Bruemmer D, et al. Heart failure:An underappreciated complication of diabetes. A Consensus Report Of The American Diabetes Association[J]. Diabetes Care, 2022, 45(7):1670-1690.
6 Mcmurray J, Solomon SD, Inzucchi SE, et al.DAPA-HF Trial Committees and Investigators. Dapagliflozin in patients with heart failure and reduced ejection fraction[J]. N Engl J Med, 2019,381(21):1995-2008.
7 中华医学会糖尿病学分会.中国2型糖尿病防治指南（2017年版）[J].中国使用内科杂志，2018,38(4):292-344.
8 Abdui-Rahim AH, Shen L, Rush CJ, et al. Effect of digoxin in patients with heart failure and mid-range(borderline)left ventricular ejection fraction[J]. Eur J Heart Fail,2018,20(7):1139-1145.
9 Brann A, Janvanishstaporn S, Greenberg B, et al. Association of prior left ventricular ejection fraction with clinical outcomes in patients with heart failure with midrange ejection fraction[J]. JAMA Cardiol, 2020, 5(9):1027-1035.
10 McDonagh TA, Metra M, Adamo M, et al.2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC)with the special contribution of the Heart Failure Association(HFA)of the ESC[J].Eur Heart J, 2021,42(36):3599-3726.
11 阮征，黄建玉，姜文才，等.射血分数中间值心力衰竭——究竟该如何认识？[J].中国全科医学杂志，2022,25(5):522-529.
12 Honka H, Solis-Herrera C, Triplitt C, et al. Therapeutic manipulation of myocardial metabolism:JACC state-of-the-art review[J]. J Am Coll Cardiol, 2021,77(16):2022-2039.
13 崔洁，钱菊英.糖尿病相关心力衰竭的发病机制、治疗及钠-葡萄糖协同转运蛋白-2抑制剂的应用[J].中华心力衰竭和心肌病杂志，2021,5(2):138-144.
14 Agashe S, Petak S. Cardiac autonomic neuropathy in diabetes mellitus[J]. Methodist Debakey Cardiovasc J,2018,14(4):251-256.
15 Spallone V. Update on the impact, diagnosis and management of cardiovascular autonomic neuropathy in diabetes:What is defined, what is new, and what is unmet[J]. Diabetes Metab J, 2019, 43(1):3-30.
16 Jankauskas SS, Kansakar U, Varzideh F, et al. Heart failure in diabetes[J]. Metabolism, 2021,125:154910.
17 Kenny HC, Abel ED. Heart failure in type 2 diabetes mellitus[J]. Circ Res, 2019,124(1):121-141.
18 Nassif ME, Windsor SL, Borlaug BA, et al. The SGLT2 inhibitor dapagliflozin in heart failure with preserved ejection fraction:A multicenter randomized trial[J]. Nat Med, 2021,27(11):1954-1960.
19 Griffin M, Rao VS, Ivey Miranda J, et al. Empagliflozin in heart failure:Diuretic and cardiorenal effects[J]. Circulation, 2020,142(11):1028-1039.
20 Li H, Shin SE, Seo MS, et al. The anti-diabetic drug dapagliflozin induces vasodilation via activation of PKG and Kv channels[J]. Life Sci, 2018,197:46-55.
21 Palmiero G, Cesaro A, Vetrano E, et al. Impact of SGLT2 inhibitors on heart failure:From pathophysiology to clinical effects[J]. Int J Mol Sci, 2021,22(11):5863.
22 Pabel S, Hamdani N, Luedde M, et al. SGLT2 inhibitors and their mode of action in heart failure-has the mystery been unravelled?[J]. Curr Heart Fail Rep, 2021,18(5):315-328.
23 戴日新，刘露佳，杨锡恒，等.达格列净在合并2型糖尿病的射血分数中间值心力衰竭患者中的研究[J].实用医学杂志，2020,36(18):2505-2509.
基本信息:
DOI：10.13210/j.cnki.jhmu.20230322.002
中图分类号:R541.6;R587.1
引用信息:
[1]许琳慧,王万虹,张义,等.达格列净治疗2型糖尿病合并射血分数轻度下降心力衰竭患者的临床疗效[J].海南医学院学报,2023,29(09):681-687.DOI:10.13210/j.cnki.jhmu.20230322.002.
基金信息:
宿迁科技计划项目（Z2019178）~~
2023-03-23
2023-03-23
2023-03-23