摘要
目的 探究达格列净联合常规治疗对2型糖尿病伴心力衰竭患者的心血管保护作用及对血清炎症因子和可溶性生长刺激表达基因2(sST2)水平的影响.方法 前瞻性选取2020年9月至2022年8月江苏省昆山市第一人民医院收治的86例2型糖尿病伴心力衰竭患者为研究对象,按随机数字表法分为对照组和观察组,各43例.对照组予以常规治疗降糖及抗心力衰竭治疗,观察组在对照组基础上增加达格列净治疗.比较两组治疗前、治疗6个月后的血糖[糖化血红蛋白(HbA1c)、空腹血糖、餐后2 h血糖(2 h PG)]、血脂[总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL-C)]、心功能[左心室射血分数(LVEF)、血浆N端脑钠肽前体(NT-proBNP)、6 min步行试验(6MWT)]、血清指标[白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、sST2]水平及心血管事件及不良反应发生率.结果 治疗6个月后,观察组的HbA1c、空腹血糖、2 h PG、总胆固醇、甘油三酯、LDL-C水平分别为(6.65±0.73)％、(6.25±1.54)mmol/L、(7.88±1.35)mmol/L、(3.87±0.85)mmol/L、(1.52±0.46)mmol/L、(2.41±0.63)mmol/L,均明显低于对照组[(7.07±0.85)％、(7.16±1.49)mmol/L、(8.82±1.48)mmol/L、(4.24±0.82)mmol/L、(1.73±0.51)mmol/L、(2.69±0.61)mmol/L],差异均有统计学意义(P＜0.05).治疗6个月后,观察组的LVEF、6MWT水平分别为(52.28±3.43)％、(424.87±72.58)m,均明显高于对照组[(50.79±3.25)％、(367.52±74.43)m],血浆 NT-proBNP 水平为(1 778.65±224.37)pg/mL,低于对照组[(2 943.41±256.22)pg/mL],差异均有统计学意义(P＜0.05).治疗 6 个月后,观察组的血清 IL-1β、TNF-α、sST2 水平分别为(6.60±1.14)pg/mL、(22.15±4.30)ng/L、(0.42±0.13)g/L,均明显低于对照组[(7.19±1.39)pg/mL、(29.68±5.24)ng/L、(0.50±0.16)g/L],差异均有统计学意义(P＜0.05).观察组心血管事件总发生率为9.30％,低于对照组(25.58％),差异有统计学意义(P＜0.05).两组均无严重不良反应发生.结论 在使用常规降糖、抗心力衰竭治疗2型糖尿病伴心力衰竭患者基础上增加达格列净可有效降低其血糖、血脂及血清IL-1β、TNF-α、sST2水平,减少心血管事件的发生,具有一定心血管保护作用.
Abstract
Objective To investigate the cardiovascular protective effect of dapagliflozin combined with conventional therapy on patients with diabetes mellitus type 2 and heart failure and its effect on serum inflammatory factors and soluble growth stimulation expressed gene 2(sST2)levels.Methods A total of 86 patients with diabetes mellitus type 2 and heart failure admitted to First People's Hospital of Kunshan from Septem-ber 2020 to August 2022 were selected as the research objects and divided into control group and observation group according to the random number table method,with 43 cases in each group.The control group was treated with conventional hypoglycemic and anti-heart failure treatment,and the observation group was treated with dapagliflozin on the basis of the control group.The levels of blood glucose[hemoglobin A1c(HbA1c),fasting blood glucose,2 h postprandial blood glucose(2 hPG)],blood lipids[total cholesterol,triglyceride,low density lipoprotein cholesterol(LDL-C)],cardiac function[left ventricular ejection fraction(LVEF),plasma N-terminal pro-brain natriuretic peptide(NT-proBNP),6 min walking test(6MWT)],serum indexes[interleukin-1(3(IL-1β),tumor necrosis factor-α(TNF-α),sST2]before treatment,after 6 months of treatment,and the incidence of cardiovascular events,adverse reactions were compared between the two groups.Results After 6 months of treatment,the HbA1c,fasting blood glucose,2 h PG,total cholesterol,triglycerides,and LDL-C levels in the observation group were(6.65±0.73)％,(6.25±1.54)mmol/L,(7.88±1.35)mmol/L,(3.87±0.85)mmol/L,(1.52±0.46)mmol/L,and(2.41±0.63)mmol/L,respectively,which were significantly lower than those in the control group[(7.07±0.85)％,(7.16±1.49)mmol/L,(8.82±1.48)mmol/L,(4.24±0.82)mmol/L,(1.73±0.51)mmol/L,(2.69±0.61)mmol/L],the differences were statistically significant(P＜0.05).After 6 months of treatment,the LVEF and 6MWT levels in the observation group were(52.28±3.43)％and(424.87±72.58)m,respective-ly,which were significantly higher than those in the control group[(50.79±3.25)％and(367.52±74.43)m],the plasma NT-proBNP lev-els were(1 778.65±224.37)pg/mL,respectively,which were lower than those in the control group[(2 943.41±256.22)pg/mL],and the differences were statistically significant(P＜0.05).After 6 months of treatment,the levels of serum IL-1 β,TNF-α,sST2 in the observation group were(6.60±1.14)pg/mL,(22.15±4.30)ng/L,and(0.42±0.13)mg/L,respectively,which were significantly lower than those of the control group[(7.19±1.39)pg/mL,(29.68±5.24)ng/L,and(0.50±0.16)mg/L],and the differences were statistically significant(P＜0.05).The total incidence of cardiovascular events in the observation group was 9.30％,which was significantly lower than that in the con-trol group(25.58％),the difference was statistically significant(P＜0.05).No serious adverse reactions occurred in two groups.Conclusion On the basis of conventional hypoglycemic and anti-heart failure treatment for diabetes mellitus type 2 patients with heart failure,increasing dapagliflozin can effectively reduce their blood glucose,blood lipid and serum IL-1β,TNF-α,sST2 levels,reduce the occurrence of cardiovas-cular events,and has a certain cardiovascular protective effect.
维普
万方数据