卡维地洛治疗老年糖尿病合并慢性心力衰竭的临床疗效和安全性观察

Clinical effect and safety of carvedilol in elderly patients with diabetes mellitus and chronic heart failure

目的观察卡维地洛治疗老年2型糖尿病并慢性心力衰竭患者的疗效及安全性。方法老年2型糖尿病合并慢性心力衰竭患者73例随机分为卡维地洛组45例和对照组28例。对照组采用常规治疗,卡维地洛组在常规治疗基础上加服卡维地洛3.125mg,2次/d,每2周递增直至靶剂量(25mg,2次/d)或最大耐受剂量。随访12个月,比较治疗后两组患者的心率、血压、心脏功能以及血糖、胆固醇等变化,心脏事件以及药物耐受性。结果(1)随访12个月后,卡维地洛组死亡2例、中断卡维地洛2例,对照组死亡4例,均予剔除;(2)治疗后卡维地洛组(41例)心脏功能LVEDD、LVESD及LVEF较对照组(24例)改善明显(P<0.05),心率低于对照组(P<0.01),但2组心率均在正常范围内;随访期间,卡维地洛组心脏事件总发生率低于对照组(7/45vs12/28),差异有统计学意义(P<0.01);(3)两组均未发生低血糖反应、水肿及高度房室传导阻滞,两组患者的血压、血清钠、血清肌酐清除率、空腹血糖、糖化血红蛋白、低密度胆固醇等差异无统计学意义(P>0.05)。结论卡维地洛在老年糖尿病并心力衰竭患者治疗中具有良好的安全性和有效性,能改善患者的心脏功能,降低心脏事件发生,对血糖、血脂代谢没有明显影响。

Objective To observe the clinical effect and safety of carvedilol in elderly patients with type 2 diabetes mellitus （T2DM） and chronic heart failure （CHF）. Methods Seventy-three elderly patients with T2DM and CHF were randomly divided into two groups： control group （ n = 28） received conventional therapy, while carvedilol group （ n = 45） was treated with addi- tional carvedilol. Heart rate, blood pressure, cardiac function, blood glucose and cholesterol, heart event, and drug tolerance were compared in two groups during 12-month follow-up. Results （I） Two cases died and two discontinued carvedilol treatment in carvedilol group, while four cases died in control group. These cases were removed. （2） Heart function, LVEDD, LVESD and LVEF were significantly improved in carvedilol group compared with control group （P〈 0.05）. Incidence of heart event in carvedilol group were significantly lower than that in control group （P 〈 0.01 ）. （3） No cases exhibited hypoglycemia, edema and advanced A-V block in both groups. There were no statistical difference in blood pressure, serum sodium, fasting blcx2d glucose, glycosylated hemoglobin and low-density cholesterol betwen two groups （P 〉0.05）. Conclusion Carvedilol may be a safe and effective drug in the treatment of elder patients with T2DM and CHF by improving heart function, reducing incidence of heart event, and being lack of effect on blood glucose and lipid.