恩格列净联合rhBNP治疗射血分数降低型心力衰竭的疗效及对患者心功能和血清FGF-21、sVEGFR-2水平的影响  

Efficacy of empagliflozin combined with rhBNP in the treatment of heart failure with reduced ejection fraction and its effect on cardiac function and serum FGF-21 and sVEGFR-2 levels

作　　者：郇雷 谢纯 张增堂 亓华新 王方明 HUAN Lei;XIE Chun;ZHANG Zeng-tang(Department of Cardiology,People's Hospital Affiliated to Shandong First Medical University,Jinan Shandong 271199,China)

机构地区：[1]山东第一医科大学附属人民医院心内科,山东济南271199

出　　处：《临床和实验医学杂志》2024年第7期678-682,共5页Journal of Clinical and Experimental Medicine

基　　金：山东省医药卫生科技发展计划项目(编号:2015WS0408)。

摘　　要：目的探究恩格列净联合重组人脑利钠肽(rhBNP)治疗射血分数降低型心力衰竭(HFrEF)的疗效及对患者心功能和血清成纤维细胞生长因子-21(FGF-21)、可溶性血管内皮生长因子受体-2(sVEGFR-2)水平的影响。方法前瞻性选取2022年1月至2023年3月山东第一医科大学附属人民医院心内科收治的100例HFrEF患者为研究对象。按照随机数字表法将其分为对照组和观察组,每组各50例。对照组予以常规强心、利尿治疗及静脉泵入rhBNP,观察组在对照组基础上加用恩格列净。比较两组治疗前、治疗3个月后糖化血红蛋白(HbA1c)、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、6 min步行距离测试(6MWD)、N末端脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)及血清FGF-21、sVEGFR-2水平,并记录两组主要心血管不良事件(MACE)发生情况。结果观察组临床总有效率为94.00%,高于对照组(80.00%),差异有统计学意义(P<0.05)。治疗3个月后,观察组HbA1c水平为(5.34±1.51)%,低于对照组[(6.03±1.65)%],差异有统计学意义(P<0.05);两组患者的总胆固醇、LDL-C水平比较,差异均无统计学意义(P>0.05)。治疗3个月后,观察组LVEF、6MWD水平分别为(38.52±7.24)%、(493.66±47.79)m,均高于对照组[(34.02±8.06)%、(455.92±50.25)m],NT-proBNP水平为(4386.75±875.89)pg/mL,低于对照组[(4326.04±843.66)pg/mL],差异均有统计学意义(P<0.05)。治疗3个月后,观察组血清FGF-21水平为(54.93±12.51)pg/mL,低于对照组[(61.50±15.66)pg/mL],sVEGFR-2水平为(8.96±1.95)ng/mL,高于对照组[(8.14±1.67)ng/mL],差异均有统计学意义(P<0.05)。观察组与对照组MACE总发生率分别为6.00%、16.00%,差异无统计学意义(P>0.05)。结论在rhBNP治疗HFrEF的基础上加用恩格列净可明显提高临床疗效,改善患者心功能,降低HbA1c、FGF-21水平,并提高sVEGFR-2水平可能是其增效的作用机制。Objective To investigate the efficacy of empagliflozin combined with recombinant human brain natriuretic peptide(rhBNP) in the treatment of heart failure with reduced ejection fraction(HFrEF) and its effects on cardiac function and serum fibroblast growth factor-21(FGF-21) and soluble vascular endothelial growth factor receptor-2(sVEGFR-2) levels.Methods A total of 100 HFrEF patients admitted to the Department of Cardiology at People's Hospital Affiliated to Shandong First Medical University from January 2022 to March 2023 were prospectively selected as the study subjects.They were divided into the control group and the observation group according to the random number table method,50 cases in each group.The control group was treated with routine cardiotonic,diuretic therapy and intravenous pumping of rhBNP;the observation group was treated with empagliflozin on the basis of the control group.The levels of glycosylated hemoglobin(HbA1c),total cholesterol,low density lipoprotein cholesterol(LDL-C),6-minute walking distance test(6MWD),N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),serum FGF-21 and sVEGFR-2 were compared between the two groups.The occurrence of major cardiovascular adverse events(MACE) in two groups was recorded.Results The total clinical effective rate of the observation group was 94.00%,which was higher than that of the control group(80.00%),and the difference was statistically significant(P<0.05).After 3 months of treatment,the HbA1c level in the observation group was(5.34±1.51)%,which was lower than that in the control group [(6.03±1.65)%],and the difference was statistically significant(P<0.05);there were no statistically significant differences in total cholesterol and LDL-C levels between the two groups of patients(P>0.05).After 3 months of treatment,the LVEF and 6MWD levels in the observation group were(38.52±7.24)% and(493.66±47.79) m,respectively,which were higher than those in the control group [(34.02±8.06)% and(455.92±50.25) m],and the

关 键 词：心力衰竭 成纤维细胞生长因子 血管内皮生长因子受体-2 恩格列净 重组人脑利钠肽 心功能 

分 类 号：R541.6[医药卫生—心血管疾病]