作者：李辛一，孟宪晛，冯高科，宋涛，胡丹，黄燕

单位：

1.武汉大学人民医院心内科2.武汉大学第一临床学院

Units：

1.DepartmentofCardiology,RenminHospitalofWuhanUniversity,Wuhan430060,China2.TheFirstClinicalCollageofWuhanUniversity,Wuhan430060,China

关键词：

心力衰竭; 肾功能不全; 钠-葡萄糖协同转运蛋白2抑制剂; N末端脑钠肽前体; 估算肾小球滤过率;

Keywords：

Heartfailure;Renalinsufficiency;Sodium-glucosecotransporter2inhibitor;N-terminalpro-brainnatriureticpeptide;Estimateglomerularfiltrationrate

CLC：

R541.6

DOI：

10.12114/j.issn.1008-5971.2023.00.051

Funds：

国家自然科学基金资助项目( 82100331，82270332)；武汉市知识创新专项项目( 2022020801020484)；中央高校自主科研项目( 2042019kf0058，2042022kf1217)

摘要：

目的 探讨钠-葡萄糖协同转运蛋白2(SGLT-2)抑制剂对慢性心力衰竭合并肾功能不全患者心功能及肾功能的影响。方法 回顾性收集2022年1—7月于武汉大学人民医院就诊的慢性心力衰竭合并肾功能不全患者88例为研究对象，根据治疗方案将患者分为对照组（n=52）与观察组（n=36）。对照组患者采用标准抗心力衰竭药物进行常规治疗，观察组患者在对照组治疗基础上给予SGLT-2抑制剂，两组患者均连续用药3个月。比较两组治疗前后实验室检查指标[N末端脑钠肽前体（NT-proBNP）、估算肾小球滤过率（eGFR）]、超声心动图检查指标[左心室舒张末期内径（LVEDD）、室间隔厚度（IVST）、左心室后壁舒张末期厚度（LVPWT）、左心室射血分数（LVEF）]。结果 治疗前两组NT-proBNP比较，差异无统计学意义（P>0.05）；两组治疗后NT-proBNP分别低于本组治疗前，且治疗后观察组NT-proBNP低于对照组（P<0.05）。治疗前及治疗后，两组eGFR比较，差异无统计学意义（P>0.05）；两组治疗前eGFR分别与本组治疗后比较，差异无统计学意义（P>0.05）。治疗前及治疗后，观察组LVEDD大于对照组（P<0.05）；治疗前及治疗后，两组IVST、LVPWT、LVEF比较，差异无统计学意义（P>0.05）；对照组治疗前与治疗后LVEDD、IVST、LVPWT、LVEF比较，差异无统计学意义（P>0.05）；观察组治疗后LVEDD小于治疗前，LVEF高于治疗前（P<0.05）；观察组治疗前与治疗后IVST、LVPWT比较，差异无统计学意义（P>0.05）。结论 SGLT-2抑制剂可改善慢性心力衰竭合并肾功能不全患者的心功能，但短期内对心室重构、肾功能无明显影响。

Abstract：

ObjectiveToinvestigatetheeffectofsodiumglucosecotransporter2(SGLT-2)inhibitoroncardiacfunctionandrenalfunctioninpatientswithchronicheartfailurecombinedwithrenalinsufficiency.MethodsAtotalof88patientswithchronicheartfailurecombinedwithrenalinsufficiencyinRenminHospitalofWuhanUniversityfromJanuarytoJulyin2022wereretrospectivelyselected.Thepatientsweredividedintocontrolgroup(n=52)andobservationgroup(n=36)accordingtothetreatmentplan.Patientsinthecontrolgroupwereconventionalytreatedwithstandardanti-heartfailuredrugs,patientsintheobservationgroupweretreatedwithSGLT-2inhibitoronthebasisofthecontrolgroup,andtheyweretreatedcontinuouslyfor3months.Thelaboratoryindicators[N-terminalpro-brainnatriureticpeptide(NT-proBNP),estimateglomerularfiltrationrate(eGFR)],echocardiographicindexes[leftventricularenddiastolicdiameter(LVEDD),interventricularseptalthickness(IVST),leftventricularposteriorwallend-diastolicthickness(LVPWT),leftventricularejectionfraction(LVEF)]werecomparedbetweenthetwogroupsbeforeandaftertreatment.ResultsBeforetreatment,therewasnostatisticallysignificantdifferenceinNT-proBNPbetweenthetwogroups(P>0.05);aftertreatment,theNT-proBNPinthetwogroupswaslowerthanthatbeforetreatment,respectively(P<0.05);aftertreatment,theNT-proBNPintheobservationgroupwaslowerthanthatinthecontrolgroup(P<0.05).Beforeandaftertreatment,therewasnostatisticallysignificantdifferenceineGFRbetweenthetwogroups(P>0.05);therewasnostatisticallysignificantdifferenceineGFRinthetwogroupsbeforeandaftertreatment(P>0.05).Beforeandaftertreatment,theLVEDDintheobservationgroupwasgreaterthanthatinthecontrolgroup(P<0.05).Beforeandaftertreatment,therewasnostatisticallysignificantdifferenceinIVST,LVPWT,LVEFbetweenthetwogroups(P>0.05).TherewasnostatisticallysignificantdifferenceinLVEDD,IVST,LVPWT,LVEFinthecontrolgroupbeforeandaftertreatment(P>0.05).Aftertreatment,LVEDDintheobservationgroupwaslowerthanthatbeforetreatment,LVEFintheobservationgroupwashigherthanthatbeforetreatment(P<0.05).TherewasnostatisticallysignificantdifferenceinIVST,LVPWTintheobservationgroupbeforeandaftertreatment(P>0.05).ConclusionSGLT-2inhibitorcanimprovethecardiacfunctioninpatientswithchronicheartfailurecombinedwithrenalinsufficiency,buthasnoobviouseffectonventricularremodelingandrenalfunctionintheshortterm.

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