卡格列净对行生物瓣膜置换术的2型糖尿病老年患者的短期预后影响  

Effect of canagliflozin on short-term prognosis in elderly patients undergoing bioprosthetic valve replacement

作　　者：柳莹莹 田阳玲 王琼琳 Liu Yingying;Tian Yangling;Wang Qionglin(Department of General Medicine,Henan Second Provincial People’s Hospital,Affiliated Hospital of Henan Medical College,Zhengzhou 451191,China)

机构地区：[1]河南医学高等专科学校附属医院,河南省第二人民医院全科医学科,郑州451191

出　　处：《中国心血管杂志》2022年第6期552-556,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨卡格列净对行生物瓣膜置换的2型糖尿病老年患者术后随访1年的预后影响。方法回顾性选取2019年1月至2020年8月河南省第二人民医院收治的行生物瓣膜置换手术的2型糖尿病老年患者,根据是否应用卡格列净治疗分为观察组(112例)和对照组(112例)。主要观察指标为术后随访1年发生主要不良心血管事件(MACE),包括心原性死亡或心脏骤停、心力衰竭住院、急性冠状动脉综合征和卒中。结果共纳入224例患者,平均年龄(70.7±9.0)岁。两组患者的年龄、合并衰弱、B型利钠肽、左室舒张末期容积、入住ICU后舒张压和心率等均有统计学差异(均为P<0.05)。平均随访(13.5±2.2)个月,观察组的心力衰竭住院(HR=0.807)、急性冠状动脉综合征(HR=0.789)和MACE(HR=0.792)均低于对照组(均为P<0.05)。Spearman相关性分析结果显示,卡格列净与心力衰竭住院风险(r=-0.797,P=0.01)、急性冠状动脉综合征(r=-0.763,P=0.02)和MACE(r=-0.720,P=0.04)均呈负相关。Cox回归分析结果显示,年龄(HR=1.847,P=0.012)、合并衰弱(HR=1.785,P=0.011)、B型利钠肽(HR=2.138,P=0.005)和改良心脏危险指数评分(HR=2.346,P=0.007)是发生MACE的独立危险因素,而卡格列净(HR=0.672,P=0.001)是其保护因素。结论卡格列净可降低行生物瓣膜置换手术的2型糖尿病老年患者随访1年的MACE风险。Objective To investigate the 1-year prognosis of canagliflozin in elderly patients with type 2 diabetes who underwent bioprosthetic valve replacement.Methods The elderly patients with type 2 diabetes who underwent bioprosthetic valve replacement surgery in Henan Second Provincial People’s Hospital from January 2019 to August 2020 were retrospectively selected and divided into observation group(112 cases)and control group(112 cases)according to whether they were treated with canagliflozin or not.The main outcome measure was the occurrence of major adverse cardiovascular events(MACE)at 1-year follow-up,including cardiac death/arrest,heart failure hospitalization,acute coronary syndrome and stroke.Results A total of 224 patients were included,with an average age of(70.9±9.7)years.There were significant differences in age,frailty,B-type natriuretic peptide,left ventricular end-diastolic volume,diastolic blood pressure and heart rate detected after hospitalized to ICU between the two groups(all P<0.05).After an average follow-up of(13.5±2.2)months,the rates of heart failure hospitalization(HR=0.807),acute coronary syndrome(HR=0.789)and MACE(HR=0.792)in the observation group were lower than those in the control group(HR=0.792)(all P<0.05).The results of Spearman correlation analysis showed that canagliflozin was associated with the rate of heart failure hospitalization(r=-0.797,P=0.01),acute coronary syndrome(r=-0.763,P=0.02)and MACE(r=-0.720,P=0.04)were negatively correlated.Cox regression analysis showed that age(HR=1.847,P=0.012),frailty(HR=1.785,P=0.011),B-type natriuretic peptide(HR=2.138,P=0.005)and revised cardiac risk index score(HR=2.346,P=0.007)were independent risk factors for MACE,and canagliflozin(HR=0.672,P=0.001)was its protective factor.Conclusions Canagliflozin can reduce the 1-year risk of MACE in elderly patients with type 2 diabetes who underwent bioprosthetic valve replacement surgery.

关 键 词：瓣膜置换 卡格列净 不良心血管事件 危险因素 

分 类 号：R654.2[医药卫生—外科学] R587.2[医药卫生—临床医学]