联合用药对糖尿病射血分数中间值心力衰竭患者预后的影响  

The impact of combination therapy on the prognosis of patients with heart failure with mid-range ejection fraction combined with diabetes mellitus

作　　者：段国宇[1] 郑绪伟[2] 高艳霞[1] 袁丁[1] 孙昌华[1] 李莉[1] DUAN Guoyu;ZHENG Xuwei;GAO Yanxia;YUAN Ding;SUN Changhua;LI Li(Department of Emergency Medical,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院急诊医学部,450000 [2]郑州大学第一附属医院心内科,450000

出　　处：《心肺血管病杂志》2023年第6期541-546,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探索在射血分数中间值的心力衰竭(heart failure with mid-range ejection fraction,HFmrEF)合并糖尿病患者中,沙库巴曲缬沙坦(angiotensin receptor-neprilysin inhibitor,ARNI)和钠-葡萄糖协同转运蛋白-2(sodium-dependent glucose transporters 2,SGLT2)抑制剂联合用药治疗对患者预后的影响。方法:回顾性研究2020年3月至2021年2月,于郑州大学第一附属医院诊断为HFmrEF合并糖尿病的患者593例。所有患者根据是否服用ARNI和SGLT2抑制剂分为四组:对照组(n=234),ARNI组(n=111),SGLT2抑制剂组(n=136)和联合用药组(n=103)。主要结局:心力衰竭(HF)再住院、心源性死亡。随访2年。采用生存分析明确不同用药方案与HF再住院结局间的关系。通过多元Cox回归分析探索不同用药方案对HF再住院风险的影响。结果:在四个组别中,联合用药组HF再住院发生率显著降低(61.7%vs.46.8%vs.45.6%vs.30.1%,P<0.001)。而心源性死亡发生率四组间差异无统计学意义(P>0.05)。生存分析表明,联合用药组HF再住院率显著低于其他三组(Log-rank P均<0.05)。多元Cox回归分析表明:相比于对照组,ARNI(HR=0.70,95%CI:0.51~0.97,P=0.033)、SGLT2抑制剂(HR=0.71,95%CI:0.53~0.96,P=0.028)及联合用药治疗(HR=0.40,95%CI:0.27~0.60,P<0.001)患者HF再住院风险显著降低。其中,联合用药的保护作用显著优于单用ARNI(HR=0.58,95%CI:0.37~0.92,P=0.021)或SGLT2抑制剂(HR=0.59,95%CI:0.37~0.94,P=0.026)。结论:在HFmrEF合并糖尿病的患者中,ARNI和SGLT2抑制剂联合治疗可显著降低HF再住院的发生风险,从而改善患者的预后。Objective:The objective of this study was to assess the prognostic impact of combination therapy using angiotensin receptor-neprilysin inhibitor(ARNI)and SGLT2 inhibitors in individuals affected by heart failure with mid-range ejection fraction(HFmrEF)and diabetes meuitus.Methods:This study is a single-center retrospective cohort study,involving participants who received a diagnosis of HFmrEF and diabetes meuitus at the First Affiliated Hospital of Zhengzhou University between March 2020 and February 2021.A total of 593 patients were included and subsequently categorized into four distinct groups,depending on their usage of ARNI and SGLT2 inhibitors:control group(n=234),ARNI group(n=111),SGLT2 inhibitor group(n=136),and combination group(n=103).The primary endpoints of the study were the incidence of rehospitalization due to heart failure(HF)and cardiogenic death.The follow-up time was 2 years.The study utilized survival analysis to examine the correlation between different medication regimens and HF rehospitalization.Furthermore,multivariate Cox regression analysis was implemented to assess the effect of different medication regimens on the risk of HF rehospitalization,with the results presented in terms of hazard ratio HR and a 95%CI confidence interval.Results:The incidence of HF rehospitalization was significantly lower in the combination group than the rest of groups(control vs.ARNI group vs.SGLT2 inhibitor group vs combination group:150,61.7%vs.52,46.8%vs.62,45.6%vs.31,30.1%,P<0.001).While,the incidence of cardiogenic death was not statistically different between the four groups(P>0.05).Survival analysis showed a significantly lower rate of rehospitalization for HF in the combination group than the rest of groups(Log-rank P<0.05 for all).Multiple Cox regression analysis showed that the risk of HF rehospitalization decreased significantly in ARNI group(HR=0.70,95%CI:0.51-0.97,P=0.033),SGLT2 inhibitor group(HR=0.71,95%CI:0.53-0.96,P=0.028)and combination group(HR=0.40,95%CI:0.27-0.60,P<0.001).The protective e

关 键 词：射血分数中间值心力衰竭 糖尿病 沙库巴曲缬沙坦 钠-葡萄糖协同转运蛋白-2抑制剂 

分 类 号：R54[医药卫生—心血管疾病]