摘要
目的探讨真实世界中达格列净对急性ST段抬高型心肌梗死(STEMI)合并2型糖尿病(T2DM)患者的心肾保护作用。方法纳入2022年1月1日至2022年12月31日就诊于河北医科大学第二医院接受再灌注治疗的STEMI合并T2DM患者,依据两组患者入院24 h内是否应用达格列净分为达格列净组和对照组,随访6个月。观察住院期间心肾复合终点(包括心肌梗死后心绞痛、心力衰竭加重、心源性死亡和对比剂肾病),以及随访6个月时主要不良心脑血管事件。采用单因素与多因素Logistic回归分析探讨达格列净对STEMI合并T2DM患者住院期间心肾复合终点的影响。结果共纳入STEMI合并T2DM患者180例,其中达格列净组92例,对照组88例。对照组术后血清肌酐水平变化量明显高于达格列净组[6.0(-3.0~15.8)mol/L vs.-0.8(-8.41~13.5)mol/L,P=0.007]。达格列净组总出量明显高于对照组(5394.7±2001.1 ml vs.4748.6±1360.9 ml,P=0.013)。随访6个月时,达格列净组空腹血糖水平低于对照组[(6.6±1.8)mmol/L vs.(7.9±3.7)mmol/L,P=0.005]。达格列净组患者住院期间心肾复合终点发生率较对照组低(9.78%vs.23.86%,P=0.011)。随访6个月时两组患者主要不良心脑血管事件发生率比较,差异无统计学意义(8.43%vs.10.8%,P=0.599)。多因素Logistic回归结果显示,吸烟[OR=3.466,95%CI(1.196~10.042),P=0.022]、达格列净[OR=0.391,95%CI(0.161~0.953),P=0.039]、入院时空腹血糖[OR=3.146,95%CI(1.268~7.806),P=0.013]是STEMI合并T2DM患者心肾复合终点的影响因素。结论对于STEMI合并T2DM患者,在保证早期恢复梗死相关血管血流的前提下,尽早采用达格列净可以有效发挥心肾保护作用,且安全性良好。
Objective To investigate the cardiorenal protective effect of dapagliflozin in patients with STsegment elevation myocardial infarction(STEMI)complicated by type 2 diabetes mellitus(T2DM)in the real world.Methods The patients with STEMI complicated by T2DM received reperfusion therapy were selected from the Second Hospital of Hebei Medical University from Jan.1,2022 to Dec.31,2022.The patients were divided into dapagliflozin group and control group according to whether dapagliflozin was used within 24 h after admission,and they were followed up for 6 months.The composite endpoints of heart and kidney[including angina after myocardial infarction(MI),exacerbated heart failure(HF),cardiac death,and contrast-induced nephropathy(CIN)]during hospitalization,and major adverse cardiovascular and cerebrovascular events(MACCE)during 6-months follow-up period were observed.The influence of dapagliflozin on composite endpoints of heart and kidney during hospitalization was discussed by using single-factor and multi-factor Logistic regression analyses in patients with STEMI complicated by T2DM.Results There were totally 180 patients included,and 92 in dapagliflozin group and 88 in control group.The level of postoperative serum creatinine(SCr)was higher in control group than that in dapagliflozin group[6.0(-3.0~15.8)mol/L vs.-0.8(-8.41~13.5)mol/L,P=0.007].The total output was significantly higher in dapagliflozin group than that in control group(5394.7±2001.1 ml vs.4748.6±1360.9 ml,P=0.013).During 6-month follow-up period,level of fasting blood glucose(FBG)was lower in dapagliflozin group than that in control group[(6.6±1.8)mmol/L vs.(7.9±3.7)mmol/L,P=0.005].The incidence of composite endpoints of heart and kidney was lower in dapagliflozin group than that in control group during hospitalization(9.78%vs.23.86%,P=0.011).During 6-month follow-up period,the difference MACCE incidence had no statistical significance between 2 groups(8.43%vs.10.8%,P=0.599).The results of multi-factor Logistic regression analysis showed that smoking(OR=3.466,95%CI:1.196~10.042,P=0.022),dapagliflozin(OR=0.391,95%CI:0.161~0.953,P=0.039)and FBG at admission time(OR=3.146,95%CI:1.268~7.806,P=0.013)were influence factors for composite endpoints of heart and kidney in patients with STEMI complicated by T2DM.Conclusion For patients with STEMI complicated by T2DM,early administration of dapagliflozin-while ensuring timely restoration of blood flow in infarct-related artery-can effectively provide cardiorenal protection with a favorable safety profile.
作者
刘畅畅
汪雁博
苏利芳
周庆
田佳
郝国贞
谷新顺
Liu Changchang;Wang Yanbo;Su Lifang;Zhou Qing;Tian Jia;Hao Guozhen;Gu Xinshun(Fifth Department of Cardiovascular Medicine,Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei China;不详)
出处
《中国循证心血管医学杂志》
2025年第9期1115-1121,共7页
Chinese Journal of Evidence-Based Cardiovascular Medicine
关键词
达格列净
ST段抬高型心肌梗死
2型糖尿病
心肾保护作用
Dapagliflozin
ST-segment elevation myocardial infarction
Type 2 diabetes mellitus
Cardiorenal protective effect
作者简介
通讯作者:汪雁博,E-mail:28302551@hebmu.edu.cn。
