目的 探讨达格列净在行经皮冠状动脉介入治疗（Percutaneous Coronary Intervention，PCI）后2型糖尿病（Type 2 Diabetes Mellitus,T2DM）伴不稳定型心绞痛（Unstable Angina，UA）患者中的应用价值及短期心功能改善效果。方法 本研究为单中心、随机对照试验，纳入90例PCI术后2型糖尿病合并不稳定型心绞痛患者，随机分为达格列净组（n=43）和二甲双胍组（n=47），规范调整降糖药物保证降糖强度一致。治疗期间及治疗后6-12个月通过心脏彩超测量左心室射血分数（Left Ventricular Ejection Fraction，LVEF）、左室舒张末期内径（Left Ventricular End-Diastolic Diameter，LVEDD），并采集静脉血样检测N端B型利钠肽前体（N-terminalpro-Brain Natriuretic Peptide，NT-proBNP）水平，以评估心功能变化。 结果 PCI治疗后的6-12个月随访中，观察组NT-proBNP（P<0.01）显著降低，左心室射血分数LVEF（P<0.01）显著提升。与对照组相比：观察组NT-ProBNP水平明显下降（P<0.01），且低于对照组。结论 在PCI术后合并不稳定型心绞痛的T2DM患者中，加用达格列净治疗可显著改善NT-proBNP和LVEF等心功能替代指标，且安全性良好。

Objective:To explore the application value of dapagliflozin and its short-term cardiac function improvement effect in patients with type 2 diabetes mellitus (T2DM) combined with unstable angina (UA) after percutaneous coronary intervention (PCI). Methods: This was a single-center, randomized controlled trial. A total of 90 patients with type 2 diabetes mellitus (T2DM) complicated with unstable angina (UA) after percutaneous coronary intervention (PCI) were enrolled and randomly assigned to a dapagliflozin group (n=43) and a metformin group (n=47). Hypoglycemic agents were adjusted routinely to ensure consistent glycemic control intensity between the two groups. During treatment and at 6–12 months after treatment, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were measured by echocardiography, and venous blood samples were collected to determine the level of N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) for the evaluation of cardiac function changes. Results: During the 6-month follow-up after PCI treatment, the N-terminal pro-brain natriuretic peptide (NT-proBNP) level in the observation group decreased significantly (P<0.01), and the left ventricular ejection fraction (LVEF) increased significantly (P<0.01).Compared with the control group, the NT-proBNP level in the observation group was notably lower (P<0.01) and also remained below that of the control group. Conclusion: For type 2 diabetes mellitus (T2DM) patients complicated with unstable angina pectoris after PCI, adjuvant treatment with dapagliflozin for 6 months can significantly improve cardiac function surrogate markers such as NT-proBNP and LVEF, with favorable safety profile.

        目的   分析达格列净联合沙库巴曲缬沙坦治疗射血分数降低的心力衰竭（HFrEF）效果。方法  连续抽取2021年1月—2023年6月在广州市第一人民医院心内科住院的射血分数降低的心力衰竭（HFrEF）患者203例，随访至少6个月，按照接受的治疗进行分组。对照组予常规治疗和沙库巴曲缬沙坦治疗；观察组予常规治疗、沙库巴曲缬沙坦和达格列净治疗；对比两组疗效，观察指标包括住院时间，入院及出院后6个月的心功能状态（NYHA纽约心脏病协会心功能分级）、心脏超声指标左室射血分数（LVEF）、左室舒张末内径（LVEDD）、左室收缩末内径（LVSDD）、血液指标-端脑钠肽前体（NT-proBNP N）、糖化血红蛋白（HBA1c）、血肌酐（Cr）、6个月时的再住院率及全因死亡率。结果   观察组心脏监护病房（CCU）停留时间（2.54±1.26）d，短于对照组的（3.73±1.21）d；观察组6个月时观察组心功能NYHA改善≥2级比例为95.05%高于对照组的86.27%，差异有统计学意义（P＜0.05）；观察组6个月时的LVEDD、LVESD水平分别为（48.22±7.35）（34.61±4.32）mm，低于对照组的（51.47±8.02）（43.07±5.33）mm，LVEF为（51.49±5.40）%，高于对照组的（46.18±4.21）%，差异有统计学意义（P＜0.05）；6个月时观察组的NT-proBNP为（415.58±31.57）pg/mL，低于对照组的（520.23±385.56）pg/mL，差异有统计学意义（P＜0.05）；两组的住院时间、血清肌酐（Cr）、HBA1c、6个月时的再住院率、全因病死率对比，差异不显著（P＞0.05）。观察组HBA1c值为（6.04±0.66）mmol/L，高于对照组的（5.20±0.56）mmol/L（P＜0.05）。结论  HFrEF患者采取达格列净+沙库巴曲缬沙坦治疗，可通过协同作用，缩短CCU停留时间，改善患者6个月时的心功能状态，降低NT-proBNP值，减少心脏扩大趋势，提高LVEF水平。

       Objective  To analyze the efficacy of  dapagliflozin combined with  sacubitril/valsartan in the treatment of heart failure with reduced ejection fraction（HFrEF）．Methods  A total of 203 patients with HFrEF who were hospitalized in the cardiology department of the hospital between January 2021 and June 2023 were enrolled and followed up for at least six months．Patients were divided into groups based on their treatment regimens：the control group received conventional treatment plus sacubitril/valsartan，while the observation group received conventional treatment plus sacubitril/valsartan and dapagliflozin．The two groups were compared for clinical outcomes，including length of hospital stay，cardiac function（NYHA classification）at admission and six months after discharge，echocardiographic indicators（LVEF，LVEDD，LVESD），blood indicators（NT-proBNP，HbA1c，creatinine），six-month rehospitalization rate，and all-cause mortality．Results  The observation group had a shorter CCU stay（2.54±1.26 days）compared to the control group（3.73±1.21 days）．At sixth month，the proportion of patients in the observation group with an NYHA improvement ≥2 grades（95.05%）was significantly higher than that in the control group（86.27%）（P＜0.05）．The observation group demonstrated lower LVEDD（48.22±7.35 mm）and LVESD（34.61±4.32 mm）levels and higher LVEF（51.49±5.40%）compared to the control group（LVEDD：［51.47±8.02］ mm，LVESD：［43.07±5.33］mm，LVEF：［46.18±4.21］%）（P＜0.05）．NT-proBNP levels in the observation group（［415.58±31.57］ pg/mL）were significantly lower than those in the control group（［520.23±385.56］ pg/ml）（P＜0.05）．There were no significant differences between the two groups in length of total hospital stay，serum creatinine，HbA1c，six-month rehospitalization rate，or all-cause mortality（P＞0.05）．However，HbA1c levels in the observation group（［6.04±0.66］ mmol/L）were higher than those in the control group（［5.20±0.56］ mmol/L）（P＜0.05）．Conclusions  The combination of dapagliflozin and sacubitril/valsartan in the treatment of HFrEF patients can exert a synergistic effect，shorten CCU stay，improve cardiac function at sixth month，reduce NT-proBNP levels，mitigate cardiac dilation，and increase LVEF．