西格列汀联合二甲双胍对2型糖尿病合并非酒精性脂肪肝患者心肌损伤及心功能的影响

Effect of Sitagliptin combined with Metformin on myocardial injury and cardiac function in patients with type 2 diabetes and nonalcoholic fatty liver disease

目的探讨西格列汀联合二甲双胍对2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)患者心肌损伤及心功能的影响。方法选取2018年7月至2020年10月徐州市肿瘤医院内分泌科收治的232例T2DM合并NAFLD患者作为研究对象,采用随机数字表法分为对照组和观察组,每组各116例。对照组患者给予二甲双胍和糖尿病饮食、运动治疗,观察组患者给予二甲双胍联合西格列汀及糖尿病饮食、运动治疗,两组患者疗程均为24周。比较两组患者的心肌损伤及肥大指标、心功能和血浆炎症指标。结果治疗24周后,观察组患者的B型利钠肽前体(NT-proBNP)、心肌肌钙蛋白T(cTnT)水平低于对照组,二尖瓣尖部舒张早期峰速度和舒张晚期峰速度的比值(E/A)、左心室射血分数(LVEF)高于对照组,差异有统计学意义(P<0.05);观察组患者治疗后的室间隔厚度(IVST)、左心室质量指数(LVMI)、左室后壁厚度(LVPWT)低于对照组,差异有统计学意义(P<0.05);观察组患者治疗后的血浆超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)低于对照组,差异有统计学意义(P<0.05)。结论T2DM合并NAFLD患者给予西格列汀联合二甲双胍治疗,可减轻心肌损伤及心肌肥厚,增强心脏收缩和舒张功能。

Objective To discuss the effect of Sitagliptin combined with Metformin on myocardial injury and cardiac function in patients with type 2 diabetes(T2DM)and nonalcoholic fatty liver disease(NAFLD).Methods A total of 232 patients with T2DM complicated with NAFLD admitted to the Department of Endocrinology of Xuzhou Cancer Hospital from July 2018 to October 2020 were selected as the study objects,and were divided into control group and observation group by random number table method,with 116 cases in each group.The control group was given Metformin and diabetic diet and exercise therapy,and the observation group was given Metformin combined with Sitagliptin and diabetic diet and exercise therapy.The treatment course of both groups was 24 weeks.The indexes of myocardial injury and hypertrophy,cardiac function and plasma inflammation were compared between the two groups.Results After 24 weeks of treatment,the levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP)and cardiac troponin T(cTnT)in observation group were lower than those in control group,and the ratio of valve blood flow of early flow rate to valve blood flow of atrial systolic phase(E/A)and left ventricular ejection fraction(LVEF)in observation group were higher than those in control group,the differences were statistically significant(P<0.05).The interventricular septum thickness(IVST),left ventricular mass index(LVMI)and left ventricular posterior wall thickness(LVPWT)in observation group were lower than those in control group after treatment,and the differences were statistically significant(P<0.05).The plasma high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in observation group were lower than those in control group after treatment,and the differences were statistically significant(P<0.05).Conclusion Sitagliptin combined with Metformin can reduce myocardial injury and hypertrophy and enhance systolic and diastolic function in T2DM patients with NAFLD.