| Purpose: To explore the effects of Dapagliflozin on left ventricular mass index(LVMI)in patients with DKD combined with hypertension,and further analyze the effects of Dapagliflozin on left ventricular hypertrophy.Methods: Clinical data of patients with type 2 diabetic kidney disease and hypertension treated in Taizhou People’s Hospital from October 2020 to March 2022 were retrospectively analyzed.DKD patients with hypertension who received Dapagliflozin and other hypoglycemic drugs for 6 months and had complete data before and after treatment were selected and divided into Dapagliflozin group and control group.A total of 196 patients were selected by 1:1 matching of propensity score,including 98 patients in Dapagliflozin group and 98 patients in control group.Body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),blood creatinine(Scr),urea nitrogen(BUN),uric acid(UA),glomerular filtration rate(e GFR),urinary protein/creatinine(UACR),ventricular septal thickness(IVS),left ventricular posterior wall thickness(LVPW),left ventricular end-diastolic diameter(LVDd)and left ventricular mass index(LVMI)were compared between the two groups before treatment and 6 months after treatment.Patients in Dapagliflozin group were divided into LVH and non-LVH according to the presence or absence of left ventricular hypertrophy,and LVMI levels in the two groups were compared.The influence factors of LVMI level and LVMI change were analyzed through Peason or Spearman correlation analysis and multiple stepwise regression.Results:1.A total of 196 patients were matched through propensity score matching,including 98 patients in the control group and 98 patients in the Dapagliflozin group.After matching,there were no statistical differences in gender,age,diabetes course,hypertension course,systolic blood pressure,diastolic blood pressure,BMI,medication,systolic blood pressure,diastolic blood pressure,glycosylated hemoglobin,fasting blood glucose,serum creatinine,blood urea nitrogen,e GFR,blood uric acid,LVDd,IVS,LVPW,EF,LVMI and other clinical data between the two groups(all P>0.05)).2.Compared with before treatment,body mass index,systolic blood pressure,diastolic blood pressure,blood uric acid,fasting blood glucose,glycosylated hemoglobin,serum creatinine,urea nitrogen and UACR were significantly decreased,while e GFR was significantly increased in Dapagliflozin group after treatment,with statistical significance(P < 0.05).Compared with the control group after 6 months of treatment,BMI,systolic blood pressure,serum creatinine,uric acid and UACR were significantly decreased,while e GFR was significantly increased in Dapagliflozin group after treatment,with statistical significance(P < 0.05).3.There was no significant difference in LVDd,IVS,LVPW,EF and LVMI between 2 groups at baseline(P > 0.05).Compared with before treatment,LVDd,IVS,LVPW and LVMI in Dapagliflozin group after treatment were significantly decreased,while LVMI levels in control group after treatment were significantly decreased,with statistical significance(P < 0.05).LVDd,IVS,LVPW and LVMI in Dapagliflozin group after treatment were significantly decreased compared with control group after 6 months of treatment,the difference was statistically significant(P < 0.05).4.According to left ventricular hypertrophy or not at baseline,patients in Dapagliflozin group were divided into LVH(36 cases)and non-LVH(62 cases).The average LVMI level in patients with LVH after treatment decreased from 108.36(100.92,117.66)g/m2 to 90.82(76.76,103.05)g/m2,the difference was statistically significant(P < 0.05).The average level of LVMI in patients without LVH after treatment decreased from 86.31(75.77,94.62)g/m2 to 81.76(68.77,92.90)g/m2,with no statistical significance(P > 0.05).LVMI in patients with LVH in Dapagliflozin group was significantly lower than those without LVH(P < 0.05).5.Univariate analysis showed that at baseline,LVMI level in all DKD patients with hypertension was positively correlated with SBP(r=0.367,P < 0.05).After6 months of treatment,there was no correlation between LVMI and SBP in Dapagliflozin group(r=0.038,P=0.709)and control group(r=0.087,P=0.065).Multiple stepwise regression analysis was performed to further analyze the independent influencing factors of LVMI changes,and the results showed that Dapagliflozin treatment was the independent influencing factors of LVMI changes(? 0.161,95%CI0.702-12.708,P=0.029).Conclusion:1.Dapagliflozin can significantly reduce BMI,blood pressure,blood glucose,uric acid,urea nitrogen,serum creatinine and UACR in patients with DKD and hypertension,and significantly increase e GFR,showing renal protective effect.2.Dapagliflozin can significantly reduce left ventricular mass index and improve left ventricular hypertrophy in patients with DKD and hypertension. |
PDF Full Text Request