SGLT-2抑制剂辅助降糖治疗对老年2型糖尿病患者尿酸水平及血管内皮功能的影响

Effect of SGLT-2 inhibitor adjuvant hypoglycemic therapy on uric acid level and vascular endothelial function in elderly patients with type 2 diabetes mellitus

目的探讨钠-葡萄糖协同转运蛋白-2(SGLT-2)抑制剂辅助降糖治疗对老年2型糖尿病(T2DM)患者尿酸水平及血管内皮功能的影响。方法将92例老年T2DM患者随机分为对照组和观察组,各46例。对照组采用常规降糖方案进行治疗,观察组在常规降糖方案基础上给予SGLT-2抑制剂达格列净口服,均治疗3个月(1个疗程)。比较两组患者治疗前后血糖控制相关指标、尿酸排泄相关指标、血管内皮功能指标。记录两组患者治疗期间的药物不良反应发生情况。结果治疗1个疗程后,两组患者空腹血糖水平、餐后2 h血糖(2hPBG)水平、HbA1c水平、臂踝脉搏波传导速度(ba-PWV)、踝臂指数、血尿酸水平均较治疗前降低,血流介导的血管舒张(FMD)功能、24 h尿尿酸(24hUUA)水平、尿酸排泄分数、尿酸清除率均较治疗前提高(均P<0.05)。治疗1个疗程后,观察组空腹血糖水平、2hPBG水平、HbA1c水平、ba-PWV、踝臂指数、血尿酸水平均低于对照组,FMD功能、24hUUA水平、尿酸排泄分数、尿酸清除率均高于对照组(均P<0.05)。两组药物不良反应发生率差异无统计学意义(P>0.05)。结论SGLT-2抑制剂辅助降糖治疗可提高老年T2DM患者的血糖控制效果,进一步改善患者的血管内皮功能,并可有效促进尿酸持续排泄以降低血尿酸水平,且安全性较高。

Objective To explore the effect of sodium-glucose cotransporter-2(SGLT-2)inhibitor adjuvant hypoglycemic therapy on uric acid level and vascular endothelial function in elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 92 elderly patients with T2DM were randomly divided into control group or observation group,with 46 cases in each group.The control group was treated with conventional hypoglycemic regimen,based on which the observation group was orally administrated SGLT-2 inhibitor dapagliflozin,for a 3-month treatment(one disease course).The pre-and post-treatment indices related to blood glucose control,to uric acid excretion,and vascular endothelial function indices were compared between the two groups.The occurrence of drug adverse reactions in both groups was recorded during treatment.Results After 1 course of treatment,the patients in both groups obtained lower fasting blood glucose level,2 hours postprandial blood glucose(2hPBG)level and HbA1c level,and lower brachial-ankle pulse wave velocity(ba-PWV),ankle-brachial index,blood uric acid level,whereas higher flow-mediated dilation(FMD)function,24-hour urinary uric acid(24hUUA)level,uric acid excretion fraction,and uric acid clearance as compared with before treatment(all P<0.05).After 1 course of treatment,the observation group exhibited lower levels of fasting blood glucose,2hPBG,HbA1c,and lower ba-PWV,ankle-brachial index and blood uric acid level,whereas higher FMD function,24hUUA level,uric acid excretion fraction,and uric acid clearance as compared with the control group(all P<0.05).There was no statistically significant difference in the incidence rate of drug adverse reactions between the two groups(P>0.05).Conclusion SGLT-2 inhibitor adjuvant hypoglycemic therapy can improve the effect of blood glucose control in elderly patients with T2DM,ameliorate further patients′vascular endothelial function,promote the continuous excretion of uric acid to decrease blood uric acid level,exerting a relatively high safety.