伊伐布雷定对糖尿病伴冠心病患者的效果观察

Effect of ivabradine on patients with diabetes mellitus with coronary heart disease

目的探讨伊伐布雷定对糖尿病伴冠心病患者的效果观察.方法选择2018年1月至2019年1月本院收治的糖尿病伴冠心病患者90例,采用随机数字表法分为两组,各45例.对照组采用常规治疗,观察组在对照组基础上服用伊伐布雷定.对比两组临床疗效、心功能指标、炎性因子、血流动力学指标.结果治疗后,观察组总有效率97.78%高于对照组80.00%,差异具有统计学意义(P<0.05).观察组心率(71.63±3.21)次/min、氨基末端脑钠肽前体水平(NT-proBNP)(755.48±346.42)ng/L、空腹血糖(FPG)(6.55±1.14)mmol/L、糖化血红蛋白(HbA1c)(6.13±1.08)%、餐后2 h血糖(2hPG)(7.14±0.52)mmol/L、肿瘤坏死因子-α(TNF-α)(0.81±0.21)ng/L、白介素-6(IL-6)(7.42±1.21)ng/L、血清超敏C反应蛋白(hs-CRP)(1.24±0.54)mg/L水平、全血黏度(33.92±1.13)mpa/s、血浆黏度(1.35±0.09)mpa/s、血浆纤维蛋白原(2.01±0.03)g/L低于对照组心率(84.06±3.54)次/min、NT-proBNP(1598.14±309.34)ng/L、FPG(7.95±1.02)mmol/L、HbA1c(7.12±1.23)%、2hPG(7.87±0.76)mmol/L、TNF-α(1.06±0.28)ng/L、IL-6(9.24±1.52)ng/L、hs-CRP(1.67±0.72)mg/L、全血黏度(38.10±1.18)mpa/s、血浆黏度(1.58±0.13)mpa/s、血浆纤维蛋白原(2.64±0.16)g/L;且观察组左心室射血分数(LVEF)(50.69±4.98)%、左心室收缩末期内径(LVESD)(45.70±4.70)mm、左心室舒张末期内径(LVEDD)(45.20±3.81)mm、6 min步行距离(422.67±70.54)m高于对照组LVEF(46.72±5.38)%、LVESD(50.52±5.20)mm、LVEDD(49.40±4.03)mm、6 min步行距离(322.04±53.12)m,差异具有统计学意义(P<0.05).结论伊伐布雷定有助于糖尿病伴冠心病患者降低NT-proBNP水平、改善心功能指标、降低炎性因子水平和血液流变学指标,改善患者临床疗效,提高患者生活质量,有助于患者转归.

Objective To investigate the effect of Ivabradine on diabetic patients with coronary heart disease.Methods Select from January 2018 to January 2019 in our hospital 90 cases of diabetic patients with coronary heart disease,were randomly assigned into two groups,with 45 cases in each group.The control group was treated with conventional therapy and the observation group was given Ivabradine plus conventional therapy given to the control group.The clinical efficacy,cardiac function index,inflammatory factor and hemorheology index were compared between the two groups.Results After treatment,the total response rate in the observation group was 97.78%,higher than that in the control group,which was 80.00%,and the difference was statistically significant(P<0.05).The heart rate,level of amino terminal brain natriuretic peptide precursor(NT-proBNP),fasting blood glucose(FPG),glycated hemoglobin(HbA1c),2 h postprandial blood glucose(2hPG),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),serum high-sensitivity C-reactive protein(hs-CRP),whole blood viscosity,plasma viscosity,and plasma fibrinogen in the observation group were(71.63±3.21)beats/min,(755.48±346.42)ng/L,(6.55±1.14)mmol/L,(6.13±1.08)%,(7.14±0.52)mmol/L,(0.81±0.21)ng/L,(7.42±1.21)ng/L,(1.24±0.54)mg/L,(33.92±1.13)mpa/s,(1.35±0.09)mpa/s,and(2.01±0.03)g/L,all shown to be lower than those in the control group,where these indicators were respectively(84.06±3.54)beats/min,(1598.14±309.34)ng/L,(7.95±1.02)mmol/L,(7.12±1.23)%,(7.87±0.76)mmol/L,(1.06±0.28)ng/L,(9.24±1.52)ng/L,(1.67±0.72)mg/L,(38.10±1.18)mpa/s,(1.58±0.13)mpa/s,and(2.64±0.16)g/L;the left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD)and 6-minute walking distance in the observation group were(50.69±4.98)%,(45.70±4.70)mm,(45.20±3.81)mm,and(422.67±70.54)m,all shown to be higher than the control group,where the LVEF,LVESD,LVEDD,and 6 min walking distance were respectively(46.72±5.38)%,(50.52±5.20)mm,(49.40±4.03)mm,and(322.04±53.12)m;the difference was statistically significant(P<0.05).Conclusion For patients with diabetes mellitus complicated by coronary heart disease,Ivabradine can help reduce the levels of NT-proBNP,improve their cardiac function indicators,reduce the levels of inflammatory factor and hemorheology and improve the clinical efficacy and the patients quality of life;therefore,it is better for the patients outcome.