老年糖尿病患者心衰的临床干预

Clinical intervention for heart failure in elderly patients with diabetes

目的研究住院2型糖尿病(Type 2 diabetes mellitus,T2DM)的老年患者中心力衰竭(heart failure,HF)的并发情况、临床特点以及影响因素,探讨磷酸肌酸钠对T2DM合并HF的老年患者的心肌能量代谢以及胰岛功能的影响。方法对2009年8月至2010年8月来我院进行住院治疗的T2DM合并HF的老年患者64例做为研究对象,在患者知情的条件下随机分配为对照组和实验组,每组各32例。对照组以维持血糖、血压、血脂等的前提下进行常规的抗心衰治疗方法,实验组在对照组的基础之上另加磷酸肌酸钠2.0g,静脉滴注,每日一次,持续给药13天为一个疗程。所有患者在治疗前后取空腹血样本,进行心脏超声检查,评价患者的心脏功能,应用全自动生化仪器对各项生化指标进行测定,对血浆脑钠肽(BNP)及腺苷酸激活蛋白激酶(AMPK)等进行测定。结果所有患者在接受治疗后,心功能指标、血液指标BNP、AMPK以及胰岛功能等均得到明显改善,具有统计学意义上的差异(P<0.05)。其中,实验组与对照组相比,实验组的心功能指标6MWT、E/A,血液指标AMPK以及胰岛功能IR等指标改善程度更为明显,具有统计学意义上的差异,实验组的疗效要明显优于对照组。结论 CP可以通过提高AMPK的活性,降低老年患者的胰岛素抵抗程度,改善心肌能量代谢过程,调节心肌舒张,有效缓解T2DM合并HM的老年患者的临床症状,具有临床推广价值。

Objective To study the complication of heart failure （HF） and its clinical features and influential factors in elderly inpatients with type 2 diabetes mellitus （T2DM）, and to investigate the effect of creatine phosphate （CP） sodium salt on the myocardial energy metabolism and islet function in elderly T2DM patients with HF. Methods Sixty-four elderly T2DM patients with HF, who were hospitalized in our hospital from August 2009 to August 2010, were randomly divided into experimental group （n = 32） and control group （n = 32） after they were informed. The control group received conventional treatment of HF on the basis of maintaining the blood glucose, blood pressure, and blood lipid, while the experimental group, in addition to the therapy for the control group, received sodium creatine phosphate （2.0 g） by intravenous drip once daily for 13 d. Before and after treatment, the fasting blood samples of all patients were collected; echocardiography was used to evaluate the cardiac function; automatic biochemical analyzers were used to determine the biochemical indices including plasma brain natriuretic peptide （BNP） level and activity of adenosine monophosphate-activated protein kinase （AMPK）. Results All patients showed improvements in cardiac function, plasma BNP level, AMPK activity, and islet function after treatment （P 〈 0.05）. Compared with the control group, the experimental group showed significantly more improvements in six-minute walk test results, E/A ratio, AMPK activity, and insulin resistance （IR）, with a better treatment outcome （P〈0.05）. Conclusion CP can increase AMPK activity, decrease IR, improve myocardial energy metabolism, regulate cardiac diastolic function, and relieve symptoms in elderly T2DM patients with HF and shows promise for clinical application.