摘要
背景2型糖尿病(T2DM)是临床常见代谢性疾病,心力衰竭是各类心脏疾病的终末阶段,T2DM与心力衰竭相互影响。沙库巴曲缬沙坦具有利尿、扩张血管、抑制心室重塑、改善心功能等作用。达格列净可通过抑制肾脏对葡萄糖重吸收、促使过量葡萄糖经尿液排出而发挥降血糖作用,且有证据显示其对心血管有保护作用。目的观察沙库巴曲缬沙坦联合达格列净治疗T2DM合并心力衰竭的临床效果。方法选取2018年10月—2020年6月于庆阳市人民医院接受诊治的208例T2DM合并心力衰竭患者,采用随机数字表法分为观察组、对照组,每组104例。后因失访脱落8例,因治疗依从性差剔除4例,因中途更改降糖方案剔除4例,实际完成观察组98例、对照组94例。两组均给予基础降血糖及抗心力衰竭治疗,此外对照组给予沙库巴曲缬沙坦口服,观察组在对照组基础上给予达格列净口服,连续治疗6个月。比较两组治疗前后血糖控制指标〔空腹血糖(FPG)、餐后2 h血糖(2 hPBG)及糖化血红蛋白(HbA1c)〕、心功能指标〔血清N末端脑钠肽前体(NT-proBNP)、左心室射血分数(LVEF)、心输出量(CO)〕、心室重塑指标〔左心室质量指数(LVMI)、左心室重构指数(LVRI)〕、心功能分级、日常生活活动能力(ADL)、体质量及血压,并监测不良反应发生情况。结果治疗前两组FPG、2 hPBG、HbA1c、血清NT-proBNP水平、LVEF、CO、LVMI、LVRI、心功能分级、ADL评分、体质量、收缩压、舒张压比较,差异无统计学意义(P>0.05);治疗后6个月,两组FPG、2 hPBG、HbA1c、血清NT-proBNP水平及LVMI、收缩压、舒张压分别低于本组治疗前,LVEF、CO、LVRI、ADL量表评分分别高于本组治疗前,心功能分级分别优于本组治疗前(P<0.05);且观察组FPG、2 hPBG、HbA1c、血清NT-proBNP水平及LVMI、体质量、收缩压、舒张压低于对照组,LVEF、CO、LVRI、ADL量表评分高于对照组,心功能分级优于
Background Type 2 diabetes mellitus(T2DM)is a common metabolic disease in the clinic.Heart failure is the end stage of various heart diseases.T2DM and heart failure can interact with each other.Sacubitril/valsartan has the functions of diuretic dilation,inhibition of ventricular remodeling,and improvement of cardiac function.Dapagliflozin can reduce blood glucose by inhibiting renal reabsorption of glucose and promoting excess glucose excretion through urine.There is evidence that it has protective effect on cardiovascular.Objective To investigate the clinical effect of sacubitril/valsartan combined with dapagliflozin in the treatment of T2DM with heart failure.Methods A total of 208 T2DM patients with heart failure who were diagnosed and treated in Qingyang People's Hospital from October 2018 to June 2020 were selected and randomly divided into the observation group and the control group,with 104 cases in each group.Eight cases were dropped due to loss of follow-up,4 cases were eliminated due to poor treatment compliance,4 cases were removed due to changes in the hypoglycemic regimen midway.Finally,98 cases in the observation group and 94 cases in the control group completed the study.Both groups have basic hypoglycemic and anti-heart failure treatments.The control group was given sacubitril/valsartan orally,and the observation group was given sacubitril/valsartan combined with dapagliflozin orally.The two groups were treated for 6 months continuously.The blood glucose cortrol indexes〔fasting blood glucose(FPG),2 h postprandial blood glucose(2 hPBG)and glycosylated hemoglobin(HbA1c)〕,cardiac function indexes〔serum N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),cardiac output(CO)〕,left ventricular remodeling indexes〔left ventricular mass index(LVMI),left ventricular remodeling index(LVRI)〕,cardiac function grading,activity of daily life(ADL),body mass and blood pressure were compared between the two groups before and after treatment.Adverse reactions were
作者
贺红祥
李贵民
张文魁
HE Hongxiang;LI Guimin;ZHANG Wenkui(Department of Cardiology,Qingyang People's Hospital,Qingyang 745000,China)
出处
《实用心脑肺血管病杂志》
2021年第6期99-104,共6页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
心力衰竭
糖尿病
2型
沙库巴曲缬沙坦
达格列净
心室重构
日常生活活动能力
Heart failure
Diabetes mellitus,type 2
Sacubitril/Valsartan
Dapagliflozin
Ventricular remodeling
Activities of daily living
