司美格鲁肽对2型糖尿病合并冠心病患者心肌缺血总负荷及血清炎症因子的影响

doi:10.3969/j.issn.1004-583X.2022.11.006

摘要/Abstract

摘要：

目的探讨胰高血糖素样肽-1受体激动剂(glucagon-like peptide-1 receptor agonist,GLP-1RA)周制剂司美格鲁肽对2型糖尿病(type 2 diabetes mellitus, T2DM)合并冠心病患者心肌缺血总负荷及血清炎症因子的影响。方法选择2021年6月至2022年6月于锦州医科大学附属第一医院诊治的T2DM合并冠状动脉粥样硬化性心脏病(冠心病)患者96例,随机分为常规治疗组和司美格鲁肽治疗组,每组各48例。常规治疗组采用规范的降糖、降压、调脂、抗血小板等治疗,根据血糖情况应用甘精胰岛素并调整剂量至血糖达标;司美格鲁肽治疗组在常规治疗基础上加用司美格鲁肽注射液1.0 mg,皮下注射,每周1次。分别于治疗前和治疗后3个月观察两组临床表现和体重指数、血压、空腹血糖、血脂、糖化血红蛋白等指标,同时检测心肌缺血总负荷及血清炎症指标。结果两组均失访1例,完成观察47例。治疗后,两组临床症状、空腹血糖、血脂及糖化血红蛋白均改善。与常规治疗组比较,司美格鲁肽治疗组体重指数、低密度脂蛋白胆固醇明显下降,甘精胰岛素用量、低血糖发生率均明显降低。此外,两组心肌缺血总负荷均明显减少,且司美格鲁肽治疗组心肌缺血总负荷低于常规治疗组。与常规治疗组比较,司美格鲁肽治疗组血清超敏C反应蛋白、白细胞介素-6水平均明显下降。结论司美格鲁肽通过降糖、调脂、减重等作用使T2DM患者多重获益;通过抗炎、降低心肌缺血总负荷,延缓T2DM合并冠心病患者冠状动脉粥样硬化进展,改善心肌供血,改善患者预后。

关键词: 糖尿病, 2型, 冠心病, 司美格鲁肽, 心肌缺血总负荷, 炎症因子

Abstract:

Objective To investigate the effects of semaglutide, a once-weekly glucagon-like peptide-1 receptor agonist (GLP-1RA), on total myocardial ischemic burden and inflammatory factors in patients with type 2 diabetes mellitus (T2DM) complicated with coronary heart disease (CHD). Methods From June 2021 to June 2022, totally 96 patients with T2DM and CHD admitted to the First Affiliated Hospital of Jinzhou Medical University were retrospectively recruited. They were randomized 1∶1 to the conventional treatment group and the semaglutide treatment group. Patients in the conventional treatment group were treated with standard hypoglycemic, hypotensive, lipid-regulating, and antiplatelet medications. According to blood glucose target, insulin glargine was applied and adjusted. Semaglutide injection 1.0 mg subcutaneously, once a week, was additionally given to those in the semaglutide treatment group. The clinical manifestations, body mass index (BMI), blood pressure, fasting blood glucose (FPG), blood lipids, glycosylated hemoglobin A₁c (HbA₁c) and other indicators were observed in the two groups before and 3 months after treatment, and the total myocardial ischemia burden and serum inflammation indicators were detected. Results One case was lost to follow-up in both groups. At the end of the trial, clinical symptoms, FPG, blood lipid and HbA₁c were significantly improved in the both groups. BMI and low-density lipoprotein cholesterol (LDL-C) in the semaglutide treatment group were significantly decreased than those in the conventional treatment group. The dosage of insulin glargine and incidence of hypoglycemia were significantly lower in the semaglutide treatment group than in the conventional treatment group. The total load of myocardial ischemia was significantly reduced in the both groups and the effect of semaglutide treatment group was better than that of the coventional treatment group. The serum levels of high sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in the semaglutide treatment group were significantly decreased than those in the conventional treatment group. Conclusion Semaglutide provides clinical benefits to T2DM patients by lowering glucose, regulating lipid and reducing body weight. It delays the progression of coronary atherosclerosis in patients with T2DM and CHD, and improves myocardial ischemia and prognosis by inhibiting inflammatory response and reducing total myocardial ischemic load.

