达格列净对2型糖尿病伴慢性心力衰竭患者的疗效及心外膜脂肪厚度影响

Efficacy of Dapagliflozin on Type 2 Diabetic Patients with Chronic Heart Failure and Its Effect on Thickness of Epicardial Adipose Tissue

摘要: 目的：观察达格列净对2型糖尿病(T2DM)伴慢性心力衰竭(CHF)患者的临床疗效以及对心外膜脂肪(EAT)厚度的影响。方法：选择2018年8月~2021年01月住院的T2DM伴心功能II~IV级CHF患者72例，随机分为治疗组和对照组各36例，两组基础治疗相同，治疗组加用达格列净，6个月后分别比较两组患者治疗前后及两组之间EAT厚度、左房前后径(LAD)、左室舒张末内径(LVDd)、左室射血分数(LVEF)、糖化血红蛋白(HbA1c)、N端脑钠肽前体(NT-proBNP)水平、6分钟步行试验(6MWT)及生活质量变化，并观察治疗效果、再住院人次及药物不良反应。结果：与治疗前相比，治疗组EAT厚度明显降低(P < 0.01)，对照组无明显变化，两组治疗后LAD、LVDd、HbA1c、NT-proBNP、生活质量评分均明显下降，6MWT、LVEF明显提高(P < 0.01)；治疗后组间比较，两组除LAD外，其他指标均有显著差异，以治疗组为优(P < 0.05或0.01)；治疗组显效率优于对照组(P < 0.01)，但总有效率与对照组无统计学差异(P > 0.05)；治疗组再入院人次较对照组减低(P < 0.05)，两组不良反应发生率相似(P > 0.05)。结论：T2DM伴CHF患者加用达格列净能进一步改善患者心功能，提高生活质量，降低再住院次数，使用安全性高，降低EAT厚度可能是其中一个机制。

Abstract: Objective: To observe the clinical effect of Dapagliflozin on type 2 diabetes mellitus (T2DM) patients with chronic heart failure (CHF) and the influence on the thickness of epicardial adipose tissue (EAT). Methods: 72 T2DM patients with CHF of cardiac function grade II~IV who were hospitalized from August 2018 to January 2021 were randomly divided into treatment group (N = 36) and control group (N = 36). The basic treatment was the same in both groups, and Dagligliflozin was added to the treatment group. After 6 months, thickness of EAT, left atrial anter-oposterior diameter (LAD), left ventricular end-diastolic diameter (LVDd), left ventricular ejection fraction (LVEF), hemoglobin A1c (HbA1c), N-terminal pro-brain natriuretic peptide (NT-proBNP), 6-minute walking test (6MWT) and quality of life were compared before and after treatment and between the two groups. At the same time, the therapeutic effect, the number of readmission and drug reactions were observed. Results: Compared with pre-treatment, the thickness of EAT in the treatment group was significantly decreased (P < 0.01), and there was no significant change in the control group. After treatment, the scores of LAD, LVDd, HbA1c, NT-proBNP and quality of life in the two groups were significantly decreased, and 6 MWT and LVEF were significantly increased (P < 0.01). Except LAD, there were significant differences in other indexes between the two groups, the treatment group was better than the control group (P < 0.05 or 0.01). The effective rate of the treatment group was better than that of the control group (P < 0.01), but there was no significant difference in the total effective rate between the two groups (P > 0.05). The number of readmission in the treatment group was significantly lower than that in the control group (P < 0.05), and the incidence of adverse reactions was similar in the two groups (P > 0.05). Conclusion: Adding Dapagliflozin to T2DM patients with CHF can improve heart function, improve the quality of life, reduce the number of readmission, and can use safely. One of the mechanisms may be related to reducing the thickness of EAT.