标题：达格列净治疗慢性心力衰竭的疗效及对患者心功能与血清炎性因子水平的影响

      作者：陈静茹，张淑娟，赵庆彦，冯高科，彭芬，刘平    武汉大学人民医院心内科&武汉大学心血管病研究所&心血管病湖北省重点实验室，湖北 武汉 430060

      卷次： 2024年35卷12期

      【摘要】 目的 观察达格列净片治疗慢性心力衰竭(CHF)的疗效，并探讨其对患者心功能与血清炎性因子水平的影响。方法 选取2020年3月至2021年6月武汉大学人民医院心血管内科收治的120例非糖尿病CHF患者为研究对象，按随机数表法分为对照组与观察组各60例。两组患者均采用常规抗CHF治疗方法，观察组在此基础上加用达格列净片治疗，疗程为6个月。比较两组患者的治疗效果，以及治疗前后的心功能指标[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、舒张早期二尖瓣血流峰值速度和舒张早期二尖瓣环峰值速度值(E/e')]、心肌损伤标志物[可溶性生长刺激表达基因2蛋白(sST2)、N末端脑钠肽前体(NT-proBNP)]、血清炎性因子[基质金属蛋白酶9 (MMP-9)、肿瘤坏死因子-α (TNF-α)、白介素6 (IL-6)]水平，同时比较两组患者治疗期间的不良反应发生情况。结果 观察组患者的治疗总有效率为88.33%，明显高于对照组的75.00%，差异具有统计学意义(P<0.05)；治疗后，观察组患者的LVEF为(53.25±4.55)%，明显高于对照组的(46.15±4.26)%，而LVESD和E/e'值分别为(35.26 ±3.41) mm、6.13±2.64，明显低于对照组的(40.05±3.24) mm、11.09±2.67，差异均有统计学意义(P<0.05)；治疗后，观察组患者的血清 sST2、NT-proBNP、MMP-9、TNF-α、IL-6分别为(36.25 ± 2.21) μg/L、(623±214) ng/L、(136.25±29.62) mg/L、(17.32±2.96) ng/L、(65.24±8.26) ng/L，明显低于对照组的(49.26±2.42) μg/L、(1 132±406) ng/L、(296.26±25.36) mg/L、(24.26±4.29) ng/L、(69.23±7.25) ng/L，差异均具有统计学意义(P<0.05)；观察组和对照组患者治疗期间的不良反应总发生率分别为30.00%、31.67%，差异无统计学意义(P>0.05)。结论 达格列净片治疗非糖尿病的CHF可改善患者心功能，减少心肌损伤、降低血清炎性因子水平，临床疗效确切且不良反应少。
      【关键词】 慢性心力衰竭；达格列净；疗效；心功能；炎性因子
      【中图分类号】 R541.6 【文献标识码】 A 【文章编号】 1003—6350（2024）12—1694—05

Efficacy of Dagliazine in the treatment of chronic heart failure and its effect on cardiac function andinflammatory factor level of patients.
CHEN Jing-ru, ZHANG Shu-juan, ZHAO Qing-yan, FENG Gao-ke, PENG Fen,LIU Ping. Department of Cardiology, Renmin Hospital of Wuhan University/Cardiovascular Research Institute, WuhanUniversity/Hubei Key Laboratory of Cardiology, Wuhan 430060, Hubei, CHINA
【Abstract】 Objective To investigate the efficacy of Dagliazine in the treatment of chronic heart failure (CHF)and to explore its effect on cardiac function and inflammatory factor level of patients. Methods A total of 120 non-dia-betic CHF patients admitted to Department of Cardiology, Renmin Hospital of Wuhan University from March 2020 toJune 2021 were selected as the research objects. According to the random number table method, they were divided into acontrol group and an observation group, with 60 patients in each group. Both groups of patients were treated with con-ventional anti-CHF treatment, and the patients in the observation group were additionally treated with Dagliazine tablets,for 6 months. The therapeutic effects, the cardiac function indexes [left ventricular ejection fraction (LVEF), left ventricu-lar end-systolic diameter (LVESD), the ratio of mitral valve flow peak velocity in early diastolic period to mitral annularpeak velocity in early diastolic period (E/e')], myocardial injury markers [soluble growth stimulation expression gene 2protein (sST2), N-terminal brain natriuretic peptide precursor (NT-proBNP)], inflammatory factors [matrix metallopro-teinase 9 (MMP-9), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6)], and occurrence of adverse reactions werecompared between the two groups. Results The total effective rate in the observation group was 88.33%, which wassignificantly higher than 75.00% in the control group (P<0.05). After treatment, the level of LVEF in the observationgroup was (53.25±4.55)%, which was significantly higher than (46.15±4.26)% in the control group, while the LVESDand E/e' values were (35.26±3.41) mm and 6.13±2.64, significantly lower than (40.05±3.24) mm and 11.09±2.67 in thecontrol group, with statistically significant differences (P<0.05). After treatment, the levels of sST2, NT-proBNP,MMP-9, TNF-α, and IL-6 in the observation group were (36.25±2.21) μg/L, (623±214) ng/L, (136.25±29.62) mg/L,(17.32±2.96) ng/L, and (65.24 ± 8.26) ng/L, significantly lower than (49.26±2.42) μg/L, (1132±406) ng/L, (296.26±25.36) mg/L, (24.26±4.29) ng/L, (69.23±7.25) ng/L in the control group (P<0.05). The total incidence of adverse reac-tions in the observation group was 30.00% , which was slightly lower than 31.67% in the control group (P>0.05).Conclusion Daglipzin in the treatment of CHF can improve cardiac function, reduce myocardial damage and the levelof inflammatory factors, with definite clinical efficacy and few adverse reactions.
      【Key words】 Chronic heart failure; Dapagliflozin; Efficacy; Cardiac function; Inflammatory factor