Effects of dapagliflozin on serum uric acid in non-diabetic patients with heart failure
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摘要: 目的 探讨达格列净对不伴糖尿病的心力衰竭患者血尿酸的影响。 方法 选取2023年1月—2024年1月于哈尔滨二四二医院住院的心力衰竭合并高尿酸血症并不伴糖尿病患者200例，随机分为试验组(达格列净+心力衰竭标准治疗)和对照组(心力衰竭标准治疗)，每组100例。记录两组患者治疗前后尿酸、氨基末端脑钠肽前体(NT-proBNP)和左室射血分数(LVEF)。随访6个月，观察痛风发作和不良事件发生情况。 结果 治疗7 d和6个月后，对照组尿酸水平较治疗前均显著上升(均P＜0.05)，试验组尿酸水平较治疗前均显著下降(均P＜0.05)。治疗6个月后，对照组LVEF改善不明显，NT-proBNP水平显著下降(P＜0.05)；试验组LVEF显著升高，NT-proBNP水平显著下降(均P＜0.05)。随访期间，试验组痛风发生率显著低于对照组(4.2% vs 22.3%，P＜0.05)。对照组和试验组均未发生低血糖、低血压、酮症酸中毒、急性肾损伤或肾功能损害等事件；与对照组相比较，试验组泌尿生殖系感染发生率升高(9.4% vs 2.1%，P=0.032)、心血管死亡率降低(0.06% vs 0，P=0.013)、住院率降低(25.5% vs 0.08%，P=0.002)。 结论 达格列净整体安全性良好，能有效降低不伴糖尿病的心衰患者的血尿酸水平，减少痛风发作，降低心衰恶化风险，改善长期预后。
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关键词:
- 心力衰竭 /
- 高尿酸血症 /
- 钠-葡萄糖协同转运蛋白-2 /
- 达格列净
Abstract: Objective To investigate the effect of dapagliflozin on serum uric acid in non-diabetic patients with heart failure. Methods A total of 200 non-diabetic patients with heart failure combined with hyperuricemia who were be hospitalized in Harbin 242 Hospital from January 2023 to January 2024 were included. All patients were randomly divided into the experimental group(dapagliflozin and standard treatment of heart failure) and the control group(standard treatment of heart failure), 100 patients in each group. The levels of uric acid, N-terminal pro-brain natriuretic peptide(NT-proBNP), and left ventricular ejection fraction(LVEF) before and after treatment in two groups were recorded. Followed up for 6 months to observe the occurrence of gout and adverse events. Results After 7 days and 6 months of treatment, the uric acid levels in the control group significantly increased compared to before treatment (both P < 0.05), while in the experimental group significantly decreased (both P < 0.05). In the control group, LVEF remained unchanged while NT-proBNP levels significantly decreased (P < 0.05); The LVEF in the experimental group significantly increased, while the level of NT-proBNP significantly decreased (both P < 0.05). During the follow-up, the incidence of gout in the experimental group was significantly lower than that in the control group (4.2% vs 22.3%, P < 0.05). Neither group experienced adverse events such as hypoglycemia, hypotension, ketoacidosis, acute kidney injury, or renal function impairment. Compared with the control group, the incidence of urinary and reproductive system infections increased in the experimental group (9.4% vs 2.1%, P=0.032), cardiovascular mortality was lower (0.06% vs 0, P=0.013), and the hospitalization rate decreased (25.5% vs 0.08%, P=0.002). Conclusion Dapagliflozin demonstrated a favorable safety profile and effectively reduced the serum uric acid in non-diabetic patients with heart failure, reduce gout attacks, reduce the risk of heart failure worsening, and improve long-term prognosis.-
Key words:
- heart failure /
- hyperuricemia /
- sodium-glucose co-transporter-2 /
- dapagliflozin
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表 1 基本资料
Table 1. General data
例(%), X±S 项目 对照组(94例) 试验组(96例) P 女/男 48/46 48/48 0.883 年龄/岁 73.9±9.4 72.4±9.7 0.305 BMI/(kg/m2) 25.5±3.7 25.2±2.7 0.474 收缩压/mmHg 130.7±12.6 133.2±12.1 0.163 舒张压/mmHg 71.4±6.6 70.4±7.8 0.318 空腹血糖/(mmol/L) 5.4±0.5 5.2±0.5 0.070 糖化血红蛋白/% 5.0±0.5 5.2±0.5 0.068 eGFR/(mL/min/1.73m2) 80.4±6.0 79.2±5.5 0.167 尿酸/(μmol/L) 478.4±52.7 489.8±44.2 0.108 NYHA分级 0.571 Ⅲ 51(54.3) 56(58.3) Ⅳ 43(45.7) 40(41.7) LVEF/% 43.5±8.2 42.4±8.9 0.357 心衰分型 0.901 HFrEF 37(39.4) 35(36.5) HFmrEF 27(28.7) 30(31.3) HFpEF 30(31.9) 31(32.2) NT-proBNP/(ng/L) 1 693.1±280.7 1 665.3±286.5 0.500 基础疾病 高血压 27(28.7) 26(27.1) 0.801 缺血性心肌病 48(51.1) 51(53.1) 0.776 扩张型心肌病 9(9.6) 7(7.3) 0.571 心房颤动 10(10.6) 12(12.5) 0.688 合并用药 沙库巴曲缬沙坦 83(88.3) 85(88.5) 0.958 β受体阻滞剂 82(87.2) 78(81.3) 0.258 螺内酯 90(95.7) 92(95.8) 0.976 利尿剂 94(100) 96(100) 1.000 地高辛 85(90.4) 87(90.6) 0.963 阿司匹林 57(60.6) 63(65.6) 0.476 他汀类 70(74.5) 61(63.5) 0.104 
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表 2 治疗前后尿酸水平比较
Table 2. Uric acid levels before and after treatment
μmol/L, X±S 组别 治疗前 治疗后 7 d 6个月 对照组(94例) 478.4±52.7 494.4±50.22) 546.3±59.22) 试验组(96例) 489.8±44.2 461.4±41.41)2) 395.3±45.41)2) 与对照组同期比较，1)P＜0.05；与同组治疗前比较，2)P＜0.05。
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表 3 治疗前后LVEF和NT-proBNP水平比较
Table 3. LVEF and NT-proBNP levels before and after treatment
X±S 项目 对照组(94例) 试验组(96例) LVEF/% 治疗前 43.5±8.2 42.4±8.9 治疗6个月 45.7±6.7 49.3±5.71)2) NT-proBNP/(ng/L) 治疗前 1 693.1±280.7 1 665.3±286.5 治疗6个月 1 457.1±304.11) 1 273.3±287.81)2) 与同组治疗前比较，1)P＜0.05；与对照组同期比较，2)P＜0.05。
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