更年期糖尿病女性发生心肌病的危险因素及不同剂量厄贝沙坦的治疗效果和安全性分析

Risk factors of cardiomyopathy in menopausal diabetic women and different doses of irbesartan analysis of therapeutic effect and safety

目的探究更年期糖尿病(DM)女性发生糖尿病心肌病(DMC)的危险因素,并分析不同剂量厄贝沙坦的治疗效果和安全性。方法选取2019年1月—2020年12月九江学院附属医院接诊的128例更年期女性DM患者为研究对象,根据患者是否出现DMC将其分为DM组(86例)和DMC组(42例),并将DMC组患者随机分为观察组(21例)和对照组(21例)。收集所有患者的临床资料,观察组患者给予0.3 g/次,1次/d厄贝沙坦治疗,对照组患者给予0.15 g/次,1次/d厄贝沙坦治疗。单因素分析影响更年期女性DM患者发生DMC的临床因素,多因素Logistic回归分析影响更年期女性DM患者发生DMC的危险因素;比较观察组和对照组患者生化指标、左心室功能及不良反应率。结果DMC组患者DM病程、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、极低密度脂蛋白(VLDL)、超敏C-反应蛋白(hs-CRP)、D-二聚体(D-D)、B型脑钠肽(BNP)水平及尿微量清蛋白排泄率(UAER)均显著高于DM组,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,DM病程、HbA1c、TG、hs-CRP、D-D及BNP为更年期女性DM患者发生DMC的主要危险因素(均P<0.05)。观察组患者左室舒张末压(LVEDP)、左室射血分数(LVEF)、血清基质金属蛋白酶2(MMP-2)、Ⅲ型前胶原氨基末端肽(PⅢNP)及血浆脑钠肽水平均明显优于对照组,差异均有统计学意义(均P<0.05);两组患者不良反应发生率(对照组19.05%,观察组14.28%)比较,差异无统计学意义(χ^(2)=0.171,P=0.679)。结论DM病程、HbA1c、TG、hs-CRP、D-D及BNP为更年期女性DM患者发生DMC的主要危险因素;厄贝沙坦治疗DMC患者能有效改善心室功能,阻碍心肌纤维化,减缓心衰进程,且0.3 g/次,1次/d服用厄贝沙坦疗效更明显,安全性较好。

Objective To investigate the risk factors of diabetic cardiomyopathy(DMC)in menopausal women with diabetes mellitus(DM),and to analyze the efficacy and safety of irbesartan at different doses.Methods A total of 128 menopausal DM patients treated in Jiujiang University Affiliated Hospital from January 2019 to December 2020 were selected as the research objects.According to the occurrence of DMC,patientswere divided into DM group(86 cases)and DMC group(42 cases),and the DMC group was randomly divided into observation group(21 cases)and control group(21 cases).All patient clinical information was collected,Patients in the observation group were given0.3 g irbesartan once a day,and patients in the control group were given 0.15 g irbesartan once a day.Single factor analysis of clinical factors affecting DMC in menopausal women with DM,The risk factors of DMC in menopausal DM patients were analyzed by multivariate Logistic regression.Biochemicalparameters,left ventricular function,andadr rates were compared between the observation group and the control group.Results The course of diabetes,fasting blood glucose(FPG),glycosylated hemoglobin(HbA1 c),triglyceride(TG),very low density lipoprotein(VLDL),hypersensitive C-reactive protein(HS-CRP),D-dimer(D-D),B-type brain natriuretic peptide(BNP)and urinary microalbumin excretion rate(UAER)in DMC group were significantly higher than those in DMC group DM group,the differences were statistically significant(all P<0.05).Multivariate Logistic regression model analysis showed that the course of diabetes,HbA1 c,TG,Hs-CRP,D-D and BNP were the main risk factors for DMC in menopausal DM patients(ALL P<0.05).The levels of left ventricular end-diastolic pressure(LVEDP),left ventricular ejection fraction(LVEF),serum matrix metalloproteinase 2(MMP-2),amino terminal peptide of taro type procollagen(PⅢNP)and plasma brain natriuretic peptide in observation group were significantly higher than those in control group,and the differences were statistically significant(P<0.05).There was no significant difference in the rate of adverse reactions between the two groups(19.05%in the control group and 14.28%in the observation group)(χ^(2)=0.171,P=0.679).Conclusion The course of diabetes mellitus,HbA1 c,TG,Hs-CRP,D-D and BNP are the main risk factors for DMC in menopausal women with DM.Irbesartan treatment of DMC patients can effectively improve ventricular function,block myocardial fibrosis,slow down the process of heart failure,and 0.3 g/time,once a day irbesartan has better efficacy and safety.