[1]郑黄生,周炳凤.钠-葡萄糖协同转运蛋白-2抑制剂治疗射血分数降低心力衰竭的疗效及预后分析[J].医学信息,2021,34(10):92-96.[doi:10.3969/j.issn.1006-1959.2021.10.025]
　ZHENG Huang-sheng,ZHOU Bing-feng.Efficacy and Prognosis of Sodium-glucose Cotransporter-2 Inhibitor in Treatment of Heart Failure with Lower Ejection Fraction[J].Medical Information,2021,34(10):92-96.[doi:10.3969/j.issn.1006-1959.2021.10.025]
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钠-葡萄糖协同转运蛋白-2抑制剂治疗射血分数降低心力衰竭的疗效及预后分析()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
34卷
期数:
2021年10期
页码:
92-96
栏目:
论著
出版日期:
2021-05-15

文章信息/Info

Title:
Efficacy and Prognosis of Sodium-glucose Cotransporter-2 Inhibitor in Treatment of Heart Failure with Lower Ejection Fraction
文章编号:
1006-1959（2021）10-0092-03
作者:
郑黄生; 周炳凤
（安徽医科大学第三附属医院/合肥市第一人民医院心血管内科，安徽 合肥 230000）
Author(s):
ZHENG Huang-sheng; ZHOU Bing-feng
(Department of Cardiovascular Medicine,The Third Affiliated Hospital of Anhui Medical University/Hefei First People’s Hospital,Hefei 230000,Anhui,China)
关键词:
钠-葡萄糖协同转运蛋白-2抑制剂; 慢性心力衰竭; 达格列净; 射血分数降低
Keywords:
Sodium-glucose co-transporter-2 inhibitor; Chronic heart failure; Dapagliflozin; Ejection fraction decreased
分类号:
R541.6；R587.1
DOI:
10.3969/j.issn.1006-1959.2021.10.025
文献标志码:
A
摘要:
目的 探讨在射血分数降低心力衰竭（HFrEF）患者的标准治疗方案基础上应用钠-葡萄糖协同转运蛋白-2抑制剂（SGLT-2i）达格列净的临床疗效及对预后的影响。方法 选取2018年10月~2019 年10 月我院门诊及住院诊治的147例伴或不伴2型糖尿病的慢性HFrEF患者作为研究对象，采用随机数字表法分为对照组（74例）和观察组（73例）。对照组接受HFrEF标准治疗方案，观察组在HFrEF标准治疗基础上联合应用SGLT-2i达格列净治疗，以心血管死亡或因心衰再住院为主要不良终点事件，并根据伴或不伴2型糖尿病预设亚组，采用Kaplan-Meier生存曲线法比较两组及亚组之间患者治疗12个月内主要终点事件、因心衰再住院事件的发生率，比较两组治疗12个月后的血浆N末端B型利钠肽原（NT-proBNP）、左室射血分数（LVEF）、左室舒张末期内径（LVEDD） 、6分钟步走试验距离（6MWD）、明尼苏达心力衰竭生活质量量表评分（MHFQL）的变化情况及不良事件反应的发生率。结果 与对照组比较，SGLT-2i达格列净使主要不良终点事件相对风险降低了40%[HR=0.60，95%CI（0.37~0.99），P=0.046]，其中因心衰再住院事件[HR=0.56，95%CI（0.31~0.99），P=0.047]的发生率低于对照组。在心力衰竭伴2型糖尿病亚组中，主要不良终点事件发生率[HR=0.62，95%CI（0.32-1.23），P=0.173]低于对照组，在心力衰竭不伴2型糖尿病亚组中，主要不良终点事件发生率[HR=0.58，95%CI（0.28-1.23），P=0.155]也低于对照组，但均无统计学意义（P＞0.05）；治疗后，两组NT-proBNP、LVEF、LVEDD均得到改善（P＜0.05），但两组改善效果比较，差异无统计学意义（P＞0.05）；两组6MWD和MHFQL均有显著改善，且观察组改善程度优于对照组（P＜0.05）；两组不良事件反应的发生情况比较，差异无统计学意义（P＞0.05）。结论 无论是否合并2型糖尿病，在HFrEF标准治疗方案基础上应用SGLT-2i达格列净能进一步降低患者的心血管死亡或因心衰再住院风险，并能提高患者的生活质量，且具有良好的安全性。
Abstract:
Objective To investigate the clinical efficacy and prognostic effects of sodium-glucose cotransporter-2 inhibitor (SGLT-2i) dapagliflozin on the basis of the standard treatment plan for patients with heart failure (HFrEF) with reduced ejection fraction.Methods 147 patients with chronic HFrEF with or without type 2 diabetes who were diagnosed and treated in our hospital from October 2018 to October 2019 were selected as the research objects.Using random number table method, they were divided into control group (74 cases) and observation group (73 cases).The control group received HFrEF standard treatment plan, and the observation group was treated with SGLT-2i dapagliflozin on the basis of HFrEF standard treatment.Cardiovascular death or rehospitalization due to heart failure was the main adverse end point, and the subgroups were preset based on whether with or without type 2 diabetes.The Kaplan-Meier survival curve method was used to compare the incidence of primary endpoint events and rehospitalization events due to heart failure between the two groups and subgroups within 12 months of treatment.Compare the plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), and 6-minute walking test distance (6MWD) between the two groups after 12 months of treatment,as well as the changes in the Minnesota Heart Failure Quality of Life Scale (MHFQL) and the incidence of adverse events.Results Compared with the control group, SGLT-2i dapagliflozin reduced the relative risk of the primary adverse end point by 40% [HR=0.60, 95%CI (0.37~0.99), P=0.046],The incidence of rehospitalization due to heart failure [HR=0.56, 95%CI (0.31~0.99), P=0.047] was lower than that of the control group.In the heart failure with type 2 diabetes subgroup, the incidence of the main adverse end point [HR=0.62, 95%CI (0.32-1.23), P=0.173] was lower than that of the control group.In the subgroup of heart failure without type 2 diabetes, the incidence of the main adverse end point [HR=0.58, 95%CI (0.28-1.23), P=0.155] was also lower than that of the control group, but there was no statistical significance (P＞0.05);After treatment, the two groups of NT-proBNP, LVEF, LVEDD were all improved (P<0.05),However, there was no statistically significant difference in the improvement effect between the two groups (P＞0.05);The 6MWD and MHFQL of the two groups were significantly improved, and the improvement degree of the observation group was better than that of the control group (P＜0.05);There was no statistically significant difference in the occurrence of adverse events between the two groups (P＞0.05).Conclusion Regardless of whether type 2 diabetes is complicated or not, the application of SGLT-2i dapagliflozin on the basis of the standard treatment plan of HFrEF can further reduce the risk of cardiovascular death or rehospitalization due to heart failure, and can improve the quality of life of patients, and has a good security.

