达格列净和维格列汀对糖尿病合并冠心病老年患者血糖、血管内皮功能及心功能的影响

Effects of dapagliflozin and vildagliptin on blood glucose,vasculaRendothelial function and cardiac function indicators in elderly patients with diabetes mellitus complicated with coronary heart disease

目的:探讨达格列净和维格列汀对糖尿病合并冠心病老年患者血糖、血管内皮功能及心功能的影响。方法:选择糖尿病合并冠心病老年患者168例为研究对象,按抽签法分为甲组和乙组,每组84例。所有患者均给予降糖药物二甲双胍片、保护心肌药物酒石酸美托洛尔片、抗凝药物阿司匹林肠溶片和调脂药阿托伐他汀片。在此基础上,甲组给予达格列净治疗,乙组给予维格列汀治疗。治疗3个月后,比较两组临床疗效。于治疗前后检查患者血糖指标[空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)]、心功能指标[左心室射血分数(LVEF)]以及血管内皮功能指标[一氧化氮(NO)、内皮素-1(ET-1)、血管内皮生长因子(VEGF)]并进行组间比较。记录两组不良反应发生情况。结果:两组临床总有效率比较差异无统计学意义(P>0.05)。治疗前两组患者FPG、2 hPG、HbA1c、LVEF水平比较差异无统计学意义(均P>0.05);治疗后甲组FPG、2 hPG、HbA1c水平低于乙组,LVEF水平高于乙组(均P<0.05)。治疗前两组VEGF、ET-1、NO比较差异无统计学意义(均P>0.05);治疗后,甲组NO水平高于乙组,VEGF、ET-1水平低于乙组(均P<0.05)。两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论:达格列净和维格列汀分别治疗糖尿病合并冠心病患者均能明显提高临床疗效,但在降低血糖、糖化血红蛋白及改善血管内皮功能、心功能方面达格列净优于维格列汀。

Objective:To explore the effects of dapagliflozin and vildagliptin on blood glucose indicators and vasculaRendothelial function in elderly patients with diabetes mellitus complicated with coronary heart disease.Methods:A total of 168 elderly patients with diabetes mellitus and coronary heart disease were enrolled and divided into group A and group B according to the lottery method,with 84 cases in each group.All patients were given the antidiabetic drug metformin tablets,the myocardial protective drug xiyuan metoprolol tartrate tablets,the anticoagulant aspirin enteric-coated tablets and the lipid-regulating drug atorvastatin tablets.On this basis,group A was treated with dapagliflozin and group B with vildagliptin.AfteR3 months of treatment,the clinical efficacy of the two groups was compared.Before and afteRtreatment,blood glucose indexes(FPG,2 hPG,and HbA1c),cardiac function index(LVEF)and vasculaRendothelial function indexes(NO,ET-1,and VEGF)were checked and compared between groups.Adverse reactions were recorded in both groups.Results:There was no significant difference in clinical total effective rate between the two groups(P>0.05).There was no significant difference in FPG,2 hPG,HbA1c and LVEF levels before treatment between the two groups(all P>0.05);afteRtreatment,FPG,2 hPG and HbA1c levels in group A were loweRthan those in group B,while LVEF level was higheRthan that in group B(all P<0.05).There was no significant difference in VEGF,ET-1 and NO before treatment between the two groups(all P>0.05);afteRtreatment,NO level in group A was higheRthan that in group B,while VEGF and ET-1 levels were loweRthan those in group B(all P<0.05).There was no significant difference in total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Both dapagliflozin and vildagliptin in the treatment of patients with diabetes mellitus and coronary heart disease can significantly enhance the clinical efficacy,but dapagliflozin is superioRto vildagliptin in reducing blood glucose,glycosylated hemoglobin and improving vasculaRendothelial function and cardiac function.