恩格列净对2型糖尿病合并冠心病患者心室重构的影响

doi:10.3969/j.issn.1004-583X.2021.08.008

摘要/Abstract

摘要：

目的观察恩格列净对2型糖尿病合并冠心病患者的临床效果,探讨恩格列净对2型糖尿病合并冠心病患者心室重构的影响。方法将128例2型糖尿病合并冠心病患者随机分为两组(每组64例),对照组患者采用常规降糖、心血管口服药治疗;试验组采用常规降糖、心血管口服药加恩格列净治疗,疗程12周。试验结束观察指标:收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、餐后2 h血糖(2 hPG)、糖化血红蛋白A₁c(HbA₁c)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、脑钠肽(BNP)、肌钙蛋白I、肌酸激酶同工酶(CKMB)、左心室舒张末期容量(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、舒张末期前后径(LVEDD)、左心室收缩末期内径(LVESD)、室间隔厚度(IVS)、左心室后壁厚度(LVPW)、空腹胰岛素(FINS)、C肽、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)。结果与治疗前比较,两组治疗后SBP、DBP、FBG、2 hPG、HbA₁c、TC、TG、LDL-C、LVEDV、LVESV、LVEDD、LVESD、IVS、LVPW、HOMA-IR均降低,LVFS、FINS、C肽、HOMA-β升高(P<0.05)。治疗后,与对照组比较,试验组SBP、DBP、FBG、2 hPG、HbA₁c、TC、TG、LDL-C、LVEDV、LVESV、LVEDD、LVESD、IVS、LVPW、HOMA-IR均降低,LVFS、FINS、C肽、HOMA-β升高(P<0.05)。结论恩格列净能改善2型糖尿病合并冠心病患者心室重构,比常规降糖、心血管药物更具优势。

关键词: 糖尿病,2型, 冠心病, 心室重构, 临床实验室技术, 超声检查,多普勒

Abstract:

Objective To investigate the effect of empagliflozin on ventricular remodeling in patients with type 2 diabetes mellitus(T2DM) complicated by coronary heart disease(CHD). Methods A total of 128 patients with T2DM complicated by CHD were randomly divided into two groups, 64 cases in each group. The control group was treated with conventional oral medicine, and the experimental group received empagliflozin on bases of conventional oral medicine, a course for 12 weeks. The experimental indicators were observed, including systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting blood glucose(FBG), 2 h postprandial glucose (2 hPG), glycosylated hemoglobin A₁c(HbA₁c), total cholesterol(TC), triglycerides(TG), low-density lipoprotein cholesterol(LDL-C), brain natriuretic peptide(BNP), C-troponin I, creatine kinase-mb(CKMB), left ventricular end diastolic volume(LVEDV), left ventricular end systolic volume(LVESV), left ventricular ejection fraction(LVEF), left ventricular fractional shortening(LVFS), left ventricular end-diastolic diameter(LVEDD), left ventricular end-stage systole diameter(LVESD), interventricular septum(IVS), left ventricular posterior wall(LVPW), Fasting Insulin(FINS), C-peptide, Homeostasis model assessment- β(HOMA-β), Homeostasis Model Assessment of Insulin Resistance(HOMA-IR).Results Compared with before treatment, SBP, DBP, FBG, 2 hPG, HbA₁c, TC, TG, LDL-C, LVEDV, LVESV, LVEDD, LVESD, IVS, LVPW and HOMA-IR in both groups decreased. While LVFS, FINS, C-peptide and HOMA-β increased after treatment (P<0.05). After treatment, SBP, DBP, FBG, 2 hPG, HbA₁c, TC, TG, LDL-C, LVEDV, LVESV, LVEDD, LVESD, IVS, LVPW and HOMA-IR were lower in experimental group than in control group.LVFS, FINS, C-peptide, HOMA-β were higher in experimental group than in control group (P<0.05).Conclusion Empagliflozin can improve ventricular remodeling in patients with T2DM complicated by CHD, which have more advantages compared with conventional hypoglycemic drugs and cardiovascular drugs.

