SGLT-2i对高血压病合并糖尿病患者左心室肥厚的逆转作用-现代医学

SGLT-2i对高血压病合并糖尿病患者左心室肥厚的逆转作用

单位：1. 东南大学医学院, 江苏南京 210000;
2. 东南大学附属中大医院心血管内科, 江苏南京 210009;
3. 中国人民解放军东部战区总医院心内科, 江苏南京 210018

分类号：R541.3

出版年·卷·期（页码）：2024·52·第六期（836-844）

摘要：

目的： 探讨SGLT-2i对高血压病合并糖尿病患者有左心室肥厚(LVH)的逆转作用。方法： 本研究纳入2018年1月至2022年12月于江苏省南京市东南大学附属中大医院住院的204例高血压病合并2型糖尿病的LVH患者，根据是否使用SGLT-2i分为SGLT-2i组与对照组，两组各102例。收集了所有纳入患者的基线时及再次至来院复查时资料，包括年龄、性别、身体质量指数(BMI)、血压、肌酐、空腹血糖、糖化血红蛋白、用药情况、左心室结构指标[左心室质量指数(LVMI)、左心室质量(LVM)、左心室射血分数(LVEF)、左心室舒张末期内径(LVDd)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)]等。并比较两组间的基线和复诊的相关指标。结果： 对基线资料的分析发现，年龄、糖化血红蛋白、IVST组间差异存在统计学意义(P<0.05)。与基线时相比，对照组LVMI、LVM、LVDd、LVPWT、舒张压前后差异存在统计学意义(P<0.05)；SGLT-2i组LVMI、LVM、LVDd、IVST、LVPWT、空腹血糖、肌酐前后差异存在统计学意义(P<0.05)。采用1∶1倾向性评分匹配平衡混杂因素后，SGLT-2i组与对照组进行比较，结果显示LVMI差值、LVM差值组间差异存在统计学意义(P<0.05)，其余指标差值组间差异无统计学意义(P>0.05)。构建多因素线性回归模型显示，SGLT-2i治疗与LVMI及LVM降低有关(LVMI：β=-0.303，P=0.002；LVM：β=-0.303，P=0.002)。但SGLT-2i对LVEF没有影响(P＞0.05)。结论： SGLT-2i对高血压病合并糖尿病患者的LVH具有逆转作用。

Objective: To investigate the reverse effect of SGLT-2i on left ventricular hypertrophy(LVH) in patients with hypertension and diabetes. Methods: This study included 204 LVH patients with hypertension and type 2 diabetes who were hospitalized in Zhongda Hospital affiliated to Southeast University in Nanjing, Jiangsu Province from January 2018 to December 2022. According to whether they used SGLT-2i or not, they were divided into SGLT-2i group and control group, with 102 cases in each group. We collected baseline and follow-up data from all enrolled patients, including age, gender, body mass index(BMI), blood pressure, creatinine, fasting blood glucose, glycated hemoglobin, medication use, and left ventricular structural indicators [left ventricular mass index(LVMI), left ventricular mass(LVM), left ventricular ejection fraction(LVEF), left ventricular end diastolic diameter(LVDd), interventricular septal thickness(IVST), and left ventricular posterior wall thickness(LVPWT)]. The baseline and follow-up related indicators were compared between the two groups. Results: The analysis of baseline data found that there were statistically significant differences in age, glycosylated hemoglobin, and IVST between groups (P<0.05). Compared with baseline, there were statistically significant differences in LVMI, LVM, LVDd, LVPWT, diastolic blood pressure, and fasting blood glucose before and after treatment in the control group(P<0.05). There were statistically significant differences in LVMI, LVM, LVDd, IVST, LVPWT, fasting blood glucose, and creatinine before and after treatment in the SGLT-2i group(P<0.05). After using 1∶1 propensity score to match the balanced confounding factors, the comparison between the SGLT-2i group and the control group showed that there were statistically significant differences in LVMI and LVM between the groups(P<0.05), while the differences in other indicators were not statistically significant(P>0.05). A multivariable linear regression model showed that SGLT-2i treatment was associated with the decreased LVMI and LVM(LVMI: β=-0.303, P=0.002; LVM: β=-0.303, P=0.002). However, SGLT-2i had no effect on LVEF(P>0.05). Conclusion: SGLT-2i can reverse LVH in hypertensive patients with diabetes.

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