沙格列汀联合二甲双胍治疗2型糖尿病合并脑梗死的临床疗效

Clinical efficacy of saxagliptin combined with metformin in the treatment of type 2 diabetes mellitus complicated with cerebral infarction

目的:观察沙格列汀联合二甲双胍治疗2型糖尿病(type 2 diabetes mellitus,T2DM)合并脑梗死的临床疗效。方法:选择2018年9月至2020年6月于徐州医科大学附属医院内分泌科住院的T2DM合并脑梗死的患者139例,将上述患者随机分为2组,A组接受沙格列汀联合二甲双胍治疗,B组接受格列美脲片治疗。2组患者连续治疗12周,比较治疗前后血糖、中性粒细胞计数与淋巴细胞计数的比值(neutrophil-to-lymphocyte ratio,NLR)、血小板计数与淋巴细胞计数的比值(platelet-to-lymphocyte ratio,PLR)、血糖波动指标、颈动脉内膜中层厚度(carotid intima-media thickness,CIMT)。结果:治疗12周后,2组空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖(2-h postprandial blood glucose,2hPG)、糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)均较治疗前明显降低(P<0.05),且A组较B组下降更明显(P<0.05)。A组NLR及PLR较治疗前明显降低(P<0.05),B组NLR和PLR较治疗前无明显变化(P>0.05)。2组血糖水平的标准差(standard deviation of the blood glucose concentrations,SDBG)、餐后血糖波动幅度(postprandial glucose excursions,PPGE)、最大血糖波动幅度(largest amplitude of glycemic excursions,LAGE)均较治疗前明显下降(P<0.05),且A组较B组下降更明显(P<0.05)。A组CIMT较治疗前降低(P<0.05),B组CIMT较治疗前降低,但差异无统计学意义(P>0.05),组间比较差异有统计学意义(P<0.05)。结论:沙格列汀联合二甲双胍治疗T2DM合并脑梗死能有效改善患者的血糖波动、NLR和PLR,改善由高血糖导致的动脉粥样硬化程度,值得临床推广。

Objective:To observe the clinical efficacy of saxagliptin combined with metformin in the treatment of type 2 diabetes mellitus(T2DM)complicated with cerebral infarction.Methods:The clinical data of 139 patients with T2DM complicated with cerebral infarction in the Department of Endocrinology,Affiliated Hospital of Xuzhou Medical University from September 2018 to June 2020 were analyzed retrospectively.They were randomly divided into two groups:group A received saxagliptin combined with metformin and group B received glimepiride.Blood glucose,neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),blood glucose fluctuation,and carotid intima-media thickness(CIMT)were compared between the two groups before and after the treatment(12 weeks).Results:After 12 weeks of treatment,fasting blood glucose(FBG),2-h postprandial blood glucose(2hPG),and glycosylated hemoglobin A1c(HbA1c)in both groups were significantly lower than those before the treatment(P<0.05),and the decline in group A was more pronounced than that in group B(P<0.05).The NLR and PLR of group A were significantly decreased compared with that before the treatment(P<0.05),while the NLR and PLR of group B had no significant changes compared with that before the treatment(P>0.05).The standard deviation of the blood glucose concentrations(SDBG),postprandial glucose excursions(PPGE)and largest amplitude of glycemic excursions(LAGE)were all significantly lower than those before the treatment(P<0.05),and the decline in group A was more pronounced than that in group B(P<0.05).CIMT in group A was lower than that before the treatment(P<0.05)and CIMT in group B was also lower than that before the treatment,but the difference was not statistically significant(P>0.05),and the difference between groups was statistically significant(P<0.05).Conclusion:Saxagliptin combined with metformin in the treatment of T2DM complicated with cerebral infarction is a safe and effective therapy for the improvement of the blood glucose fluctuation,NLR,PLR,and the degree of atherosclerosis generated by hyperglycemia.It is worthy of clinical application and promotion.