吴承杰

[摘要]目的探究達格列净治疗糖尿病合并心力衰竭的疗效及对降低炎性因子水平和心力衰竭恶化再入院率的影响。方法回顾性分析2019年3月至2020年3月广西壮族自治区桂东人民医院心内科收治的60例糖尿病合并心力衰竭患者资料，按治疗方法的不同将其分为常规组（实施常规对症治疗）和研究组（在常规组的基础上给予达格列净治疗），每组各30例。比较两组治疗前后的炎性因子[白介素-1β（IL-1β）、肿瘤坏死因子α（TNF-α）、白介素-6（IL-6）]水平、血管内皮功能[N 基末端脑钠肽前体（NT-proBNP）、一氧化氮（NO）、内皮素1（ET-1）]、糖脂指标[脂联素、空腹血清胰岛素（FINS）、糖化血红蛋白（HbA1c）、空腹血糖（FBG）]，并比较两组的临床总有效率、心力衰竭恶化再入院率、不良心血管事件发生率。结果治疗后，研究组的 IL-1β、TNF-α、IL-6、NT-proBNP、ET-1、FINS、HbA1c、FBG 水平低于常规组， NO、脂联素水平高于常规组（ P <0.05）;研究组的临床总有效率为90.00%，高于常规组的66.67%（ P <0.05）。研究组的心力衰竭恶化再入院率、不良心血管事件发生率分别为0、6.67%，低于常规组的13.33%、26.67%（ P <0.05）。结论对糖尿病合并心力衰竭患者给予达格列净治疗，能显著降低炎性因子水平，调节糖脂代谢、血管内皮功能，提高疗效，减少心力衰竭恶化、再发心绞痛等不良事件的发生，对患者预后有积极影响。

[关键词]达格列净;糖尿病合并心力衰竭;炎性因子;心力衰竭恶化再入院率;不良心血管事件

[中图分类号] R587.1;R541.6  [文献标识码] A   [文章编号]2095-0616（2021）24-0100-05

Therapeutic efficacy of dapagliflozin on diabetes mellitus complicated with heart failure and its impacts on reducing inflammatory factors and readmission rate of worsening heart failure

WU  Chengjie

Department of Cardiovascular， Guidong People's Hospital of Guangxi Zhuang Autonomous Region， Guangxi， Wuzhou 543000， China

[Abstract] Objective To investigate the therapeutic efficacy of dapagliflozin on diabetes mellitus complicated with heart failure and its impacts on reducing inflammatory factors and readmission rate of worsening heart failure. Methods The data of 60 patients with diabetes mellitus complicated with heart failure admitted to the Department of Cardiovascular of Guidong People's Hospital of Guangxi Zhuang Autonomous Region from March 2019 to March 2020 were retrospectively analyzed. According to different treatment methods， they were divided into the conventional group （with conventional symptomatic treatment） and the study group （ with dapagliflozin treatment on the basis of conventional group）， with 30 cases in each group. The levels of inflammatory factors （interleukin-1β[IL-1β]， tumor necrosis factor α[TNF-α]， interleukin-6[IL-6]）， vascular endothelial function （N-terminal pro-brain natriuretic peptide [NT-proBNP]， nitric oxide [NO]， endothelin 1[ET-1]）， glycolipid index （adiponectin， fasting insulin [FINS]， glycosylated hemoglobin [HbA1c] and fasting blood glucose [FBG]） were compared between the two groups before and after treatment. The total clinical effective rate， readmission rate of worsening heart failure and the incidence of adverse cardiovascular events were compared between the two groups. Results After treatment， the levels of IL-1β， TNF-α， IL-6， NT-proBNP， ET-1， FINS， HbA1c and FBG in the study group were lower than those in the conventional group， while the levels of NO and adiponectin in the study group were higher than those in the conventional group （P <0.05）. The total clinical effective rate of the study group was 90.00%， higher than 66.67% of the conventional group （P <0.05）. The readmission rate of worsening heart failure and the incidence of adverse cardiovascular events in the study group were 0 and 6.67%， lower than 13.33% and 26.67% in the conventional group（P <0.05）. Conclusion Dapagliflozin treatment for diabetic patients with heart failure can significantly reduce the level of inflammatory factors， regulate glycolipid metabolism， vascular endothelial function， improve the therapeutic efficacy， reduce the occurrence of adverse events such as worsening heart failure and relapsed angina pectoris， and have a positive impact on the prognosis of patients.

[Key words] Dapagliflozin; Diabetes mellitus complicated with heart failure; Inflammatory factors; The readmission rate of worsening heart failure; Adverse cardiovascular events

心力衰竭属于临床常见的心血管疾病，是各种心脏结构或功能性疾病导致心室充盈和（或）射血能力受损而引起的一组综合征，也是多种心血管疾病的终端。糖尿病与心力衰竭存在高脂血症、高血糖等共同危险因素，两者也会相互作用、共同存在[1]。近年来，糖尿病合并心力衰竭发病率越来越高，严重威胁患者的生命安全。临床多采用对症治疗，但效果缓慢，且患者停药后再次心力衰竭恶化率高[2]。达格列净属于一种钠-葡萄糖共转运蛋白2抑制剂，具有高选择性和可逆性，能减少肾脏中葡萄糖的重吸收，稳定患者血糖，而且能有效控制炎症，保护心脏，对患者预后有积极影响[3]。……