达格列净联合沙库巴曲缬沙坦钠对HFpEF合并糖尿病患者心脏保护作用及对MACE的影响  

Effects of Dapagliflozin Combined with Sacubitril Valsartan Sodium on Cardiac Protection and MACE in Patients with Diabetes Mellitus Combined with HFpEF

作　　者：马辰星 张雅中 刘业强 王兆翔 MA Chenxing;ZHANG Yazhong;LIU Yeqiang;WANG Zhaoxiang(Tangshan Central Hospital,Hebei Tangshan 063000,China;Tangshan Workers'Hospital,Hebei Tangshan 063000,China)

机构地区：[1]唐山中心医院,河北唐山063000 [2]唐山市工人医院,河北唐山63000

出　　处：《中国医药导刊》2025年第2期171-176,共6页Chinese Journal of Medicinal Guide

基　　金：河北省卫生健康委员会指导性课题(20221778)。

摘　　要：目的:探讨达格列净联合沙库巴曲缬沙坦钠对射血分数保留心力衰竭(HFpEF)合并糖尿病患者的心脏保护作用,并分析其对主要心血管不良事件(MACE)的影响。方法:纳入我院2021年6月至2023年6月收治的HFpEF合并糖尿病患者200例,依据随机数字表法,分成A组(n=50)、B组(n=50)、C组(n=50)、D组(n=50)。A组予常规治疗+达格列净+沙库巴曲缬沙坦钠,B组予常规治疗+达格列净,C组予常规治疗+沙库巴曲缬沙坦钠,D组予常规治疗,疗程均为6个月。比较4组患者总体疗效及治疗前、治疗3个月、治疗6个月的左心室质量指数(LVMI)、左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD),检测血浆N末端B型利钠肽原(NT-proBNP)水平,比较6 min步行距离(6MWD)、堪萨斯城心肌病问卷(KCCQ)评分,观察治疗期间不良反应情况。从患者出院当日开始随访,随访至出院后12个月,记录MACE发生率。结果:A组治疗总有效率为96.00%,高于B、C、D组的78.00%、78.00%、60.00%(P<0.05)。治疗3、6个月后,4组患者LVMI、LVEDD、LVESD较治疗前均降低,A、B、C组患者治疗3、6个月的LVMI、LVEDD、LVESD低于D组,且A组低于B、C组(P<0.05)。治疗3、6个月后,4组患者NTproBNP水平较治疗前降低,且A、B、C组较D组更低,A组低于B、C组(P<0.05)。治疗3、6个月后,4组患者6MWD、KCCQ评分较治疗前增高,且A、B、C组高于D组,A组高于B、C组(P<0.05)。4组不良反应发生率比较差异无统计学意义(P>0.05)。A组MACE发生率(2.00%)低于D组(20.00%)(P<0.05)。结论:达格列净联合沙库巴曲缬沙坦钠能提升HFpEF合并糖尿病患者的治疗效果,加强对心脏的保护作用,提高运动耐力,降低MACE发生率。Objective:To investigate the cardioprotective effect of dapagliflozin combined with sacubitril valsartan sodium in patients with heart failure with preserved ejection fraction(HFpEF)combined with diabetes mellitus,and to analyze its effect on major adverse cardiovascular events(MACE).Methods:200 cases of HFpEF patients with diabetes mellitus in our hospital from June 2021 to June 2023 were divided into group A(n=50),group B(n=50),group C(n=50)and group D(n=50)according to random number table method.Group A was treated with conventional therapy+dapagliflozin+sacubitril valsartan sodium,group B was treated with conven-tional therapy+depagliflozin,group C was treated with conventional therapy+sacubitril valsartan sodium,and group D was treated with conventional therapy.The course of treatment was 6 months.The overall efficacy,left ventricular mass index(LVMI),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)of the 4 groups were compared before treatment,after 3 months of treatment and after 6 months of treatment.Plasma N-terminal B-type natri-uretic peptide(NT-proBNP)levels were detected.The 6MWD and Kansas City Cardiomyopathy Questionnaire(KCCQ)scores were compared.The adverse reactions during the treatment was observed.Patients were followed up from the day of discharge to 12 months after discharge,and the incidence of MACE was recorded.Results:The total effective rate of group A was 96.00%,which was higher than that of group B,C and D(78.00%,78.00%and 60.00%)(P<0.05).LVMI,LVEDD and LVESD of 3 and 6 months after treat-ment in the 4 groups were lower than those before treatment.LVMI,LVEDD and LVESD of 3 and 6 months after treatment in groups A,B and C were lower than those in group D,and group A was lower than those in groups B and C(P<0.05).NT-proBNP level in the 4 groups at 3 and 6 months after treatment was lower than that before treatment,and group A,B and C were lower than group D,and group A was lower than group B and C(P<0

关 键 词：射血分数保留心力衰竭 糖尿病 达格列净 沙库巴曲缬沙坦钠 主要心血管不良事件 

分 类 号：R541.6[医药卫生—心血管疾病]