【摘要】 目的 探讨恩格列净对不合并2型糖尿病的射血分数保留的心力衰竭（HFp EF）患者临床效果。方法 选取2021年1月至2022年6月就诊于郑州市第七人民医院心血管内科的118例不合并2型糖尿病的HFp EF患者为研究对象，以随机数表法分为研究组（61例）和对照组（57例）。两组患者均予以包括沙库巴曲缬沙坦、美托洛尔、螺内酯等在内的常规抗心力衰竭治疗。研究组在对照组的基础上加用恩格列净（10 mg/d）。随访6个月，测定两组患者治疗6月后临床疗效，以及治疗前、治疗1月、3月、6月后由美国GE公司的Vivid7全数字彩色多普勒超声诊断仪采集左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左室射血分数（LVEF）、二尖瓣舒张早期最大峰值流速（Ea）、二尖瓣舒张晚期最大峰值流速（Aa），以免疫比浊法测定血浆超敏C反应蛋白（hs-CRP），以酶联免疫吸附法检测N末端脑钠肽前体（NT-proBNP），以荧光测定法测定血管紧张素Ⅱ（AngⅡ），测定明尼苏达心力衰竭生活质量量表（MLHFQ）评分、6 min步行距离（6MWD）与治疗6月后心力衰竭再住院率、不良反应发生率，分析恩格列净对不合并2型糖尿病的射血分数保留的心力衰竭患者临床疗效。结果 治疗6月后研究组总有效率高于对照组（P<0.05），心力衰竭再住院率低于对照组（P<0.05），两组不良反应发生率相当（P>0.05）。随着治疗时间的延长，两组LVEF、Ea、6MWD均较前升高（P<0.05），且研究组Ea、6MWD均高于对照组（P<0.05）；两组LVEDD、LVESD、Aa、hs-CRP、NT-proBNP、AngⅡ、MLHFQ评分均较前降低，且研究组均低于对照组（P<0.05）。结论 恩格列净可改善不合并2型糖尿病的HFp EF患者的心脏功能，降低其hs-CRP、NT-proBNP、AngⅡ水平，改善其临床症状、生活质量和运动耐力，降低其心力衰竭再住院率，具有良好的有效性及安全性。更多还原

【Abstract】 Objective To discuss the clinical efficacy of empagliflozin in patients with heart failure with preserved ejection fraction(HFp EF) without complicated by type 2 diabetes mellitus(T2DM). Methods HFp EF patients without complicated by T2DM(n=118) were chosen from Department of Cardiovascular Medicine in the Seventh People’s Hospital of ZhengzhouCity, and divided, according to digital table, into study group(n=61)and control group(n=57). Both groups were treated with routine anti-heart failure therapy including sacubitrilvalsartan, metoprolol and spironolactone, and study group was additionally given empagliflozin(10 mg/d). The patients were followed up for 6 months. The clinical efficacy was detected after treatment for 6 months. The values of left ventricular end-diastolic diameter(LVEDD), left ventricular end-systolic diameter(LVESD), left ventricular ejection fraction(LVEF), maximum peak flow rate of early mitral valve diastole(Ea), and maximum peak flow rate of late mitral valve diastole(Aa) were collected from 2 groups by using Vivid7 fully digital color Doppler ultrasound diagnostic instrument before and after treatment for 1 month, 3 month and 6 months. The level of high sensitivity C-reactive protein(hs-CRP) was detected by using immunoturbidimetry, N-terminal pro-brain natriuretic peptide(NT-proBNP) was detected by using ELISA, level of angiotensin Ⅱ(Ang Ⅱ) was detected by using fluorometry,scores of Minnesota Living with Heart Failure Questionnaire(MLHFQ) and 6-minute walk distance(6MWD) were detected, and re-hospitalization rate due to HF and incidence of adverse reactions were observed after treatment for 6 months.The clinical efficacy of empagliflozin was analyzed in HFp EF patients without complicated by T2DM.Results After treatment for 6 months, the total effective rate was higher(P<0.05), re-hospitalization rate due to HF was lower(P<0.05) in study group than those in control group, and incidence of adverse reactions were similar in 2groups(P>0.05). As treatment time prolonged, LVEF, Ea and 6MWD increased(P<0.05), and Ea and 6MWD were higher in study group than those in control group(P<0.05). LVEDD, LVESD, Aa, hs-CRP, NT-proBNP, AngⅡand MLHFQ scores decreased in 2 groups, and were lower in study group than those in control group(P<0.05).Conclusion Empagliflozin can improve heart function, reduce levels of hs-CRP, NT-proBNP and AngⅡ, relieve clinical symptoms, improve life quality and exercise tolerance and reduce re-hospitalization rate due to HF with higher efficacy and safety in HFp EF patients without complicated by T2DM.更多还原