达格列净在2型糖尿病合并高血压患者中的临床应用

Clinical application of Dapagliflozin in patients with type 2 diabetes mellitus and hypertension

目的探讨达格列净在2型糖尿病合并高血压患者中的临床应用。方法选取2018年1月~2019年12月北京市健宫医院内分泌科收治的2型糖尿病合并高血压且服用二甲双胍血糖不达标的285例患者作为研究对象,按照随机数字表法分为达格列净组(142例)与西格列汀组(143例)。达格列净组患者采用盐酸二甲双胍片+达格列净治疗,西格列汀组患者采用盐酸二甲双胍片+西格列汀治疗。治疗24周后,比较两组患者的糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后2 h血糖(2 h PG)、收缩压(SBP)、舒张压(DBP)、体重指数(BMI)变化情况;比较两组患者低血糖、低血压、泌尿系感染的发生情况。结果最终纳入统计分析:达格列净组为133例,西格列汀组为133例。达格列净组患者治疗后的HbA1c、2 h PG高于西格列汀组,差异有统计学意义(P<0.05);两组患者治疗后的FBG比较,差异无统计学意义(P>0.05);两组患者治疗后的HbA1c、FBG、2 h PG均低于本组治疗前,差异有统计学意义(P<0.05)。达格列净组患者治疗后的SBP、DBP均低于西格列汀组,差异有统计学意义(P<0.05);两组患者治疗后的BMI比较,差异无统计学意义(P>0.05);两组患者治疗后的SBP、DBP均低于本组治疗前,差异有统计学意义(P<0.05);达格列净组患者治疗后的BMI低于本组治疗前,差异有统计学意义(P<0.05)。达格列净组患者治疗后泌尿系感染发生率高于西格列汀组,差异有统计学意义(P<0.05)。两组患者治疗后低血糖发生率比较,差异无统计学意义(P>0.05)。两组患者均未出现低血压。结论达格列净用于2型糖尿病合并高血压患者虽然易引起泌尿系感染,但是其降糖效果确切,尤其是其降压、减重效果明显,低血糖、低血压发生事件较少,临床相对安全。

Objective To explore the clinical application of Dapagliflozin in patients with type 2 diabetes mellitus and hypertension.Methods A total of 285 patients with type 2 diabetes mellitus and hypertension were enrolled as the research objects from January 2018 to December 2019 in the Department of Endocrinology,Beijing Jiangong Hospital and were divided into the Dapagliflozin group(142 cases)and Sitagliptin group(143 cases)according to the random number table method.Patients in the Dapagliflozin group were treated with Metformin Hydrochloride Tablets+Dapagliflozin,and patients in the Sitagliptin group were treated with Metformin Hydrochloride Tablets+Sitagliptin.After 24 weeks of treatment,changes of glycosylated hemoglobin(HbA1c),fasting blood glucose(FBG),2 h postprandial blood glucose(2 h PG),systolic blood pressure(SBP),diastolic blood pressure(DBP)and body mass index(BMI)of patients between the two groups were compared.The occurrence of hypoglycemia,hypotension and urinary tract infection was compared between the two groups.Results Finally,133 cases were included in the Dapagliflozin group and 133 cases in the Sitagliptin group.After treatment,the HbA1c and 2 h PG of patients in the Dapagliflozin group were higher than those in the Sitagliptin group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in FBG between the two groups after treatment(P>0.05).The HbA1c,FBG,and 2 h PG of the two groups after treatment were lower than those before treatment,and the differences were statistically significant(P<0.05).The SBP and DBP of patients in the Dapagliflozin group after treatment were lower than those in the Sitagliptin group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in BMI between the two groups after treatment(P>0.05).The SBP and DBP of the two groups after treatment were lower than those before treatment,and the differences were statistically significant(P<0.05).The BMI in the Dapagliflozin group after treatment was lower than that before treatment in this group,and the difference was statistically significant(P<0.05).After treatment,the incidence of urinary tract infection in the Dapagliflozin group was higher than that in the Sitagliptin group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of hypoglycemia between the two groups after treatment(P>0.05).There was no hypotension in the two groups.Conclusion When Dapagliflozin is used in patients with type 2 diabetes and hypertension,it is easy to cause urinary tract infections.But its hypoglycemic effect is definite,especially its hypotensive and weight reduction effect is obvious and there are fewer hypoglycemia and hypotension events.As a whole,it is clinically relatively safe.