Key words: diabetes mellitus, type 2, coronary disease, semaglutide, total myocardial ischemic load, inflammatory cytokines

中图分类号:

R587.1

王文琦, 张涛. 司美格鲁肽对2型糖尿病合并冠心病患者心肌缺血总负荷及血清炎症因子的影响[J]. 临床荟萃, 2022, 37(11): 996-1000.

Wang Wenqi, Zhang Tao. Effect of semaglutide on total myocardial ischemic burden and serum inflammatory factors in patients with type 2 diabetes mellitus complicated with coronary heart disease[J]. Clinical Focus, 2022, 37(11): 996-1000.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.11.006

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I11/996

图/表 4

表1 两组一般临床资料比较

组别	例数	性别[例(%)]		年龄 (岁)	糖尿病病程 (年)	BMI(kg/m²)		SBP(mmHg)		DBP(mmHg)
组别	例数	男	女	年龄 (岁)	糖尿病病程 (年)	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
常规治疗组	48	26(54.2)	22(45.8)	65.8±11.1	15(8,27)	26.4±1.9	26.8±1.8	133.6±12.8	132.9±10.6	78.8±8.8	78.4±7.8
司美格鲁肽治疗组	48	25(52.1)	23(47.9)	66.5±12.1	16(8,28)	26.6±1.8	24.8±1.9^*	133.7±11.3	130.9±11.2	78.4±9.2	77.8±9.7
统计值		χ²=0.036		$t$ =0.049	$t$ =3012	$t$ =0.524	$t$ =5.239	$t$ =0.040	$t$ =0.889	$t$ =0.323	$t$ =0.330
$P$ 值		>0.05		>0.05	>0.05	>0.05	<0.05	>0.05	>0.05	>0.05	>0.05

表1 两组一般临床资料比较

组别	例数	性别[例(%)]		年龄 (岁)	糖尿病病程 (年)	BMI(kg/m²)		SBP(mmHg)		DBP(mmHg)
组别	例数	男	女	年龄 (岁)	糖尿病病程 (年)	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
常规治疗组	48	26(54.2)	22(45.8)	65.8±11.1	15(8,27)	26.4±1.9	26.8±1.8	133.6±12.8	132.9±10.6	78.8±8.8	78.4±7.8
司美格鲁肽治疗组	48	25(52.1)	23(47.9)	66.5±12.1	16(8,28)	26.6±1.8	24.8±1.9^*	133.7±11.3	130.9±11.2	78.4±9.2	77.8±9.7
统计值		χ²=0.036		$t$ =0.049	$t$ =3012	$t$ =0.524	$t$ =5.239	$t$ =0.040	$t$ =0.889	$t$ =0.323	$t$ =0.330
$P$ 值		>0.05		>0.05	>0.05	>0.05	<0.05	>0.05	>0.05	>0.05	>0.05

表2 两组实验室指标比较($\bar{x}$±s)

组别	例数	FPG(mmol/L)				HbA₁c(%)			HDL-C(mmol/L)				LDL-C(mmol/L)
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
常规治疗组	47	7.89±0.56		6.42±0.47^*		7.32±0.81		6.85±0.77	1.43±0.13		1.43±0.12		3.66±0.21		3.04±0.21^*
司美格鲁肽治疗组	47	7.85±0.59		6.53±0.38^*		7.32±0.85		6.68±0.68^*	1.44±0.11		1.42±0.11		3.64±0.22		2.48±0.17^*
$t$ 值		0.337		1.248		0.000		1.135	0.403		0.421		0.451		14.209
$P$ 值		>0.05		>0.05		>0.05		>0.05	>0.05		>0.05		>0.05		<0.05
组别	例数	TG(mmol/L)			ACR(mg/g)				hs-CRP(mg/L)			IL-6(ng/L)
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
常规治疗组	47	1.44±0.11	1.41±0.12		98.21±5.52		96.65±6.79		9.03±0.74	6.31±0.50^*		98.32±6.86		76.65±5.12^*
司美格鲁肽治疗组	47	1.46±0.12	1.37±0.11^*		97.38±8.13		86.14±6.82^*		9.07±0.65	1.89±0.19^*		89.08±6.73		36.73±2.21^*
$t$ 值		0.842	1.685		0.579		7.486		0.278	56.651		0.542		49.076
$P$ 值		>0.05	>0.05		>0.05		<0.05		>0.05	<0.05		>0.05		<0.05

