二甲双胍对2型糖尿病患者血清25-(OH)D_(3)水平及心律失常发生率的影响

Effects of metformin on serum 25-(OH)D_(3)levels and the incidence of arrhythmias in patients with diabetes mellitus

目的分析二甲双胍对血清25-羟基维生素D_(3)[25-(OH)D_(3)]水平及糖尿病(DM)相关心律失常发生率的影响。方法选取2019年7月—2020年6月就诊于北京大学人民医院的160例2型糖尿病(T2DM)患者,分为对照组、研究组,每组80例。两组分别接受利拉鲁肽、二甲双胍治疗。比较两组疗效、DM相关心律失常发生率,并观察治疗前、治疗24周后血清25-(OH)D_(3)、血糖[空腹血糖(FPG)、糖化血红蛋白(HbAlc)]、超敏C反应蛋白(hs-CRP)、血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]及左心室结构指标[左心房前后径(LAD)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、左心室射血分数(LVEF)]变化。结果研究组总有效率较对照组高。两组治疗前FPG、HbAlc、25-(OH)D_(3)、hs-CRP水平比较,差异无统计学意义(P>0.05)。研究组治疗24周后FPG、HbAlc、hs-CRP较对照组低,25-(OH)D_(3)较对照组高(P<0.05)。两组治疗24周后PG、HbAlc、hs-CRP较治疗前低,25-(OH)D_(3)较治疗前高(P<0.05)。两组治疗前TC、TG、LDL-C水平比较,差异无统计学意义(P>0.05)。研究组治疗24周后TC、TG、LDL-C水平较对照组低(P<0.05)。两组治疗24周后TC、TG、LDL-C水平较治疗前低(P<0.05)。两组治疗前LAD、LVEDd、LVEF比较,差异无统计学意义(P>0.05)。研究组治疗24周后LAD、LVEDd、LVEFLAD、LVEDd较对照组低,LVEF较对照组高(P<0.05)。研究组治疗24周后LAD、LVEDd、LVESd较治疗前低,LVEF较治疗前高(P<0.05)。研究组心律失常发生率较对照组低(P<0.05)。结论二甲双胍可提升T2DM患者血清25-(OH)D_(3)水平,调节血糖和血脂代谢,改善心室重构,预防心律失常。

Objective To analyze the effects of metformin on serum 25-(OH)D_(3) levels and the incidence of arrhythmias in patients with diabetes mellitus.Methods The 160 patients with type 2 diabetes mellitus(T2DM)seeking medical advice in Peking University People's Hospital from July 2019 to June 2020 were selected and divided into control group(80 cases)and study group(80 cases),and they were treated with liraglutide and metformin,respectively.The therapeutic efficacy and the incidence of DM-related arrhythmias were observed in both groups.The serum levels of 25-(OH)D_(3),blood glucose[fasting blood glucose(FPG)and glycosylated hemoglobin(HbAlc)],hypersensitivity C-reactive protein(hs-CRP),and blood lipids[total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)],as well as left ventricular structural parameters[left atrial anteroposterior diameter(LAD),left ventricular end diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),and left ventricular ejection fraction(LVEF)]before and 24 weeks after the treatment were also observed.Results The overall effective rate in the study group was higher than that in the control group.There was no difference in the levels of FPG,HbAlc,25-(OH)D_(3),and hs-CRP before the treatment between the two groups(P>0.05).After 24 weeks of treatment,the levels of FPG,HbAlc and hs-CRP were lower but the level of 25-(OH)D_(3) was higher in the study group compared with the control group(P<0.05).In both groups,the levels of FPG,HbAlc and hs-CRP were lower but the level of 25-(OH)D_(3) was higher after 24 weeks of treatment compared with those before the treatment(P<0.05).There was no difference in the levels of TC,TG and LDL-C before the treatment between the two groups(P>0.05),while these indicators were lower in the study group than those in the control group after 24 weeks of treatment(P<0.05).Compared with those before the treatment,the levels of TC,TG and LDL-C after 24 weeks of treatment were decreased in both groups(P<0.05).There was no difference in LAD,LVEDd and LVEF before the treatment between the two groups(P>0.05).After 24 weeks of treatment,LAD and LVEDd were lower but LVEF was higher in the study group compared with the control group(P<0.05).The LAD,LVEDd and LVESd were lower,and LVEF was higher after 24 weeks of treatment compared with those before the treatment in the study group(P<0.05).The incidence of arrhythmias in the study group was lower than that in the control group(P<0.05).Conclusions Metformin elevates the serum 25-(OH)D_(3) level and regulates the metabolisms of blood glucose and lipids in T2DM patients.Besides,it ameliorates ventricular remodeling and prevents cardiac arrhythmias.