摘要
目的 探讨达格列净联合美托洛尔治疗慢性心力衰竭(chronic heart failure,CHF)伴2型糖尿病(type 2 diabetes mellitus,T2DM)的临床治疗效果.方法 将收治的120例CHF伴T2DM患者用随机数字表法分为对照组(二甲双胍联合美托洛尔)和观察组(达格列净联合美托洛尔),每组60例.比较2组治疗前后的血流动力学、心功能、心肌损伤情况及血糖水平.结果 治疗3个月后,观察组肺动脉楔压(pulmonary artery wedge pressure,PAWP)、肺动脉平均压(mean pulmonary artery pressure,PAMP)、右心房压(right atrial pressure,RAP)及体循环血管阻力(systemic vascular resistance,SVR)低于对照组(P＜0.05),心排血量(car-diac output,CO)、心脏指数(cardiac index,CI)高于对照组(P＜0.05);观察组左心室舒张末期内径(left ventricular end diastolic dimension,LEVDD)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)低于对照组(P＜0.05),左心室每搏量(left ventricular stroke volume,LVSV)、6 分钟步行距离高于对照组(P＜0.05);观察组乳酸脱氢酶(lactate dehydrogenase,LDH)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)和心肌肌钙蛋白 I(cardiac troponin I,cTn I)低于对照组(P＜0.05);空腹血糖(fasting blood glucose,FPG)与糖化血红蛋白(glycosylated hemoglobin,HbA1c)水平低于对照组(P＜0.05).结论 达格列净联合美托洛尔治疗CHF伴T2DM,可以改善患者的血流动力学指标、心功能,减轻心肌损伤,能更好地控制血糖水平,值得临床推广.
Abstract
Objective To explore the clinical therapeutic effect of dapagliflozin combined with metoprolol in treating chronic heart failure(CHF)with type 2 diabetes mellitus(T2DM).Methods A total of 120 patients with CHF and T2DM were divided into 2 groups according to random number table method,including control group(60 cases,metformin combined with metoprolol)and observation group(60 cases,dapagliflozin combined with metoprolol).The hemodynamics,cardiac function,myocardial in-jury and blood glucose were compared between the 2 groups before and after treatment.Results After 3 months of treatment,the pulmonary artery wedge pressure(PAWP),pulmonary artery mean pressure(PAMP),right atrial pressure(RAP)and systemic vascular resistance(SVR)in the observation group were lower than those in the control group(P＜0.05),while the cardiac out-put(CO)and cardiac index(CI)were higher than those in the control group(P＜0.05).The left ventricular end-diastolic dia-meter(LEVDD)and left ventricular end-systolic diameter(LVESD)in the observation group were lower(P＜0.05)while the left ventricular stroke volume(LVSV)and 6-minute walking distance were higher or longer(P＜0.05)compared with the con-trol group.The levels of lactate dehydrogenase(LDH),creatine kinase isoenzyme(CK-MB)and cardiac troponin Ⅰ(cTn Ⅰ)were lower in the observation group than those in the control group(P＜0.05).The levels of fasting plasma glucose(FPG)and glycosylated hemoglobin(HbA1c)were lower compared with those in the control group(P＜0.05).Conclusion The combina-tion of dapagliflozin combined with metoprolol in the treatment of CHF with T2DM can improve hemodynamic indicators and cardiac function,relieve myocardial injury,and help patients better control blood glucose.
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