2026 年第 2 期 第 21 卷

达格列净联合沙库巴曲缬沙坦钠治疗对射血分数降低型心力衰竭患者心室重构的影响

Effect of dapagliflozin combined with sacubitril/valsartan sodium on ventricular remodeling in patients with heart failure with reduced ejection fraction

作者：王飞卢耀军

英文作者：Wang Fei Lu Yaojun

单位：内蒙古自治区包头市中心医院心血管内科，包头014040

英文单位：Department of Cardiology Baotou Central Hospital of Inner Mongolia Autonomous Region Baotou 014040 China

关键词：射血分数降低型心力衰竭；沙库巴曲缬沙坦钠；达格列净；心室重构；可溶性生长刺激表达基因2蛋白

英文关键词：Heartfailurewithreducedejectionfraction;Sacubitril/valsartansodium;Dapagliflozin; Ventricularremodeling;Solublesuppressionoftumorigenicity2protein

• 摘要：

• 目的 探讨达格列净联合沙库巴曲缬沙坦钠治疗对射血分数降低型心力衰竭（HFrEF）患者心室重构的影响。方法 选取内蒙古自治区包头市中心医院2023年4月至2024年3月120例HFrEF患者，按照随机数字表法分为观察组（60例）与对照组（60例），采用双盲、安慰剂对照设计，2组均接受标准药物治疗方案，在此基础上，对照组给予沙库巴曲缬沙坦钠+安慰剂治疗，观察组给予沙库巴曲缬沙坦钠+达格列净治疗，持续治疗12个月。比较2组临床疗效、心室重构与心功能［左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）、室间隔舒张末期厚度（IVST）、二尖瓣血流舒张早期/晚期最大流速（E/A）］、运动能力与生活质量［6 min步行试验距离、明尼苏达心力衰竭生活质量量表（MLHFQ）评分］、心肌损伤与心肌纤维化指标［N末端B型脑钠肽前体（NT-proBNP）、心肌肌钙蛋白I（cTnI）、层粘连蛋白（LN）、Ⅲ型胶原前肽（PⅢP）］以及血清可溶性生长刺激表达基因2蛋白（sST2）、正五聚蛋白3（PTX-3）与炎性指标［C反应蛋白（CRP）、白细胞介素6（IL-6）、IL-1β、肿瘤坏死因子α（TNF-α）］水平、治疗期间临床不良事件发生情况。结果 观察组临床治疗有效率高于对照组［95.0%（57/60）比83.3%（50/60）］(P=0.040）。与治疗前比较，治疗后2组LVEDD、LVESD、IVST减小，血清NT-proBNP、cTnI、LN、PⅢP、CRP、IL-6、IL-1β、TNF-α水平降低，且观察组均小于对照组，LVEF、E/A水平升高且观察组均高于对照组（均P＜0.05）。与治疗前比较，治疗后2组6min步行试验距离增加且观察组高于对照组，MLHFQ评分降低且观察组低于对照组（均P＜0.05）。与治疗前比较，治疗后2组血清sST2、PTX-3水平降低［观察组：（19±4）μg/L比（48±10）μg/L、（3.1±0.6）ng/L比（5.8±0.9）ng/L；对照组：（24±3）μg/L比（48±8）μg/L、（3.6±0.7）ng/L比（5.9±0.8）ng/L］，且观察组均低于对照组（均P＜0.05）。治疗期间，2组心血管不良事件总发生率比较，差异无统计学意义（P=0.752）。结论 达格列净联合沙库巴曲缬沙坦钠治疗HFrEF患者，可有效抑制患者心室重构、减轻机体心肌损伤和炎症反应，显著改善患者心功能，提升运动耐量和生活质量水平。

• Objective To investigate the effect of dapagliflozin combined with sacubitril/valsartan sodium on ventricular remodeling in patients with heart failure with reduced ejection fraction (HFrEF). Methods A total of 120 HFrEF patients admitted to Baotou Central Hospital of Inner Mongolia Autonomous Region from April 2023 to March 2024 were selected and divided into observation group (60 cases) and control group (60 cases) according to the random number table method. A double-blind, placebo-controlled design was adopted. Both groups received standard drug treatment. On this basis, the control group was treated with sacubitril/valsartan sodium+placebo, and the observation group was treated with sacubitril/valsartan sodium+dapagliflozin, with continuous treatment for 12 months. The clinical efficacy, ventricular remodeling and cardiac function ［left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), interventricular septal end-diastolic thickness (IVST), early/late diastolic maximum flow velocity of mitral valve (E/A)］, exercise capacity and quality of life ［6 min walk test distance, minnesota living with heart failure questionnaire (MLHFQ) score］, myocardial injury and myocardial fibrosis indexes ［N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), laminin (LN), procollagen Ⅲ peptide (PⅢP)］, as well as serum levels of soluble suppression of tumorigenicity 2 (sST2), pentraxin 3 (PTX-3) and inflammatory indexes ［C-reactive protein (CRP), interleukin-6 (IL-6), IL-1β, tumor necrosis factor-α (TNF-α)］, and the incidence of clinical adverse events during treatment were compared between the two groups. Results The clinical effective rate of the observation group was higher than that of the control group ［95.0%(57/60) vs 83.3% (50/60)］(P=0.040). Compared with before treatment, after treatment, LVEDD, LVESD and IVST decreased, serum levels of NT-proBNP, cTnI, LN, PⅢP, CRP, IL-6, IL-1β and TNF-α reduced in both groups, with the observation group lower than the control group; LVEF and E/A increased, with the observation group higher than the control group (all P<0.05). Compared with before treatment, after treatment, 6 min walk test distance increased and MLHFQ score decreased in both groups, with the observation group having longer walk distance and lower score than the control group (all P<0.05). Compared with before treatment, after treatment, serum sST2 and PTX-3 levels decreased in both groups ［observation group: (19±4)μg/L vs (48±10)μg/L, (3.1±0.6)ng/L vs (5.8±0.9)ng/L; control group: (24±3)μg/L vs (48±8)μg/L, (3.6±0.7)ng/L vs (5.9±0.8)ng/L］, with the observation group lower than the control group (all P<0.05). During treatment, there was no significant difference in the total incidence of cardiovascular adverse events between the two groups (P=0.752). Conclusion Dapagliflozin combined with sacubitril/valsartan sodium in the treatment of patients with HFrEF can effectively inhibit ventricular remodeling, reduce myocardial injury and inflammatory response, significantly improve cardiac function, and enhance exercise tolerance and quality of life.