参考文献/References:

[1]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2019概要[J].中国循环杂志,2020,35(9):833-854.[2]McMurray JJV,DeMets DL,Inzucchi SE,et al.A trial to evaluate the effect of the sodium-glucose co-transporter 2 inhibitor dapagliflozin on morbidity and mortality in patients with heart failure and reduced left ventricular ejection fraction(DAPA-HF)[J].Eur J Heart Fail,2019 ,21(5):665-675.[3]中华医学会心血管病学分会心力衰竭学组,中国医师协会心力衰竭专业委员会与中华心血管病杂志编辑委员会.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]Rosenstein R,Hough A.Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes[J].New England Journal of Medicine,2016,374(11):1092-1094.[5]Mahaffey KW,Neal B,Perkovic V,et al.Canagliflozin for Primary and Secondary Prevention of Cardiovascular Events: Results From the CANVAS Program (Canagliflozin Cardiovascular Assessment Study)[J].Circulation,2018,137(4):323.[6]Wiviott SD,Raz I,Bonaca MP,et al.Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes[J].N Engl J Med,2019,380(4):347-357.[7]戴日新,刘露佳,杨锡恒.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.[8]杨震,董健,张军涛,等.达格列净在2型糖尿病合并心功能不全患者中应用的临床评价分析[J].重庆医学,2019,48(16):2861-2863.[9]杨光全,展庆垒,吴付轩.达格列净对慢性心力衰竭合并2型糖尿病患者左心室舒张功能的影响[J].中国循证心血管医学杂志,2019,11(9):1118-1120,1124.[10]包丽雯,李勇.SGLT2抑制剂恩格列净心血管保护作用及研究——EMPA-HEARTCardiolink6研究简评[J].中国糖尿病杂志,2019,27(7):557-560.[11]Singh JSS,Mordi IR,Vickneson K,et al.Dapagliflozin Versus Placebo on Left Ventricular Remodeling in Patients With Diabetes and Heart Failure: The REFORM Trial[J].Diabetes Care,2020,43(6):1356-1359.[12]Nassif ME,Windsor SL,Tang F,et al.Dapagliflozin Effects on Biomarkers, Symptoms, and Functional Status in Patients With Heart Failure With Reduced Ejection Fraction[J].Circulation, 2019,140(18):1463-1476.[13]Stenlof K,Cefalu WT,Kim KA,et al.Efficacy and safety of anaglifozin monotherapy in subjectswith type 2 diabetes mel-lius inadequately controlled with diet and exercise[J].Diabetes Obes Metab,2013,15(4):372-382.[14]Ferrannini E,Seman L,Seewaldt-Becker E,et al.APhase Ib,randomized.placebo-controlled study of the SGLT2 inhibitor empagliflozin in patients with type 2 diabetes[J].Diabetes Obes Metab,2013,15(8):721-728.[15]Roden M,Weng J,Eilbracht J,et al.Empagliflozin monothera-py with sitagliptin as an active comparator in patients with type 2 diabetes:arandomised,double-blind,placebo-controlled, phase 3 trial[J].Lancet Diabetes Endocrinol,2013,1(3):208-219.[16]Gupta P,White WB.Cardiovascular safety of therapies for type 2 diabetes[J].Expert Opin Drug Saf,2017,16(1):13-25.

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更新日期/Last Update: 1900-01-01