目的 分析恩格列净治疗 2 型糖尿病合并心力衰竭(心衰)的疗效.方法 128 例 2 型糖尿病合并心衰患者,采用信封抽签分组方法分为对照组与观察组,每组64例.对照组应用二甲双胍治疗,观察组应用恩格列净治疗.比较两组患者治疗前后餐后 2 h血糖(2 h PBG)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、左心室舒张末期内径(LVEDD)、6 min步行试验距离(6MWD)、N末端B型钠尿肽前体(NT-proBNP)水平.结果 治疗后,两组患者2 h PBG、FPG、HbA1c水平均明显降低,且观察组患者2 h PBG(7.26±1.22)mmol/L、FPG(5.97±0.48)mmol/L、HbA1c(6.53±0.67)%均低于对照组的(9.84±2.07)mmol/L、(7.24±0.85)mmol/L、(7.75±0.83)%,具有统计学差异(P<0.05).治疗后,观察组和对照组患者的TNF-α、IL-6、CRP水平均明显降低,且观察组患者TNF-α(31.55±7.84)pg/ml、IL-6(68.35±9.32)pg/ml、CRP(5.09±1.25)mg/L均低于对照组的(43.23±10.45)pg/ml、(80.78±12.67)pg/ml、(6.18±1.46)mg/L,有统计学差异(P<0.05).治疗后,两组患者的LVEF、LVESV、LVEDV、LVEDD、6MWD水平较治疗前均明显改善,且观察组患者LVEF(60.18±8.47)%、6MWD(427.20±24.54)m、LVESV(42.24±6.29)ml、LVEDV(81.31±6.54)ml、LVEDD(46.29±4.78)mm 均优于对照组的(56.24±6.48)%、(405.42±11.43)m、(47.93±7.65)ml、(88.32±7.54)ml、(49.31±5.54)mm,有统计学差异(P<0.05).治疗后,两组患者的NT-proBNP水平均明显降低,且观察组患者NT-proBNP(1577.59±625.63)pg/ml低于对照组的(2248.32±939.85)pg/ml,有统计学差异(P<0.05).结论 2 型糖尿病合并心衰患者采用恩格列净治疗可显著降低患者血糖水平,也有助于改善心脏功能,是此类患者具有临床价值的用药选择.
Observation on curative effect of empagliflozin in treatment of type 2 diabetes mellitus complicated with heart failure
Objective To analyze the curative effect of empagliflozin in treatment of type 2 diabetes mellitus complicated with heart failure.Methods 128 patients with type 2 diabetes mellitus complicated with heart failure were divided into a control group and an observation group by envelope method,with 64 cases in each group.The control group was treated with metformin,and the observation group was treated with empagliflozin.Patients in both groups were compared in terms of 2-h postprandial blood glucose(2 h PBG),fasting plasma glucose(FPG),glycated hemoglobin(HbA1c),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP),left ventricular eject fraction(LVEF),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),left ventricle end-diastolic diameter(LVEDD),6-min walking distance(6MWD),N-terminal pro-B-type natriuretic peptide(NT-proBNP)before and after treatment.Results After treatment,2 h PBG,FPG and HbA1c levels decreased significantly in both groups;the observation group had 2 h PBG of(7.26±1.22)mmol/L,FPG of(5.97±0.48)mmol/L and HbA1c of(6.53±0.67)%,which were lower than(9.84±2.07)mmol/L,(7.24±0.85)mmol/L and(7.75±0.83)%in the control group;there was statistical difference between the two groups(P<0.05).After treatment,the levels of TNF-α,IL-6 and CRP in the observation group and the control group reduced significantly;the observation group had TNF-α of(31.55±7.84)pg/ml,IL-6 of(68.35±9.32)pg/ml and CRP of(5.09±1.25)mg/L,which were lower than(43.23±10.45)pg/ml,(80.78±12.67)pg/ml and(6.18±1.46)mg/L in the control group;there was statistical difference between the two groups(P<0.05).After treatment,the levels of LVEF,LVESV,LVEDV,LVEDD and 6MWD in both groups improved significantly compared with those before treatment;the observation group had LVEF of(60.18±8.47)%,6MWD of(427.20±24.54)m,LVESV of(42.24±6.29)ml,LVEDV of(81.31±6.54)ml and LVEDD of(46.29±4.78)mm,which were better than(56.24±6.48)%,(405.42±11.43)m,(47.93±7.65)ml,(88.32±7.54)ml and(49.31±5.54)mm in the control group;there was statistical difference between groups(P<0.05).After treatment,the level of NT-proBNP in both groups decreased significantly,and NT-proBNP of(1577.59±625.63)pg/ml in the observation group was lower than(2248.32±939.85)pg/ml in the control group.There was statistical difference between groups(P<0.05).Conclusion Empagliflozin can significantly reduce blood glucose level and improve cardiac function in patients with type 2 diabetes mellitus complicated with heart failure.It is a clinically valuable drug choice for these patients.
Type 2 diabetes mellitusEmpagliflozinHeart failureBlood glucose levelsCardiac function
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