达格列净联合二甲双胍对新诊断成人2型糖尿病患者的临床观察

Clinical observation of dapagliflozin combined with metformin in the treatment of newly diagnosed adult type 2 diabetes mellitus patients

目的比较钠-葡萄糖协同转运蛋白受体2(sodium-dependent glucose transporters 2,SGLT2)抑制剂达格列净联合二甲双胍在新诊断成人2型糖尿病患者中的临床效果。方法选取中国人民解放军总医院第七医学中心2017年10月至2018年12月收治的新诊断的成人2型糖尿病患者80例为研究对象,随机分为2组,每组40例,对照组给予二甲双胍单药治疗,观察组给予达格列净联合二甲双胍治疗,2组均治疗16周。观察治疗前、治疗后患者的体质指数(body mass index,BMI)、空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖(2h postprandial blood glucose,2hPG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、血脂[总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)]、C-反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白细胞介素6(interleukin-6,IL-6)的含量变化情况,并对比2组治疗期间不良反应的发生情况。结果治疗后观察组的FBG、HbA1c、BMI、2hPG、SBP、DBP、TC、TG、LDL-C、CRP、TNF-α、IL-6水平低于对照组(t=-4.057、t=-5.398、t=-4.245、t=-2.166、t=-2.502、t=-2.631、t=-2.260、t=-2.350、t=-2.131、t=-2.298、t=-2.217、t=-2.179,P<0.05);HDL-C水平与对照组比较,差异无统计学意义(t=0.604,P=0.548)。观察组的不良反应为胃肠道反应(2例)、轻度泌尿系感染(1例),对照组的不良反应为胃肠道反应(2例),观察组和对照组不良反应总发生率分别为7.5%和5.0%,差异无统计学意义(P=1.000)。结论达格列净联合二甲双胍可有效降低新诊断成人2型糖尿病患者的血糖、BMI、血压和血脂,并改善患者部分炎症指标。

Objective To compare the clinical effects of sodium-dependent glucose transporters 2(SGLT2)inhibitor dapagliflozin combined with metformin in the treatment of newly diagnosed adult type 2 diabetic patients.Methods Eighty patients with newly diagnosed adult type 2 diabetes admitted in the Seventh Meidical Center of PLA General Hospital from October 2017 to December 2018 were selected.They were randomly divided into two groups,with 40 patients in each group.The control group was given metformin,and the observation group was given dagliflozin combined with metformin.Both of the patients were treated for 16 weeks.The body mass index(BMI),fasting blood glucose(FBG),2 h postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1c),systolic blood pressure(SBP),diastolic blood pressure(DBP),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol(HDL-C),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and the adverse reactions were compared between the two groups.Results After treatment,the levels of FBG,HbA1c,BMI,2hPG,SBP,DBP,TC,TG,LDL-C,CRP,TNF-α,IL-6 in the observation group were lower than those in the control group(t=-4.057,t=-5.398,t=-4.245,t=-2.166,t=-2.502,t=-2.631,t=-2.260,t=-2.350,t=-2.131,t=-2.298,t=-2.217,t=-2.179,P<0.05). The level of HDL-C was lower than that of the control group,and there was no significant difference(t=0.604,P=0.548). Two cases of gastrointestinal reaction and one case of urinary tract infection was occurred in the observation group,and two cases of gastrointestinal reaction were occurred in the control group.The total incidence rate of adverse reactions in the observation and the control groups was 7.5% and 5.0%,respectively,and there was no statistic difference in the two groups(P=1.000). Conclusion The combination of dapagliflozin and metformin could effectively reduce the blood glucose level,body mass index,blood pressure,and the blood lipid level,as well as improve the partial inflammation index of patients in the newly diagnosed adult type 2 diabetes patients.