Impact of dapagliflozin on serum miR-29, miR-21, miR-133, and oxidative stress levels in elderly patients with persistent atrial fibrillation and reduced ejection fraction
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摘要: 目的 回顾性分析达格列净对持续心房颤动(房颤)合并射血分数降低老年患者的治疗效果，及其对血清miR-29、miR-21、miR-133表达和氧化应激水平的调控作用。 方法 将2022年1月—2024年1月来我院治疗的100例持续房颤合并射血分数降低老年患者分成非达格列净治疗组(A组，50例)和达格列净治疗组(B组，50例)，并纳入健康志愿者作为对照组(C组，50例)。治疗6个月后，检测各组患者的超声心动图参数，以及血清miR-29、miR-21、miR-133表达，氧化应激标志物超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)的水平。 结果 治疗前，与C组相比，A、B两组患者的左心房直径、左心室舒张期直径、左心室收缩末期直径、miR-21和miR-133表达、MDA含量显著增加，左心室射血分数、miR-29表达及SOD、GSH-Px的含量均显著降低。治疗6个月后，A、B两组患者超声心动图参数、miRNAs表达及氧化应激标志物均显著改善，且B组患者的各项指标变化显著大于A组。 结论 达格列净能显著改善患者的心脏功能及机体的氧化应激水平，调控miR-29、miR-21、miR-133的表达。Abstract: Objective To retrospectively analyze the therapeutic effect of dapagliflozin on elderly patients with persistent atrial fibrillation(AF) complicated by reduced ejection fraction, and its regulatory effect on serum miR-29, miR-21, miR-133 expression and oxidative stress levels. Methods The 100 elderly patients with persistent atrial fibrillation and reduced ejection fraction in our hospital from January 2022 to January 2024 were divided into a non dapagliflozin treatment group(Group A, 50 cases) and a dapagliflozin treatment group(Group B, 50 cases), and healthy volunteers were included as a control group(Group C, 50 cases). After 6 months of treatment, the echocardiographic parameters, serum miR-29, miR-21, miR-133 expression, and levels of oxidative stress markers superoxide dismutase(SOD), malondialdehyde(MDA), and glutathione peroxidase(GSH Px) were measured in each groups. Results Before treatment, compared with group C, patients in groups A and B were showed significant increases in left atrial diameter, left ventricular diastolic diameter, left ventricular end systolic diameter, miR-21 and miR-133 expression, MDA content, and significant decreases in left ventricular ejection fraction, miR-29 expression, and SOD and GSH Px content. After 6 months of treatment, both groups A and B showed significant improvements in echocardiographic parameters, miRNA expression, and oxidative stress markers. Moreover, the changes in various indicators in group B were significantly greater than those in group A. Conclusion Dapagliflozin can significantly improve cardiac function and oxidative stress levels in patients, and regulate the expression of miR-29, miR-21, and miR-133.
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Key words:
- atrial fibrillation /
- ejection fraction /
- dapagliflozin /
- oxidative stress
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表 1 各组一般资料比较
Table 1. General data
例(%), X±S 组别 例数 年龄/岁 男性 BMI/(kg/m2) 房颤持续时间/d 心功能药物使用 A组 50 69.35±4.78 32(64.0) 23.05±1.04 9.25±1.32 34(68.0) B组 50 70.62±6.57 29(58.0) 22.73±0.97 8.76±1.45 36(72.0) C组 50 70.39±4.96 27(54.0) 22.94±1.18 t/χ2 0.758 1.045 1.161 1.767 0.191 P 0.470 0.593 0.316 0.080 0.663 
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表 2 达格列净对超声心动图参数的影响
Table 2. Effects of Dapagliflozin on echocardiographic parameters
X±S 参数 A组(50例) B组(50例) C组(50例) P LAD/mm 治疗前 45.83±2.64 44.59±3.18 29.61±3.77 < 0.0001 治疗后 38.47±1.731) 30.81±3.621) 30.15±2.93 < 0.0001 LVDD/mm 治疗前 67.44±3.86 66.85±2.74 41.68±1.95 < 0.0001 治疗后 58.17±2.631) 52.19±3.841) 42.93±2.16 < 0.0001 LVSD/mm 治疗前 51.45±2.19 52.29±3.15 32.48±3.05 < 0.0001 治疗后 39.08±1.361) 33.82±1.411) 33.07±2.83 < 0.0001 LVEF/% 治疗前 35.47±2.83 34.79±2.12 65.39±1.44 < 0.0001 治疗后 48.33±2.491) 53.18±2.721) 66.09±1.78 < 0.0001 与治疗前比较，1)P < 0.05。
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表 3 达格列净对血清miR-29、miR-21、miR-133表达的影响
Table 3. Effects of Dapagliflozin on expression of miR-29, miR-21, and miR-133
X±S miRNAs A组(50例) B组(50例) C组(50例) P miR-29 治疗前 0.85±0.09 0.79±0.11 1.43±0.27 < 0.0001 治疗后 1.23±0.181) 2.46±0.351) 1.38±0.16 < 0.0001 miR-21 治疗前 1.94±0.37 2.11±0.32 1.39±0.21 < 0.0001 治疗后 1.51±0.231) 1.33±0.261) 1.44±0.19 0.0006 miR-133 治疗前 2.18±0.37 2.26±0.31 1.52±0.29 < 0.0001 治疗后 1.57±0.311) 1.36±0.221) 1.48±0.24 0.0004 与治疗前比较，1)P < 0.05。
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表 4 达格列净对血清中SOD、MDA、GSH-Px含量的影响
Table 4. Effects of Dapagliflozin on the content of SOD, MDA, and GSH Px
X±S 指标 A组(50例) B组(50例) C组(50例) P SOD/(U/mL) 治疗前 41.39±5.28 44.59±3.18 87.63±6.85 < 0.0001 治疗后 63.94±4.611) 79.15±6.281) 89.24±7.06 < 0.0001 MDA/(nmol/mL) 治疗前 19.62±4.15 18.21±2.16 5.27±1.08 < 0.0001 治疗后 11.84±2.751) 7.48±1.511) 4.15±1.13 < 0.0001 GSH-Px/(U/mL) 治疗前 85.61±5.97 87.44±4.18 127.68±7.49 < 0.0001 治疗后 116.37±7.281) 175.73±8.921) 130.52±6.25 < 0.0001 与治疗前比较，1)P < 0.05。
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