达格列净对重度退行性主动脉瓣关闭不全行瓣膜置换术后左心室重构的影响研究  

Study on the effect of dapagliflozin on left ventricular remodeling after valve replacement for severe degenerative aortic insufficiency

作　　者：满红 于浩 张誉籍 张晓云 Man Hong;Yu Hao;Zhang Yuji;Zhang Xiaoyun(Department of Cardiovascular Surgery,Northern Theater Command General Hospital,Shenyang 110001,China)

机构地区：[1]北部战区总医院心血管外科,辽宁沈阳110001

出　　处：《实用药物与临床》2025年第3期192-196,共5页Practical Pharmacy and Clinical Remedies

基　　金：辽宁省科技计划联合计划(重点研发计划项目)(2023JH2/101800015)。

摘　　要：目的评估达格列净对重度退行性主动脉瓣关闭不全行主动脉瓣置换术后(Aortic valve replacement,AVR)患者左心室重构的影响。方法回顾性分析2019年1月至2023年4月因重度退行性主动脉瓣关闭不全在北部战区总医院心血管外科行单纯主动脉瓣置换术的74例患者的临床资料。根据术后口服达格列净的情况将患者分为2组:全程服药组(全疗程口服达格列净,n=38)、间断服药组(未全程口服达格列净,n=36)。比较术前1周及术后3个月两组患者的左心室质量(LVM)、左心室质量指数(LVMI)、左心室质量指数/左心室舒张末期容积指数(LVMI/LVEDVI)、二尖瓣早期血流峰值速度/二尖瓣环舒张早期运动速度(E/e')以及室间隔厚度(IVST)和左心室后壁厚度(LVPWT)等指标的变化情况。结果术前1周两组患者各项指标比较,差异均无统计学意义(P>0.05)。术后3个月,两组LVM、LVMI、E/e'比较,差异无统计学意义(P>0.05);全程服药组的LVMI/LVEDVI[(1.37±0.04)g/ml]低于间断服药组[(1.39±0.07)g/ml],差异具有统计学意义(P<0.05);在IVST和LVPWT指标上,全程服药组的均低于间断服药组[IVST:(11.75±0.56)mm vs.(11.98±0.35)mm;LVPWT:(10.48±0.23)mm vs.(11.63±0.51)mm],差异均有统计学意义(P<0.05)。结论达格列净能明显改善重度退行性主动脉瓣关闭不全患者行AVR术后患者左心室重构,全疗程口服达格列净疗效优于间断服药,尤其对偏心性肥厚有积极作用,但对患者左心室舒张指标E/Ea影响不明显。Objective To evaluate the effect of dapagliflozin on left ventricular remodeling in patients with severe degenerative aortic valve insufficiency who underwent aortic valve replacement(AVR).Methods A retrospective analysis was conducted on the clinical data of 74 patients who underwent isolated AVR for severe degenerative aortic valve insufficiency at the Cardiovascular Surgery Department of Northern Theater Command General Hospital from January 2019 to April 2023.Based on the use of oral dapagliflozin postoperatively,patients were divided into two groups:full-course medication group(patients took dapagliflozin for the entire course,n=38)and intermittent medication group(other patients,n=36).The changes in left ventricular mass(LVM),left ventricular mass index(LVMI),LVMI/left ventricular end-diastolic volume index(LVMI/LVEDVI),early mitral inflow velocity/early diastolic mitral annular velocity(E/e'),interventricular septal thickness(IVST),and left ventricular posterior wall thickness(LVPWT)were compared between the two groups at one week before operation and three months after operation.Results There were no statistically significant differences between the two groups in any of the indicators one week before surgery(P>0.05).At three months after surgery,there were no significant differences between the two groups in LVM,LVMI,or E/Ea(P>0.05);however,the LVMI/LVEDVI in the full-course medication group[(1.37±0.04)g/ml]was lower than that in the intermittent medication group[(1.39±0.07)g/ml],and the difference was statistically significant(P<0.05).In terms of IVST and LVPWT,the full-course medication group showed lower values compared to the intermittent medication group[IVST:(11.75±0.56)mm vs.(11.98±0.35)mm;LVPWT:(10.48±0.23)mm vs.(11.63±0.51)mm],with statistically significant differences(P<0.05).Conclusion Dapagliflozin can significantly improve left ventricular remodeling in patients with severe degenerative aortic valve insufficiency undergoing AVR.Fullcourse oral dapagliflozin treatment is more effective t

关 键 词：主动脉瓣关闭不全 左心室质量指数 达格列净 左心室重构 

分 类 号：R54[医药卫生—心血管疾病]