葡萄糖钠协同转运体-2抑制剂对2型糖尿病合并急性心肌梗死直接经皮冠状动脉介入治疗心力衰竭预后的效果  

Effect of sodium-glucose cotransporter-2 inhibitors on the prognosis of direct percutaneous coronary intervention in heart failure in type 2 diabetes mellitus complicated with acute myocardial infarction

作　　者：李军华 高鸿 江小杰[1] LI Junhua;GAO Hong;JIANG Xiaojie(The First Department of Cardiology,the First Hospital of Nanchang,Jiangxi Province,Nanchang 330008,China)

机构地区：[1]南昌市第一医院心血管一科,江西南昌330008

出　　处：《中国当代医药》2025年第4期27-35,共9页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(202311204)。

摘　　要：目的探讨葡萄糖钠协同转运体-2抑制剂(SGLT-2i)联合应用“金三角”药物[血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)/血管紧张素受体脑啡肽酶抑制剂(ARNI)+β受体阻滞剂+醛固酮受体拮抗剂]对2型糖尿病合并急性心肌梗死直接经皮冠脉介入术(PCI)后心力衰竭预后的疗效和安全性。方法选取2022年1月至12月南昌大学第三附属医院心血管内科收治的2型糖尿病合并急性ST段抬高型心肌梗死,并在入院12 h内行直接PCI的80例患者作为研究对象,采用随机数字表法将其分为试验组和对照组,每组40例。试验组采用恩格列净联合“金三角”药物,对照组采用盐酸二甲双胍片联合“金三角”药物,比较随访1年期间两组患者的各项观察指标,包括血压、心率、心脏彩超(心室重构、射血分数、心肌应变率等指标)、糖代谢情况及体重指数、脂代谢情况和肾脏功能,以及治疗期间的并发症发生情况。结果随访1年期间,两组患者的平均血压和心率均控制在正常范围。试验组治疗6个月、1年左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)低于对照组,治疗1年左心室后壁厚度(LVPW)低于对照组,治疗1、3、6个月,1年室间隔厚度(IVST)、血浆氨基末端脑钠肽前体(NT-proBNP)低于对照组,左室射血分数(LVEF)、心肌应变率、二尖瓣舒张早期血流速度峰值与二尖瓣舒张晚期血流速度峰值的比值(E/A)高于对照组,差异有统计学意义(P<0.05)。试验组治疗3个月糖化血红蛋白(HbA1c)、总胆固醇(TC)高于对照组,治疗1个月、1年TC低于对照组,治疗1、3、6个月,1年总甘油三酯(TG)、血肌酐低于对照组,肾小球滤过率(eGFR)高于对照组,差异有统计学意义(P<0.05)。结论相较于其他非SGLT-2i抑制剂类降糖药,SGLT-2i更能改善远期患者心室重构情况、血脂代谢情况和肾功能。使用SGLT-2i联合“金三角”药物,对PCI术后的2型�Objective To investigate the efficacy and safety of sodium-glucose cotransporter-2 inhibitors(SGLT-2i)combined with"golden triangle"drugs(angiotensin converting enzyme inhibitors[ACEI]/angiotensin receptor blocker[ARB]/angiotensin receptor-neprilysin inhibitor[ARNI]+β-blockers+aldosterone receptor antagonists)in the prognosis of heart failure after direct percutaneous coronary intervention(PCI)for type 2 diabetes mellitus complicated with acute myocardial infarction.Methods A total of 80 patients with type 2 diabetes mellitus complicated with acute ST-segment elevation myocardial infarction admitted to the Department of Cardiovascular Medicine of the Third Affiliated Hospital of Nanchang University from January to December 2022 who underwent direct PCI within 12 hours of admission were selected as the research objects,and they were divided into experimental group and control group according to random number table method,with 40 cases in each group.The experimental group was treated with Empagliflozin combined with"golden triangle"drug,and the control group was treated with Metformin Hydrochloride Tablets combined with"golden triangle"drug.During 1-year follow-up,various observation indexes of the two groups were compared,including blood pressure,heart rate,color Doppler ultrasonography(ventricular remodeling,ejection fraction,myocardial strain rate,etc.),glucose metabolism,body mass index,lipid metabolism,kidney function,and the occurrence of complications during treatment.Results During 1 year follow-up,the mean blood pressure and heart rate of both groups were controlled in the normal range.Left ventricular end diastolic diameter(LVEDD)and left ventricular end systolic diameter(LVESD)of experimental group were lower than those of control group at 6 months and 1 year,and left ventricular posterior wall(LVPW)of experimental group were lower than those of control group at 1,3,6 month.The interventricular septal thickness(IVST)and N terminal pro B type natriuretic peptide(NT-proBNP)were lower than those of control

关 键 词：葡萄糖钠协同转运体-2抑制剂 2型糖尿病 急性心肌梗死 心力衰竭 

分 类 号：R542.22[医药卫生—心血管疾病]