达格列净对急性心肌梗死患者NLRP3炎症小体、血管内皮细胞功能及心室重塑的影响

Effect of Dapagliflozin on NLRP3 Inflammasome, Vascular Endothelial Cell Function and Ventricular Remodeling in Patients with Acute Myocardial Infarction

摘要: 目的：探讨达格列净对急性心肌梗死患者NLRP3炎症小体、血管内皮细胞功能及心室重塑的影响。方法：选取2020年9月~2021年3月就诊于延安大学附属医院心内科并住院的急性心肌梗死患者共120例，其中对照组给予常规药物治疗，观察组在对照组基础上加用达格列净治疗，两组均在确诊后立即给药。并按疾病类型分为ST段抬高组和NST段抬高组，比较各组治疗前后NLRP3炎症小体、ET1、ICAM、EMPs和心肌重塑指标的表达水平以及主要不良事件(MACE)发生率。结果：1) 达格列净治疗3个月后NLRP3炎症小体、内皮素(ET1)、细胞间黏附分子(ICAM)和血浆内皮微粒(EMPs)、左室舒张末期内径(LVEDD)、左房内径(LAD)、左室心肌质量指数(LVMI)较治疗前明显降低，而左室射血分数(LVEF)明显升高；2) 观察组各指标降低显著，与ST段抬高组比较，NST段抬高组的各指标降低更明显；3) 通过后期随访两组患者心脏不良事件的发生情况，结果加用达格列净治疗可明显降低MACE事件的发生率。结论：急性心肌梗死患者使用达格列净治疗可显著降低炎症因子水平、维持血管内皮细胞的稳定性、延缓心室重塑、降低MACE事件的发生率，并对非ST段抬高型患者疗效更佳。

Abstract: Objective: To investigate the effect of dapagliflozin on NLRP3 inflammasome, vascular endothelial cell function and ventricular remodeling in patients with acute myocardial infarction. Methods: A total of 120 patients with acute myocardial infarction who were admitted to the Department of Cardiology of the Affiliated Hospital of Yan’an University and were hospitalized from September 2020 to March 2021 were selected. The control group was given conventional drug treatment, and the observation group was given dapagliflozin treatment on the basis of the control group. Both groups were given drugs immediately after diagnosis. The patients were divided into ST-segment elevation group and NST-segment elevation group according to disease type, and the expression levels of NLRP3 inflammasome, ET1, ICAM, EMPs and myocardial remodeling indexes and the incidence of major adverse events (MACE) were compared in each group before and after treatment. Results: 1) After 3 months of dapagliflozin treatment, NLRP3 inflammasome, endothelin (ET1), intercellular adhesion molecule (ICAM) and plasma endothelial microparticles (EMPs), left ventricular end-diastolic diameter (LVEDD), Left atrial diameter (LAD) and left ventricular myocardial mass index (LVMI) were significantly lower than those before treatment, while left ventricular ejection fraction (LVEF) was significantly increased; 2) The indexes in the observation group decreased significantly. Compared with the ST-segment elevation group, the NST-segment elevation group decreased more obviously; 3) The incidence of adverse cardiac events in the two groups of patients was followed up later, and the addition of dapagliflozin treatment could significantly reduce the incidence of MACE events. Conclusion: Dapagliflozin treatment in patients with acute myocardial infarction can significantly reduce the level of inflammatory factors, maintain the stability of vascular endothelial cells, delay ventricular remodeling, reduce the incidence of MACE events, and have better efficacy in patients with non-ST segment elevation.