表2 两组实验室指标比较($\bar{x}$±s)

组别	例数	FPG(mmol/L)				HbA₁c(%)			HDL-C(mmol/L)				LDL-C(mmol/L)
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
常规治疗组	47	7.89±0.56		6.42±0.47^*		7.32±0.81		6.85±0.77	1.43±0.13		1.43±0.12		3.66±0.21		3.04±0.21^*
司美格鲁肽治疗组	47	7.85±0.59		6.53±0.38^*		7.32±0.85		6.68±0.68^*	1.44±0.11		1.42±0.11		3.64±0.22		2.48±0.17^*
$t$ 值		0.337		1.248		0.000		1.135	0.403		0.421		0.451		14.209
$P$ 值		>0.05		>0.05		>0.05		>0.05	>0.05		>0.05		>0.05		<0.05
组别	例数	TG(mmol/L)			ACR(mg/g)				hs-CRP(mg/L)			IL-6(ng/L)
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
常规治疗组	47	1.44±0.11	1.41±0.12		98.21±5.52		96.65±6.79		9.03±0.74	6.31±0.50^*		98.32±6.86		76.65±5.12^*
司美格鲁肽治疗组	47	1.46±0.12	1.37±0.11^*		97.38±8.13		86.14±6.82^*		9.07±0.65	1.89±0.19^*		89.08±6.73		36.73±2.21^*
$t$ 值		0.842	1.685		0.579		7.486		0.278	56.651		0.542		49.076
$P$ 值		>0.05	>0.05		>0.05		<0.05		>0.05	<0.05		>0.05		<0.05

表3 两组甘精胰岛素注射液日剂量和低血糖发生率比较

组别	例数	甘精胰岛素注射液日剂量(IU)	低血糖[例(%)]
组别	例数	甘精胰岛素注射液日剂量(IU)	是		否
常规治疗组	47	28.9±5.6	15(31.9)		32(68.1)
司美格鲁肽治疗组	47	8.5±3.6	5(10.6)		42(89.4)
统计值		$t$ =41.952		χ²=12.289
$P$ 值		<0.05		<0.05

表3 两组甘精胰岛素注射液日剂量和低血糖发生率比较

组别	例数	甘精胰岛素注射液日剂量(IU)	低血糖[例(%)]
组别	例数	甘精胰岛素注射液日剂量(IU)	是		否
常规治疗组	47	28.9±5.6	15(31.9)		32(68.1)
司美格鲁肽治疗组	47	8.5±3.6	5(10.6)		42(89.4)
统计值		$t$ =41.952		χ²=12.289
$P$ 值		<0.05		<0.05

表4 两组心肌缺血总负荷比较($\bar{x}$±s)

组别	例数	心肌缺血总负荷(mm·min)
组别	例数	治疗前	治疗后
常规治疗组	47	418.61±12.99	286.11±12.43^*
司美格鲁肽治疗组	47	417.24±12.66	113.29±8.33^*
$t$ 值		0.569	63.261
$P$ 值		>0.05	<0.05

表4 两组心肌缺血总负荷比较($\bar{x}$±s)

组别	例数	心肌缺血总负荷(mm·min)
组别	例数	治疗前	治疗后
常规治疗组	47	418.61±12.99	286.11±12.43^*
司美格鲁肽治疗组	47	417.24±12.66	113.29±8.33^*
$t$ 值		0.569	63.261
$P$ 值		>0.05	<0.05

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