达格列净在NAFLD并CHF患者中的应用效果及可能机制  

Effects and potential mechanisms of dapagliflozin in patients with nonalcoholic fatty liver disease complicated by chronic heart failure

作　　者：张磊 ZHANG Lei(Xinjiang Integrated Traditional Chinese and Western Medicine Hospital,Urumqi,830011,China)

机构地区：[1]新疆维吾尔自治区中西医结合医院,乌鲁木齐830011

出　　处：《新疆医学》2025年第1期68-72,共5页Xinjiang Medical Journal

摘　　要：目的 研究达格列净在非酒精性脂肪肝(NAFLD)并慢性心力衰竭(CHF)患者中的临床效果及可能机制。方法 92例NAFLD并CHF患者被随机分为观察组、对照组(各46例),两组均予以规范化NAFLD并CHF治疗,观察组另增用达格列净治疗。对比两组糖脂代谢、心功能、脂肪肝相关指标差异。结果 治疗前两组糖脂代谢指标、心功能指标、内脏脂肪面积、炎症反应及氧化应激反应指标均无统计学意义(P>0.05),治疗后两组患者的空腹血糖(FPG)、餐后2h血糖(2h PG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)与丙二醛(MDA)水平均下降,高密度脂蛋白(HDL-C)水平均增加,且观察组变化更大;治疗后两组左心室收缩末期与舒张末期内径(LVDs与LVED)参数值均较治疗前明显减低,左心室射血分数(LVEF)、血管内皮生长因子(VEGF)表达水平明显增高,且观察组变化更大;治疗后两组脂肪面积均下降,且观察组较对照组更低,(均P<0.05)。结论 达格列净可能够通过调节糖脂代谢、对抗炎症反应与氧化应激反应、调节肠道菌群分布、调节肾素-血管紧张素-醛固酮系统机制来改善NAFLD并CHF患者的心功能与内脏脂肪面积。ZHANG Lei;Xinjiang Integrated Traditional Chinese and Western Medicine Hospital;ObjectiveTo study the clinical effect and mechanism of dapagliflozin in patients with non-alcoholic fatty liver disease(NAFLD)and chronic heart failure(CHF).Methods92 patients with NAFLD and CHF were randomly divided into study group and control group,with 46 cases in each group.Both groups were treated with normalized NAFLD and CHF,and the study group was additionally treated with dapagliflozin.The differences of glycolipid metabolism,heart function and fatty liver related indexes were compared between the two groups.ResultsThere was no statistical significance in glycemic and lipid metabolism indexes,cardiac function indexes,visceral fat area,inflammatory response and oxidative stress response indexes between the two groups before treatment(P>0.05).After treatment,the levels of FPG,2hFPG,HbA1c,HOMA-IR,TFG,TC,LDL-C,hs-CRP,IL-6 and MDA between the two groups all decreased,while HDL-C levels increased,and all changes were greater in the study group than those in the control group.After treatment,the values of LVDs and LVED parameters in both groups were significantly lower than those before treatment,while the expression levels of LVEF and VEGF were significantly increased,and all changes were greater in the study group.After treatment,the fat area of both groups decreased,and the study group was lower than that in the control group(all P<0.05).ConclusionDapagliflozin can improve the cardiac function and visceral fat area in patients with NAFLD and CHF by regulating glycolipid metabolism,resisting inflammation and oxidative stress,regulating intestinal flora distribution,and regulating renin-angiotensin-aldosterone system.

关 键 词：非酒精性脂肪肝 慢性心力衰竭 二甲双胍 达格列净 糖脂代谢 血管内皮功能 心脏功能 

分 类 号：R543[医药卫生—心血管疾病]