【摘要】 目的 探讨钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂用于慢性心功能不全伴高尿酸血症与2型糖尿病患者的有效性及不良反应。方法 入选2021年5—11月于河南省胸科医院就诊的慢性心功能不全伴高尿酸血症及2型糖尿病患者160例，应用随机数字表法分为两组:对照组80例，接受常规抗心力衰竭方案联合控制血糖方案; SGLT-2抑制剂组80例，接受常规抗心力衰竭方案+控制血糖方案联合SGLT-2抑制剂口服。研究期间，SGLT-2抑制剂组排除8例，入选72例;对照组排除6例，入选74例。两组均连续治疗12个月，记录每组7 d时及12个月时血尿酸水平; 12个月时左室射血分数(LVEF)和血清N末端B型脑钠肽前体(NT-pro BNP)水平;研究过程中不良反应(泌尿与生殖系统感染、糖尿病酮症酸中毒、低血糖事件)发生率。结果 在7 d及12个月时SGLT-2抑制剂组血尿酸水平比对照组及基线时降低;而对照组治疗7 d时血尿酸水平比基线时上升(P<0.05)。SGLT-2抑制剂组及对照组治疗12个月时LVEF及血清NT-pro BNP水平比基线时均有改善(P<0.01)，但SGLT-2抑制剂组与对照组相比，LVEF及NT-pro BNP改善情况差异无统计学意义(P > 0.05)。研究期间SGLT-2抑制剂组泌尿与生殖系统感染发生率比对照组升高(9.72%比1.35%,P=0.032)。结论 SGLT-2抑制剂能有效降低血尿酸水平，延缓心功能恶化进展，减少患者死亡风险，且安全性好，适用于合并多种疾病的慢性病患者。更多还原

【Abstract】 Objective To explore efficacy and adverse reactions on using sodium-glucose co-transporter 2( SGLT-2)inhibitor in patients with chronic cardiac insufficiency and concomitant hyperuricemia and type 2 diabetes. Methods A total of160 consecutive patients with chronic cardiac insufficiency and concomitant hyperuricemia and type 2 diabetes in Henan Province Chest Hospital were enrolled from May to November 2021,they were divided into two groups by using the random number table method. Eighty patients in control group received conventional anti-heart failure treatment and controlling blood glucose treatment,80 patients in SGLT-2 inhibitor group received conventional anti-heart failure treatment and controlling blood glucose treatment and a dose of SGLT-2 inhibitor. During the study,8 patients were excluded from SGLT-2 inhibitor group and72 patients were enrolled; 6 patients were excluded from control group and 74 patients were enrolled. Both groups continued treatment for 12 months. Serum uric acid levels,within 7 days and12 months was recorded; left ventricular ejection fraction( LVEF) and serum N terminal B natriuretic peptide( NT-pro BNP)levels within 12 months was recorded. The incidence of adverse reactions( urogenital tract infection,diabetes ketoacidosis,hypoglycemia) within 12 months was recorded. Results After 7 days and 12 months,the serum uric acid levels of the SGLT-2 inhibitor group were decreased compared with the control group and baseline,while after 7 days,the serum uric acid levels of the control group were increased( P < 0. 05). After 12 months treatment,the SGLT-2 inhibitor group with the control group of LVEF and NT-pro BNP were improved than baseline( P < 0. 01),while there was not statistically significant between the SGLT-2 inhibitor group and the control group( P > 0. 05). The incidence of urogenital tract infection in the SGLT-2 inhibitors group was higher than that in control group within 12 months( 9. 72% vs 1. 35%,P = 0. 032). Conclusion Not only serum uric acid level are effectively reduced,but also worsening risk of heart failure are delayed and finally are going to reduce the risk of patient death by using SGLT-2 inhibitor. The SGLT-2 inhibitor is safety and is suitable for patients with multiple diseases.更多还原