达格列净联合二甲双胍对2型糖尿病合并心力衰竭患者C-反应蛋白与脑肭肽水平的影响

The effect of Dapagliflozin combined with Metformin on the levels of C-reactive protein and brain natriuretic peptide in patients with type 2 diabetes mellitus complicated with heart failure

目的观察达格列净联合二甲双胍治疗2型糖尿病合并心力衰竭患者的临床效果及对C-反应蛋白(CRP)、脑肭肽(BNP)水平的影响,探讨治疗2型糖尿病合并心力衰竭的有效方式,为临床提供参考依据。方法按照随机数字表法将南京市红十字医院于2019年4月至2020年12月期间收治的60例2型糖尿病合并心力衰竭患者分为对照组和观察组,各30例。两组患者均控制饮食并监测血糖,同时对照组患者应用二甲双胍治疗,观察组患者在对照组的基础上联合应用达格列净治疗,两组患者均连续治疗3个月,并随访6个月。对比两组患者临床总有效率,治疗前后血糖、CRP及BNP水平,随访期间再入院、不良反应及死亡情况。结果观察组患者临床总有效率显著高于对照组;与治疗前比,治疗后两组患者空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)、CRP及BNP水平均显著降低,且观察组低于对照组;观察组患者不良反应总发生率显著低于对照组(均P<0.05);两组患者死亡率、再入院率比较,差异均无统计学意义(均P>0.05)。结论2型糖尿病合并心力衰竭患者联合应用达格列净和二甲双胍治疗可有效提高患者临床治疗效果,降低血糖、炎症因子及BNP水平,改善患者心功能,有效控制病情进展。

Objective To observe the clinical effects of Dapagliflozin combined with Metformin on the levels of C-reactive protein(CRP)and brain natriuretic peptide(BNP)in the treatment of patients with type 2 diabetes mellitus complicated with heart failure,in order to explore the effective way to treat type 2 diabetes mellitus complicated with heart failure,and to provide reference for clinical practice.Methods According to the random number table method,60 patients with type 2 diabetes mellitus complicated with heart failure who were admitted to Nanjing Red Cross Hospital from April 2019 to December 2020 were divided into the control group and the observation group,with 30 cases in each group.The two groups of patients were controlled their diet and monitored their blood sugar.At the same time,the patients in the control group were treated with Metformin,and the patients in the observation group were treated with Dapagliflozin on the basis of the control group.Both groups were treated for 3 consecutive months and followed up for 6 months.The total clinical response rate,blood glucose,CRP and BNP levels before and after treatment,readmission,adverse reactions and mortality rate during the follow-up period were compared between the two groups.Results The clinical total effective rate of patients in the observation group was significantly higher than that in the control group;compared with before treatment,the levels of fasting blood glucose(FBG),2 h postprandial blood glucose(2 h PBG),glycated hemoglobin(HbA1c),CRP and BNP in the two groups after treatment significantly decreased,and the observation group was lower than the control group;the total incidence of adverse reactions in the observation group was significantly lower than that in the control group(all P<0.05);there was no significant difference in mortality and readmission rate between the two groups(all P>0.05).Conclusion The combined application of Dapagliflozin and Metformin during the treatment of patients with type 2 diabetes mellitus and heart failure can effectively improve the clinical treatment effect of the patients,reduce the levels of blood sugar,inflammatory factors and BNP,improve the cardiac function of the patients,and effectively control the progression of the disease.