达格列净对2型糖尿病患者急性心肌梗死后住院期间新发心房颤动发生风险的影响研究

背景新发心房颤动是急性心肌梗死的常见并发症，其发生率为5%~20%。急性心肌梗死后新发心房颤动患者死亡风险和卒中风险显著增加。糖尿病是急性心肌梗死也是心房颤动的危险因素，在疾病进程中起着重要作用。达格列净作为一种新型降糖药物，其降糖效果确切，然而鲜有研究报道其对糖尿病患者急性心肌梗死后心房颤动发生风险的影响。目的探讨达格列净对2型糖尿病患者急性心肌梗死后新发心房颤动发生风险的影响。方法收集2018年12月至2020年6月因急性心肌梗死于郑州大学第一附属医院心内科住院的2型糖尿病患者764例，根据是否存在新发心房颤动将研究对象分为新发心房颤动组188例和无心房颤动组576例。收集研究对象的人口统计学资料、超声心动图检查指标和实验室检验指标。采用多因素Logistic回归分析探讨达格列净对2型糖尿病患者急性心肌梗死后新发心房颤动发生风险的影响。结果新发心房颤动组年龄、男性比例、吸烟比例、糖化血红蛋白、左心房内径、N末端B型钠尿肽前体（NT-proBNP）、C反应蛋白（CRP）水平高于无心房颤动组，而收缩压、胰岛素比例、达格列净比例、高密度脂蛋白水平低于无心房颤动组（P<0.05）。多因素Logistic回归分析结果显示，达格列净与急性心肌梗死后新发心房颤动风险降低相关，达格列净降低了2型糖尿病患者急性心肌梗死后34%的新发心房颤动风险（OR=0.66，P=0.008）。结论达格列净的使用与2型糖尿病患者急性心肌梗死后新发心房颤动的低风险相关。

Effect of Dapagliflozin on the Risk of New-onset Atrial Fibrillation during Hospitalization for Acute Myocardial Infarction in Patients with Type 2 Diabetes

Background Atrial fibrillation is a common complication of acute myocardial infarction with an incidence varying from 5%to 20%.New-onset atrial fibrillation developing after acute myocardial fibrillation indicates a significantly increased risk of death and stroke.Diabetes mellitus,as a shared risk factor in both acute myocardial infarction and atrial fibrillation,plays an important role in the development of acute myocardial infarction and atrial fibrillation.It has been reported that dapagliflozin,a new hypoglycemic agent,has a positive effect on lowering glucose.However,there are few data regarding its impact on the risk of atrial fibrillation after acute myocardial infarction in patients with diabetes.Objective To investigate the effect of dapagliflozin on the risk of new-onset atrial fibrillation after acute myocardial infarction in patients with type 2 diabetes mellitus.Methods Total 764 patients with type 2 diabetes mellitus admitted during December 2018 to June 2020 in Cardiovascular Department,the First Affiliated Hospital of Zhengzhou University for acute myocardial infarction were selected.The demographic data,echocardiographic indices and laboratory data were collected,and compared between participants with new-onset atrial fibrillation(n=188)and those without(n=576).Multivariate Logistic regression analysis was used to assess the impact of dapagliflozin on the risk of new-onset atrial fibrillation after acute myocardial infarction.Results Patients with new-onset atrial fibrillationhad older mean age,higher male proportion,and proportion of smokers,higher mean levels of glycosylated hemoglobin,left atrial diameter,NT-proBNP and C-reactive protein,and lower mean levels of systolic blood pressure and high-density lipoprotein,as well as lower prevalence of using insulinand dapagliflozinthan those without(P<0.05).Multivariate Logistic regression analysis found that dapagliflozin was associated with a 34%reduced risk for new-onset atrial fibrillation after acute myocardial infarction in patients with type 2 diabetes mellitus〔OR=0.66,95%CI(0.57,0.91),P=0.008〕.Conclusion Dapagliflozin may be associated with a lower risk of new-onset atrial fibrillation after acute myocardial infarction in type 2 diabetics.