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投稿时间：2023-01-12 网络发布日期：2023-10-20
投稿时间：2023-01-12 网络发布日期：2023-10-20
中文摘要: 目的 探讨早期使用达格列净对老年急性心肌梗死（AMI）后心力衰竭患者急性期心功能及炎症因子水平的影响。
方法 回顾性分析2021年5月至2022年2月在华中科技大学同济医学院附属梨园医院治疗的AMI后心力衰竭59例患者的临床资料，将常规治疗基础上服用达格列净的患者列为治疗组（n=30），未服用达格列净的患者列为对照组（n=29）。药物治疗7d后，检测对比两组患者的心功能指标［左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、每搏输出量（SV）、左心射血分数（LVEF）］、血清炎症因子水平［超敏C反应蛋白（hs-CRP）、降钙素原（PCT）］、N末端B型利钠肽前体（NT-proBNP）水平以及6min步行试验距离（6MWD）；采用Pearson相关分析评价治疗前患者的LVEF与炎症因子、NT-proBNP水平的相关性。
结果 药物治疗7d后评价，两组患者的LVEF、SV水平均较前升高，LVEDD、LVESD水平均较前降低，且治疗组患者的LVEF、SV水平均高于对照组，LVEDD、LVESD水平均低于对照组（P＜0.05）；两组患者的hs-CRP、PCT、NT-proBNP水平均较前降低，且治疗组患者上述指标水平均低于对照组（P＜0.05）；治疗组6MWD优于对照组（P＜0.05）。治疗前指标相关性分析显示，患者LVEF分别与hs-CRP、PCT、NT-proBNP水平呈负相关（r=-0.92，-0.76，-0.93，P＜0.01）。
结论 与常规抗心力衰竭治疗方法相比，早期联用达格列净治疗AMI后心力衰竭患者，可以更好地改善患者心功能、抑制炎症因子水平，改善患者预后。
Abstract:ObjectiveTo investigate the effects of early application of dapagliflozin on cardiac function and the level of inflammatory factors in acute phase in elderly patients with heart failure after acute myocardial infarction(AMI).
Methods The clinical data of 59 patients with post-AMI heart failure treated in Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology from May 2021 to February 2022 was retrospectively analyzed. Patients who took dapagliflozin on the basis of routine treatment were classified as the treatment group (n=30), while patients who did not take dapagliflozin were classified as the control group (n=29). After 7-day treatment, the cardiac function indexes ［left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), stroke volume (SV), left heart ejection fraction (LVEF)］, serum inflammatory factor levels ［hypersensitivity C-reactive protein (hs-CRP), procalcitonin (PCT)］, N-terminal B-type natriuretic peptide precursor (NT-proBNP), and 6-min walk distance (6MWD) were compared between the two groups. Pearson correlation analysis was used to evaluate the correlation between LVEF and inflammatory factors and NT-proBNP levels of the patients.
Results After 7-day treatment, compared with pre-treatment, the levels of LVEF and SV increased, while the levels of LVEDD and LVESD decreased in two groups, and the levels of LVEF and SV in treatment group were higher than those in control group, while the levels of LVEDD and LVESD were lower than those in control group (P<0.05). The levels of hs-CRP, PCT and NT-proBNP decreased compared with pre-treatment in two groups, and the above indexes in treatment group were lower than those in control group (P<0.05). The 6MWD of the treatment group after 7-day treatment was significantly improved compared with the control group (P＜0.05). Before treatment, the LVEF of the patients was negatively correlated with the levels of PCT，hs-CRP and NT-proBNP，respectively (r=-0.92, -0.76, -0.93, P＜0.01).
Conclusion Compared with conventional anti heart failure therapy, that combined with dapagliflozin can better improve the cardiac function, inhibit the levels of inflammatory factors and improve the prognosis of patients with post-AMI heart failure.
keywords: Acute myocardial infarction Heart failure Dapagliflozin Cardiac function Inflammatory factors
文章编号： 中图分类号：R541.6 文献标志码：B
基金项目:湖北省自然科学基金一般面上项目（2021CFB337）
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引用文本：
刘侃玲,张瑶.达格列净早期使用对老年急性心肌梗死后心力衰竭患者急性期心功能及炎症因子的影响[J].中国临床研究,2023,36(10):1518-1523.
刘侃玲,张瑶.达格列净早期使用对老年急性心肌梗死后心力衰竭患者急性期心功能及炎症因子的影响[J].中国临床研究,2023,36(10):1518-1523.