磷酸肌酸钠对糖尿病合并心力衰竭老年患者的疗效观察

Effectiveness of creatine phosphate on elderly diabetic patients combined with heart failure

目的 观察磷酸肌酸钠对糖尿病合并心力衰竭老年患者的临床治疗效果.方法 选取2009年2月至6月在四川省人民医院住院治疗的糖尿病合并心力衰竭(纽约心脏病学会心功能分级Ⅲ～Ⅳ级)老年患者60例,采用抽签法随机分为对照组(n=30)和治疗组(n=30).在维持血糖、血压、血脂达标的情况下,对照组给予常规抗心力衰竭治疗,包括一般治疗与药物治疗(利尿剂、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体阻滞剂、β-受体阻滞剂、正性肌力药、醛固酮受体拮抗剂等),治疗组在此基础上静脉滴注磷酸肌酸钠2.0 g,每日1次,共14 d.治疗前后留取空腹血液标本,检测血糖、胰岛素、C肽、糖化血红蛋白、血浆脑钠肽、腺苷酸激活蛋白激酶,借助心脏超声检查评价患者心功能.应用t检验进行数据分析.结果 治疗后,2组患者心功能指标6 min步行试验、左心室射血分数、左心室缩短分数、E峰与A峰比值均显著改善,治疗组6 min步行试验[分别为(106±21)、(94±17)m]和E峰与A峰比值(分别为0.29 ±0.14、0.19±0.10)较对照组改善更好,差异有统计学意义(t值分别为2.776、3.099,均P＜0.05).治疗后,2组患者血浆脑钠肽、腺苷酸激活蛋白激酶、胰岛素抵抗及胰岛素敏感指数均显著改善,治疗组较对照组腺苷酸激活蛋白激酶[分别为(12±4)、(10±5)ng/L]和胰岛素抵抗(分别为1.7±0.9、0.9±0.4)改善更好,差异有统计学意义(t值分别为2.586、4.258,均P＜0.05).结论 磷酸肌酸钠可显著增强糖尿病合并心力衰竭老年患者心肌能量代谢,纠正胰岛素抵抗,调整心肌舒张功能,进而改善患者的临床症状及预后.

Objective To observe the effectiveness of creatine phosphate (CP) in the elderly diabetic patients combined with heart failure (HF). Methods Sixty elderly diabetic patients combined with HF ( NYHA Ⅲ to Ⅳ grade) were enrolled in Sichuan Provincial People's Hospital from February to June in 2009, and adopting sortition was randomly assigned to the control group ( n = 30) and the treatment group (n = 30). In keeping glucose, blood pressure and lipid to reach purpose, subjects of the control group received routine treatment, including general treatment and medication such as diuretic, angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor blocker, beta-receptor blocker, positive inotropic, and aldosterone receptor antagonist. Those of the treatment group additionally had 2.0 g CP once per day.Glucose, insulin, C-peptide, glycosylated hemoglobin, plasma brain natriuretic peptide (BNP), AMP-activated protein kinase (AMPK) were tested before and after the intervention. t test was used for data analysis. Results After the intervention, 6-minute walking test (6MWT), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS) and E peak and A peak ratio (E/A ratio) were significantly improved in both groups ( t values were 2.776 and 3.099, both P ＜ 0.05 ). After the intervention, BNP, AMPK, insulin resistance (IR) and insulin sensitivity index were significantly improved in both groups. AMPK ((12±4) vs (10±5) ng/L) and IR (1.7±0.9 vs 0.9 ±0.4) were found to be significantly different between the treatment group and the control group ( t values were 2. 586 and 4.258,both P ＜ 0.05). Conclusion CP may be able to significantly improve myocardium energy metabolism,correct insulin resistance and regulate myocardial relaxation function, so as to improv clinical symptom and prognosis of elderly diabetic patients combined with HF.