钠-葡萄糖共转运蛋白2抑制剂对合并射血分数中间值心力衰竭的糖尿病患者心肾临床结局的影响  

Effect of sodium-glucose cotransporter-2 inhibitors on the clinical outcome of heart and kidney in diabetic patients with heart failure with midrange ejection fraction

作　　者：郝修宏[1] 王磊[1] 白智峰[1] Hao Xiuhong;Wang Lei;Bai Zhifeng(Department of Cardiology,Ward 2,the First People’s Hospital of Shangqiu City,Shangqiu 476100,China)

机构地区：[1]商丘市第一人民医院心内二科,476100

出　　处：《中国心血管杂志》2022年第1期49-52,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)对合并射血分数中间值心力衰竭(HFmrEF)的糖尿病患者心肾临床结局的影响。方法回顾性选取2019年1月至2020年10月商丘市第一人民医院心内科收治的合并HFmrEF的糖尿病患者350例,根据是否应用SGLT2i分为SGLT2i组76例和对照组274例。主要观察指标为随访发生心肾事件,包括死亡、急性心力衰竭入院、急性冠状动脉综合征和急性肾功能不全。结果两组患者的基线资料均相似。平均随访时间为(10.3±5.6)个月,有33例(9.4%)心肾事件。SGLT2i组和对照组分别有5例(6.6%)和28例(10.2%)。SGLT2i组的急性心力衰竭入院发生率显著低于对照组(3.9%比6.6%,HR=0.599,95%CI:0.380~0.944,P=0.022),但死亡(0比0.4%)、急性冠状动脉综合征(1.3%比1.8%)和急性肾功能不全(1.3%比1.5%)发生率均相似(均为P>0.05)。Kaplan-Meier生存分析结果显示,SGLT2i与心力衰竭住院风险呈显著负相关(OR=0.582,Log-rank检验P=0.016),与心肾临床结局呈显著负相关(OR=0.649,Log-rank检验P=0.011)。Logistic回归分析结果显示,SGLT2i(OR=0.867,P=0.002)、老年(OR=1.814,P=0.012)和N末端B型利钠肽原(OR=1.681,P=0.031)是发生心肾事件的独立影响因素。结论SGLT2i可降低合并HFmrEF的糖尿病患者心肾临床结局风险。Objective To investigate the effect of sodium-glucose cotransporter-2 inhibitors(SGLT2i)on the clinical outcome of diabetic patients with heart failure with midrange ejection fraction(HFmrEF).Methods A retrospective selection of 350 diabetic patients with HFmrEF admitted to the First People’s Hospital of Shangqiu City from January 2019 to October 2020 were divided into SGLT2i group(n=76)and control group(n=274)according to whether SGLT2i were applied or not.The main observation indicators were the occurrences of cardio-renal events during follow-up,including death,hospitalization with acute heart failure,acute coronary syndrome,and acute renal insufficiency.Results The baseline data of the two groups were similar.The average follow-up time was(10.3±5.6)months,and there were 33 cases(9.4%)of cardio-renal events,including 5 cases(6.6%)in SGLT2i group and 28 cases(10.2%)in control group.The acute heart failure admission rate was significantly lower in SGLT2i group than that in control group(3.9%vs.6.6%,HR=0.599,95%CI:0.380-0.944,P=0.022),but the incidences of death(0 vs.0.4%),acute coronary syndrome(1.3%vs.1.8%)and acute renal insufficiency(1.3%vs.1.5%)were similar(all P>0.05).The result of Kaplan-Meier survival analysis showed that SGLT2i was significantly negatively correlated with the risk of heart failure hospitalization and cardio-renal events(OR=0.582,Log-rank test P=0.016;OR=0.649,Log-rank test P=0.011).Logistic regression analysis showed that SGLT2i(OR=0.867,P=0.002),old age(OR=1.814,P=0.012),NTproBNP(OR=1.681,P=0.031)were independent factors for the occurrence of heart and kidney events.Conclusions SGLT2i can reduce the risk of cardio-renal clinical outcomes in diabetic patients with HFmrEF.

关 键 词：钠-葡萄糖共转运蛋白2抑制剂 射血分数中间值心力衰竭 糖尿病 心肾临床结局 

分 类 号：R541.6[医药卫生—心血管疾病] R587.1[医药卫生—内科学]