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目的 探讨达格列净联合托伐普坦对冠心病(CHD)合并心力衰竭(HF)患者的治疗效果及对患者运动耐量、心功能等指标的影响。方法 选取2023年5月至2024年5月华北医疗健康集团邢台总医院收治的110例CHD合并HF患者，采用随机数字表法分为对照组和研究组，每组55例。对照组为常规干预+托伐普坦治疗，研究组为常规干预+托伐普坦、达格列净治疗。比较两组患者的总有效率、心功能指标、血清生化指标、运动耐量、生活质量及不良反应发生情况。结果 研究组的总有效率为87.27%(48/55)，高于对照组的69.09%(38/55)(χ2=5.329,P<0.05)；研究组的左心室射血分数、基质金属蛋白酶组织抑制因子4水平、6 min步行试验距离均高于对照组[(52.28±6.43)%vs(46.37±5.56)%]、[(129.22±15.75)μg/L vs(97.68±11.36)μg/L]、[(397.11±42.56) m vs(366.25±38.65) m](t=5.156、12.045、3.981，均P<0.05)，左室收缩末内径、游离脂肪酸水平、明尼苏达心功能不全生命质量量表评分、左室舒张末内径均低于对照组[(39.33±4.04) mm vs(42.52±4.66)mm]、[(0.42±0.09) mmol/L vs(0.61±0.13) mmol/L]、[(47.25±5.75)分vs(56.88±6.58)分]、[(47.77±4.96) mm vs(51.34±5.51) mm](t=3.836、8.912、8.173、3.571，均P<0.05)。研究组和对照组的胃肠道反应、血管性水肿等不良反应发生率比较[9.09%(5/55)vs 3.64%(2/55)]，差异无统计学意义(Fisher精确检验，P=0.242)。结论 达格列净联合托伐普坦治疗CHD合并HF患者的疗效较好，可以增强患者的心室射血能力，保护心功能。
Abstract：Objective To investigate the effect of dapagliflozin combined with tolvaptan on the treatment of coronary heart disease(CHD) and heart failure(HF), and the impacts on patients' exercise tolerance and cardiac function. Methods A total of 110 patients with CHD and HF admitted to Xingtai General Hospital of North China Medical and Health Group from May 2023 to May 2024 were selected and divided into the control group and the study group by the random number table method, with 55 cases per group. The control group received conventional intervention plus tolvaptan treatment, while the study group received conventional intervention plus tolvaptan and dapagliflozin treatment. The total effective rate, cardiac function indicators, serum biochemical indicators, exercise tolerance, quality of life, and adverse reactions were compared between the two groups. Results The total effective rate of the study group was 87.27%(48/55), higher than that of the control group(69.09%(38/55))(χ2=5.329, P<0.05). The left ventricular ejection fraction and the levels of tissue inhibitor of matrix metalloproteinase 4 and 6-minute walk test in the study group were higher than those in the control group((52.28±6.43)% vs(46.37±5.56)%,(129.22±15.75) μg/L vs(97.68±11.36) μg/L,(397.11±42.56) m vs(366.25±38.65) m)(t=5.156, 12.045, 3.981, all P<0.05). The left ventricular end systolic diameter, the level of free fatty acid, Minnesota Living with Heart Failure Questionnaire scores, and left ventricular end diastolic diameter were lower than those in the control group((39.33±4.04) mm vs(42.52±4.66) mm,(0.42±0.09) mmol/L vs(0.61±0.13) mmol/L,(47.25±5.75) points vs(56.88±6.58) points,(47.77±4.96) mm vs(51.34±5.51) mm)(t=3.836, 8.912, 8.173, 3.571, all P<0.05). There was no statistically significant difference in the incidence of gastrointestinal reactions and angioedema between the study group and the control group(9.09%(5/55) vs 3.64%(2/55))(Fisher's exact test, P=0.242). Conclusion The combination of dapagliflozin and tolvaptan demonstrates good efficacy in treating patients with CHD and HF. It can enhance ventricular ejection capacity and protect cardiac function.
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基本信息:
中图分类号:R541.4;R541.6
引用信息:
[1]周立宾,乔福斌,张晓强,等.达格列净联合托伐普坦治疗CHD合并HF的临床评价[J].中国药物应用与监测,2025,22(09):1465-1468.
基金信息:
河北省2024年度医学科学研究课题计划（20242280）