利拉鲁肽联合依帕司他治疗2型糖尿病心脏自主神经病变的研究

Liraglutide combined with epalrestat in the treatment of type 2 diabetic cardiac autonomic neuropathy

目的:探讨利拉鲁肽联合依帕司他在2型糖尿病(T2DM)合并心脏自主神经病变(CAN)患者中的治疗价值。方法:2021年1月—2022年1月江西省萍乡市人民医院门诊收治的T2DM合并CAN患者90例,随机分成A组、B组与C组3组,每组30例。A组经二甲双胍治疗,B组基于A组方案加用依帕司他,C组基于A组方案加用利拉鲁肽与依帕司他。比较3组治疗前后空腹血糖、餐后2h血糖、糖化血红蛋白(HbA1c)、C反应蛋白(CRP)、超氧化物歧化酶(SOD)水平与临床虚弱程度量表(CFS)评分。经动态心电图检测正常窦性心搏R-R间期总体标准差(SDNN)、每5minR-R间期均值的标准差(SDANN)、全程相邻R-R间期均方根(RMSSD)、正常相邻R-R间期差值>50ms的百分比(PNN50),比较3组CAN疗效,记录不良反应情况。结果:C组疗程结束后空腹血糖、餐后2h血糖、HbA1c、CRP水平以及CFS评分低于A、B组(P<0.05),血清SOD水平高于A、B组,且SDNN、SDANN、RMSSD、PNN50高于A、B组(P<0.05)。3组不良反应发生情况比较差异无统计学意义(P>0.05)。结论:T2DM合并CAN患者在二甲双胍治疗基础上联合利拉鲁肽与依帕司他治疗,能进一步改善血糖水平与心率变异性指标,减轻炎症,缓解机体氧化应激状态,且用药安全。

Objective: To investigate the therapeutic value of liraglutide combined with epalrestat in the patients with type 2 diabetes mellitus(T2DM) with cardiac autonomic neuropathy(CAN). Methods: A total of 90 patients with T2DM and CAN who were admitted to Jiangxi Pingxiang People’s Hospital from Jan. 2021 to Dec. 2022 were enrolled and divided into group A, group B and group C with 30 cases each according to the random number table method. Group A was treated with metformin, group B with epalrestat on the basis of group A, and group C with liraglutide combined with epalrestat on the basis of group A. Before treatment, the levels of fasting blood glucose(FPG), 2-hour postprandial blood glucose(2hPG), glycosylated hemoglobin(HbA1c), serum C-reactive protein(CRP), superoxide dismutase(SOD)levels and clinical frailty scale( CFS) score of the three groups were compared. The overall standard deviation of the R-R interval of normal sinus beats(SDNN), the standard deviation of the mean R-R interval for each 5 minutes(SDANN),the root mean square of the whole adjacent R-R interval(RMSSD), the normal adjacent R-R interval difference > the percentage of 50 ms(PNN50), the therapeutic efficacy of CAN was compared between the three groups, and the adverse reactions were recorded. Results: After the course of treatment, the levels of FPG, 2hPG, HbA1c, CRP and CFS in group C were lower than those in group A and group B(P<0.05). Serum SOD level in group C was higher than that in group A and group B after the course of treatment. SDNN, SDANN, RMSSD, and PNN50 were higher than those in group A and group B(P<0.05). There was no significant difference in the incidence of adverse reactions rate among the three groups(P>0.05). Conclusions: Combined treatment of liraglutide and epalrestat on the basis of metformin can further improve blood glucose level and heart rate variability indicators, reduce inflammation and oxidative stress,improve the therapeutic efficacy of CAN, and the drug is safe to use in patients with T2DM and CAN.