达格列净对2型糖尿病患者血胆固醇及颈动脉内膜中层厚度的影响

Effects of dapagliflozin on blood cholesterol and carotid intima-media thickness in patients with type 2 diabetes

目的探讨达格列净对2型糖尿病(T2DM)患者血胆固醇及颈动脉内膜中层厚度(CIMT)的影响。方法选取2017年5月至2020年6月福建医科大学附属泉州第一医院内分泌科新诊断经二甲双胍治疗3个月后血糖控制欠佳的T2DM患者208例,根据随机数字表法分为达格列净组104例,给予达格列净10 mg,1次/d;西格列汀组104例,给予西格列汀100 mg,1次/d,共观察24周。评估治疗前后体质量、腰臀比、空腹血糖、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、血压、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、小而密低密度脂蛋白胆固醇(sdLDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油、尿酸、CIMT及白细胞介素-6(IL-6)、超氧化物歧化酶(SOD)、同型半胱氨酸(Hcy)的水平。结果两组患者治疗后HbA1c、空腹血糖、HOMA-IR、IL-6、SOD、Hcy水平降低(均P<0.05),CIMT下降[达格列净治疗后:(0.88±0.20)比治疗前:(1.18±0.11)mm,t=15.204,P<0.01;西格列汀治疗后:(1.10±0.11)比治疗前:(1.19±0.12)mm,t=7.979,P<0.01],达格列净组CIMT下降幅度大于西格列汀组[-0.30(-0.40~-0.20)比-0.10(-0.20~0)mm,t=-8.130,P<0.01],两组HbA1c、空腹血糖降幅差异无统计学意义(P>0.05);与西格列汀组比较,达格列净改善HOMA-IR、CIMT、IL-6、SOD、Hcy更明显(P<0.05),达格列净组LDL-C较基线水平上升(P<0.05),sdLDL-C下降,西格列汀组的LDL-C、sdLDL-C较基线变化的差异无统计学意义(均P>0.05)。两组均无退出情况,各有2例患者出现1次一级低血糖事件,未记录到其他不良反应。结论达格列净能降低T2DM患者的sdLDL-C和CIMT水平。

Objective To investigate the effect of dapagliflozin on blood cholesterol and carotid intima-media thickness(CIMT)in patients with type 2 diabetes mellitus(T2 DM).Methods A total of 208 T2 DM patients prooly reacted to 3 months treatment of metformin were recruited during May 2017 to June 2020 in the Department of Endocrinology,Quanzhou First Hospital Affiliated to Fujian Medical University and divided into 2 groups(104 for each group)by random number table.Patients in dapagliflozin group and sitagliptin group were given dapagliflozin 10 mg and sitagliptin 100 mg once a day,respectively,for 24 weeks.Weight,waist hip ratio,fasting plasma glucose,glycosylated hemoglobin A1 c(HbA1 c),homeostatic model assessment of insulin resistance(HOMA-IR),systolic blood pressure,diastolic blood pressure,triacylglycerol,total cholesterol,high density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),small dense low-density lipoprotein cholesterol(sdLDL-C),uric acid,interleukin-6(IL-6),superoxidedismutase(SOD),homocysteine(Hcy)were assessed before and after the treatment.Results HbA1 c,fasting plasma glucose,HOMA-IR,IL-6,SOD and Hcy were all decreased in the two groups after treatment(P<0.05).CIMT in both groups decreased[dapagliflozin group:after treatment(0.88±0.20)vs before treatment(1.18±0.11)mm,t=15.204,P<0.01;sitagliptin group:after treatment:(1.10±0.11)vs before treatment:(1.19±0.12)mm,t=7.979,P<0.01],which was more significantly in dapagliflozin group than in sitagliptin group[-0.30(-0.40 to-0.20)vs-0.10(-0.20 to 0)mm,t=-8.130,P<0.01].There was no significant difference in the decrease of HbA1 c and fasting plasma glucose between the two groups(P>0.05).Compared with sitagliptin group,HOMA-IR,CIMT,IL-6,SOD and Hcy in dapagliflozin group improved more significantly(P<0.05).The level of LDL-C increased in dapagliflozin group(P<0.05),while sdLDL decreased(P<0.01),and the level of LDL-C and sdLDL did not change in sitagliptin group(P>0.05).There was no withdrawal in the two groups.There were 2 cases of first-degree hypoglycemia in each group,and no other side-effects were recorded.Conclusion Dapagliflozin can reduce sdLDL and CIMT in type 2 diabetic patients.