摘要
目的探讨达格列净联合沙库巴曲缬沙坦治疗慢性心力衰竭(CHF)合并2型糖尿病(T2DM)的效果及对血脂和主要心血管不良事件(MACE)发生率的影响。方法前瞻性选取2020年2月至2021年2月华中科技大学同济医学院附属梨园医院收治的CHF合并T2DM患者120例,采用随机数字表法分为观察组和对照组,每组60例;对照组采用常规治疗+沙库巴曲缬沙坦治疗,观察组在对照组治疗的基础上联合达格列净治疗。比较两组的疗效、治疗前后心脏结构及功能指标、血糖波动情况、血脂水平以及总复发率。结果观察组治疗总有效率高于对照组[96.67%(58/60)比85.00%(51/60)],差异有统计学意义(χ^(2)=4.90,P<0.05)。观察组治疗后左室射血分数(LVEF)高于对照组,左房容积指数、左室舒张末期容积指数及左室收缩末期容积指数低于对照组[(50.12±5.78)%比(41.23±5.13)%、(30.52±4.28)ml/m^(2)比(36.73±4.58)ml/m^(2)、(89.27±9.26)ml/m^(2)比(95.34±9.73)ml/m^(2)、(68.46±5.17)ml/m^(2)比(71.32±6.58)ml/m^(2)],差异有统计学意义(P<0.05)。观察组治疗后最大血糖波动幅度、日间血糖平均绝对差、平均血糖波动幅度、空腹血糖低于对照组[(7.52±1.03)mmol/L比(10.87±1.76)mmol/L、(1.45±0.31)mmol/L比(1.72±0.35)mmol/L、(3.12±0.67)mmol/L比(4.71±0.78)mmol/L、(7.84±1.97)mmol/L比(8.67±2.08)mmol/L],差异有统计学意义(P<0.05)。观察组治疗后低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)低于对照组,高密度脂蛋白胆固醇(HDL-C)高于对照组[(3.18±0.35)mmol/L比(3.35±0.5)mmol/L、(1.35±0.17)mmol/L比(1.43±0.28)mmol/L、(1.65±0.41)mmol/L比(1.51±0.32)mmol/L],差异有统计学意义(P<0.05)。观察组治疗半年内出现心力衰竭再住院7例,MACE 14例,总复发率为35.00%(21/60);对照组治疗半年内出现全因死亡1例,心力衰竭再住院8例,MACE 26例,总复发率为58.33%(35/60);观察组总复发率低于对照组,差异有统计学意义(χ^(2)=6.56,P<0.05)。结论达格列净联合沙库巴曲缬沙坦可明显改善CHF合并T2DM患者心肌功能、血糖血脂水平,且能够降低MACE的发生风险。
Objective To investigate the effect of dalglitazin combined with sacubatrovalsartan in the treatment of chronic heart failure(CHF)complicated with type 2 diabetes mellitus(T2DM)and its effect on blood lipids and the incidence of major adverse cardiovascular events(MACE).Methods One hundred and twenty patients with CHF and T2DM admitted to Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology from February 2020 to February 2021 were divided into observation group and control group by random digits table method,each group with 60 cases.The control group was treated with routine therapy and sacubatrovalsartan,the observation group was treated with dalglitazin on the basis of the control group.The therapeutic effects of the two groups were compared.The cardiac structure and function,blood glucose fluctuation and blood lipid level were compared between the two groups before and after treatment.The recurrence of the two groups after treatment was compared.Results The total effective rate in the observation group was higher than that in the control group:96.67%(58/60)vs.85.00%(51/60),there was statistical difference(χ^(2)=4.90,P<0.05).After treatment,the level of left ventricular ejection fraction(LVEF)in the observation group was higher than that in the control group and the levels of left atrial volume index(LAVI),left ventricular end diastolic volume index(LVEDVI)and left ventricular end systolic volume index(LVESVI)in the observation group were lower than those in the control group:(50.12±5.78)%vs.(41.23±5.13)%,(30.52±4.28)ml/m^(2) vs.(36.73±4.58)ml/m^(2),(89.27±9.26)ml/m^(2) vs.(95.34±9.73)ml/m^(2),(68.46±5.17)ml/m^(2) vs.(71.32±6.58)ml/m^(2),there were statistical differences(P<0.05).After treatment,the levels of largest amplitude of glycemic excursion(LAGE),mean absolute value of daytime blood glucose(MODD),mean blood glucose fluctuation range(MAGE)and fasting blood glucose(FBG)in the observation group were lower than those in the control group:(7.52±1.03)mmol/L vs.(10.87±1.76)mmol/L,(1.45±0.31)mmol/L vs.(1.72±0.35)mmol/L,(3.12±0.67)mmol/L vs.(4.71±0.78)mmol/L,(7.84±1.97)mmol/L vs.(8.67±2.08)mmol/L,there were statistical differences(P<0.05).After treatment,the levels of low density lipoprotein cholesterol(LDL-C)and triglyceride(TG)in the observation group were lower than those in the control group,and the level of high density lipoprotein cholesterol(HDL-C)in the observation group was higher than that in the control group:(3.18±0.35)mmol/L vs.(3.35±0.5)mmol/L,(1.35±0.17)mmol/L vs.(1.43±0.28)mmol/L,(1.65±0.41)mmol/L vs.(1.51±0.32)mmol/L,there were statistical differences(P<0.05).In the observation group,there were 7 cases of heart failure rehospitalized within 6 months of treatment and 14 cases of MACE,the total recurrence rate was 35.00%(21/60).In the control group,there were 1 case of all-cause death,8 cases of heart failure rehospitalized within 6 months of treatment and 26 cases of MACE,the total recurrence rate was 58.33%(35/60),the total recurrence rate in the observation group was lower than that in the control group,and the difference was statistically significant(χ^(2)=6.56,P<0.05).Conclusions Dalglitazin combined with sacubatrovalsartan can significantly improve myocardial function,blood glucose and blood lipid levels in patients with CHF and T2DM,reduce the risk of MACE.
作者
王彬宇
刘侃玲
赖娜
李正义
肖书娜
黄浪静
Wang Binyu;Liu Kanling;Lai Na;Li Zhengyi;Xiao Shuna;Huang Langjing(Cardiovascular Clinical Medicine Center,Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430000,China)
出处
《中国医师进修杂志》
2024年第4期327-331,共5页
Chinese Journal of Postgraduates of Medicine
基金
国家自然科学基金(81390542)
湖北省科技厅自然科学基金(2021CFB337)。
作者简介
通信作者:黄浪静,Email:2058347008@qq.com。