Key words: diabetes mellitus, type 2, coronary disease, ventricular remodeling, clinical laboratory techniques, ultrasonography,Doppler

中图分类号:

尹晓康, 张继平, 朱育刚, 申红霞, 王德峰. 恩格列净对2型糖尿病合并冠心病患者心室重构的影响[J]. 临床荟萃, 2021, 36(8): 713-718.

Yin Xiaokang, Zhang Jiping, Zhu Yugang, Shen Hongxia, Wang Defeng. Effect of empagliflozin on ventricular remodeling in patients with type 2 diabetes mellitus and coronary heart disease[J]. Clinical Focus, 2021, 36(8): 713-718.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.08.008

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I8/713

图/表 15

参考文献 20

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组别	例数	性别(例)		年龄 (岁)	体质量指数 (kg/m²)	病程 (年)
组别	例数	男	女	年龄 (岁)	体质量指数 (kg/m²)	病程 (年)
试验组	64	36	28	48±12.48	24.97±3.57	8.56±7.03
对照组	64	34	30	50±11.75	25.16±3.92	8.92±7.64
统计值		χ²=0.032		t=0.285	t=0.179	t=0.862
P值		0.859		0.776	0.858	0.390

组别	例数	性别(例)		年龄 (岁)	体质量指数 (kg/m²)	病程 (年)
组别	例数	男	女	年龄 (岁)	体质量指数 (kg/m²)	病程 (年)
试验组	64	36	28	48±12.48	24.97±3.57	8.56±7.03
对照组	64	34	30	50±11.75	25.16±3.92	8.92±7.64
统计值		χ²=0.032		t=0.285	t=0.179	t=0.862
P值		0.859		0.776	0.858	0.390

组别	例数	BNP(pg/ml)		肌钙蛋白I(μg/L)		CK-MB(U/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	64	105.41±10.13	101.32±11.32	0.14±0.12	0.12±0.06	14.65±5.46	14.16±4.63
试验组	64	108.74±12.94	102.25±10.62	0.13±0.15	0.11±0.04	14.37±5.35	13.82±4.12
t值		0.599	1.246	0.698	1.641	0.156	1.848
P值		0.550	0.215	0.486	0.103	0.876	0.067

组别	例数	BNP(pg/ml)		肌钙蛋白I(μg/L)		CK-MB(U/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	64	105.41±10.13	101.32±11.32	0.14±0.12	0.12±0.06	14.65±5.46	14.16±4.63
试验组	64	108.74±12.94	102.25±10.62	0.13±0.15	0.11±0.04	14.37±5.35	13.82±4.12
t值		0.599	1.246	0.698	1.641	0.156	1.848
P值		0.550	0.215	0.486	0.103	0.876	0.067

组别	例数	LVEDV(ml)				LVESV(ml)				LVEF(%)				LVFS(%)
组别	例数	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
对照组	64	123.54±12.69		114.68±13.78^*		64.75±5.65		55.82±6.37^*		62.73±5.64		63.25±4.32		25.35±1. 51		27.18±1.83^*
试验组	64	121.37±15.13		108.94±12.95^*#		62.86±6.49		52.19±5.64^*#		63.35±5.48		64.76±3.86		25.84±1.65		28.79±1.28^*#
t值		1.025		4.169		0.661		5.327		0.854		1.635		1.265		4.386
P值		0.307		0.000		0.510		0.000		0.395		0.105		0.208		0.000
组别	例数	LVEDD(mm)			LVESD(mm)				IVS(mm)				LVPW(mm)
组别	例数	治疗前	治疗后		治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
对照组	64	62.64±3.42	57.93±2.12^*		51.29±4.35		48.13±3.58^*		14.82±0.58		12.32±0.43^*		14.39±0.46		14.03±0.84^*
试验组	64	63.53±5.37	56.71±4.94^*#		52.37±4.71		46.83±3.12^*#		13.68±0.41		10.97±0.75^*#		13.97±0.76		12.56±0.68^*#
t值		0.258	6.137		0.324		5.789		0.166		7.374		0.812		7.842
P值		0.798	0.000		0.746		0.000		8.868		0.000		0.418		0.000