Citation: | SU Jianpei, WANG Yongli, WANG Zhimin, WU Qi, GU Jun, LI Jin, LIANG Bijuan. Effects of dapagliflozin on inflammatory cytokines and cardiac function in elderly patients with preserved ejection fraction heart failure complicated with type 2 diabetes mellitus[J]. Journal of Clinical Medicine in Practice, 2024, 28(7): 85-89,95. DOI: 10.7619/jcmp.20233206 |
To investigate the effects of dapagliflozin on inflammatory cytokines, blood glucose control and cardiac function in elderly with preserved ejection fraction heart failure (HFpEF) combined with type 2 diabetes.
A total of 80 elderly HFpEF patients with type 2 diabetes mellitus were randomly divided into control group (40 cases) and study group (40 cases). The control group received hypoglycemic and anti-heart failure standard therapy, and the study group received hypoglycemic and anti-heart failure standard therapy and dapagliflozin therapy. Both groups were treated for 6 months. The levels of inflammatory factors, blood glucose control, myocardial markers, exercise endurance [6 min walking distance (6MWD)], cardiac ultrasound related indexes and adverse drug reactions were compared between the two groups.
After 6 months of treatment, serum interleukin-6 (IL-6), hypersensitive C-reactive protein (hs-CRP) and tumor necrosis factor (TNF)-α in the study group were significantly lower than those in the control group (P<0.05); the glycated hemoglobin (HbA1c), fasting blood glucose (FPG), amino terminal B-type brain natriuretic peptide precursor (NT-proBNP) and hypersensitive troponin (hs-TNT) of the study group were significantly lower than those of the control group (P<0.05); the 6MWD and left ventricular ejection fraction (LVEF) of the study group were higher than those of the control group, and the left ventricular end-diastolic diameter (LVEDD), right atrial and right ventricular diameter, left atrial and left ventricular diameter, right ventricular wall thickness and pulmonary artery pressure of the study group were significantly lower than those of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).
The use of dapagliflozin in the treatment of elderly HFpE patients complicated with type 2diabetes can effectively control their blood sugar level, reduce inflammation, improve exercise endurance, and improve patients' heart function without increasing adverse drug reactions.
[1] |
SANUSI I, SARNOWSKI A, RUSSELL-JONES D, et al. A potential diagnostic problem on the ICU: Euglycaemic diabetic Ketoacidosis associated with SGLT2 inhibition[J]. J Crit Care, 2020, 57: 19-22. doi: 10.1016/j.jcrc.2019.12.007
|
[2] |
HITZEROTH J, MPE M, KLUG E, et al. 2020 Heart Failure Society of South Africa perspective on the 2016 European Society of Cardiology Chronic Heart Failure Guidelines[J]. Suid Afrikaanse Tydskrif Vir Geneeskunde, 2020, 110(8b): 13057.
|
[3] |
MARTINEZ F A, SERENELLI M, NICOLAU J C, et al. Efficacy and safety of dapagliflozin in heart failure with reduced ejection fraction according to age: insights from DAPA-HF[J]. Circulation, 2020, 141(2): 100-111. doi: 10.1161/CIRCULATIONAHA.119.044133
|
[4] |
刘姗姗, 罗力亚, 赵璨. 达格列净对老年2型糖尿病合并射血分数保留型心力衰竭患者的治疗效果及对心功能的影响[J]. 中国医药, 2022, 17(4): 539-543. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202204015.htm
|
[5] |
中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华内分泌代谢杂志, 2021, 37(4): 311-398. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYX202112018.htm
|
[6] |
中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789.
