Eur J Heart Fail:射血分数降低心衰患者肝脏检查结果与结局的关系

2022-08-08 MedSci原创 MedSci原创

胆红素浓度是HFrEF患者较差结局的独立预测因素,但不能改变达格列净对HFrEF中的疗效。达格列净与肝脏检查结果的变化无关。

肝脏检查异常反映静脉压升高和心排血量减少,在严重心力衰竭患者中很常见,并与患者不良临床结局相关。

近日,心血管领域权威杂志European Journal of Heart Failure上发表了一篇研究文章,研究人员的目的是探究异常的肝脏检查对射血分数降低心衰(HFrEF)患者的预后意义,并探讨胆红素和钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)治疗之间的相互作用,并评估SGLT2i治疗对肝脏检查结果的影响。

研究人员在达格列净和心脏衰竭不良结局预防试验(DAPA-HF)中探索了这些研究内容,重点是胆红素。研究人员根据胆红素三分位数计算了导致心血管死亡或加重心力衰竭的发生率。研究结束时评估了二级心血管结局,以及肝脏检查结果的变化情况。

基线时,4720例患者(99.5%)测量了胆红素水平。在胆红素水平最高三分位数(T3)的参与者伴有更严重的HFrEF(较低的LVEF,较高的NT-proBNP和较差的NYHA分级),伴有更大的房颤负担,但糖尿病负担更少。即使在调整了NT-proBNP和肌钙蛋白-T等其他预测变量后,较高的胆红素水平(T3 vs T1)仍与较差的预后相关:调整后主要结局的HR分别为1.73(95%置信区间[CI]为1.37-2.17,P<0.001)和1.52(1.12-2.07;P=0.01)。基线胆红素不影响达格列净的疗效。在随访期间,达格列净治疗对肝脏检查结果没有影响。

由此可见,胆红素浓度是HFrEF患者较差结局的独立预测因素,但不能改变达格列净对HFrEF中的疗效。达格列净与肝脏检查结果的变化无关。

原始出处:

Carly Adamson.et al.Liver tests and outcomes in heart failure with reduced ejection fraction: Findings from DAPA-HF.European journal of heart failure.2022.https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.2649

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    2022-08-09 zhaojie88
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    2022-08-09 slcumt
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    2022-08-09 赖寒

    胆红素与糖尿病的治疗无关?

    0

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