|
[7] |
TOMASONI D, ADAMO M, ANKER M S, et al. Heart failure in the last year: progress and perspective[J]. ESC Heart Fail, 2020, 7(6): 3505-3530. doi: 10.1002/ehf2.13124
|
[8] |
FRANSSEN C, CHEN S, UNGER A, et al. Myocardial microvascular inflammatory endothelial activation in heart failure with preserved ejection fraction[J]. JACC Heart Fail, 2016, 4(4): 312-324. doi: 10.1016/j.jchf.2015.10.007
|
[9] |
TAHARA A, KUROSAKI E, YOKONO M, et al. Effects of sodium-glucose cotransporter 2 selective inhibitor ipragliflozin on hyperglycaemia, oxidative stress, inflammation and liver injury in streptozotocin-induced type 1 diabetic rats[J]. J Pharm Pharmacol, 2014, 66(7): 975-987. doi: 10.1111/jphp.12223
|
[10] |
OJIMA A, MATSUI T, NISHINO Y, et al. Empagliflozin, an inhibitor of sodium-glucose cotransporter 2 exerts anti-inflammatory and antifibrotic effects on experimental diabetic nephropathy partly by suppressing AGEs-receptor axis[J]. Horm Metab, 2015, 47(9): 686-692. doi: 10.1055/s-0034-1395609
|
[11] |
CHANDRASEKAR B, MUMMIDI S, CLAYCOMB W C, et al. Interleukin-18 is a pro-hypertrophic cytokine that acts through a phosphatidylinositol 3-kinase-phosphoinositide-dependent kinase-1-Akt-GATA4 signaling pathway in cardiomyocytes[J]. J Biol Chem, 2005, 280(6): 4553-4567. doi: 10.1074/jbc.M411787200
|
[12] |
李莉娟, 胡瑞玲. 左西孟旦对急性心衰患者心功能及炎症介质的影响[J]. 实用中西医结合临床, 2021, 21(4): 17-18, 57. https://www.cnki.com.cn/Article/CJFDTOTAL-SZXL202104006.htm
|
[13] |
MVLLER-WIELAND D, KELLERER M, CYPRYK K, et al. Efficacy and safety of dapagliflozin or dapagliflozin plus saxagliptin versus glimepiride as add-on to metformin in patients with type 2 diabetes[J]. Diabetes Obes Metab, 2018, 20(11): 2598-2607. doi: 10.1111/dom.13437
|
[14] |
HAN J H, OH T J, LEE G, et al. The beneficial effects of empagliflozin, an SGLT2 inhibitor, on atherosclerosis in ApoE -/- mice fed a western diet[J]. Diabetologia, 2017, 60(2): 364-376. doi: 10.1007/s00125-016-4158-2
|
[15] |
SHI L, ZHU D Q, WANG S B, et al. Dapagliflozin attenuates cardiac remodeling in mice model of cardiac pressure overload[J]. Am J Hypertens, 2019, 32(5): 452-459. doi: 10.1093/ajh/hpz016
|
[16] |
SOGA F, TANAKA H, TATSUMI K, et al. Impact of dapagliflozin on the left ventricular diastolic function in diabetic patients with heart failure complicating cardiovascular risk factors[J]. Intern Med, 2021, 60(15): 2367-2374. doi: 10.2169/internalmedicine.6127-20
|
[17] |
张奇, 翁志远, 苏大宇. 达格列净对射血分数保留心力衰竭合并2型糖尿病患者心功能及炎症因子的影响[J]. 河南医学研究, 2023, 32(12): 2226-2229. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYX202312027.htm
|
[18] |
GRUBIC ROTKVIC P, CIGROVSKI BERKOVIC M, BULJ N, et al. Sodium-glucose cotransporter 2 inhibitors' mechanisms of action in heart failure[J]. World J Diabetes, 2020, 11(7): 269-279. doi: 10.4239/wjd.v11.i7.269
|
[19] |
MCMURRAY J J V, DEMETS D L, INZUCCHI S E, et al. A trial to evaluate the effect of the sodium-glucose co-transporter 2 inhibitor dapagliflozin on morbidity and mortality in patients with heart failure and reduced left ventricular ejection fraction (DAPA-HF)[J]. Eur J Heart Fail, 2019, 21(5): 665-675. doi: 10.1002/ejhf.1432
|
[20] |
GREENE S J, VADUGANATHAN M, KHAN M S, et al. Prevalent and incident heart failure in cardiovascular outcome trials of patients with type 2 diabetes[J]. J Am Coll Cardiol, 2018, 71(12): 1379-1390. doi: 10.1016/j.jacc.2018.01.047
|