达格列净对冠心病合并2型糖尿病患者PCI后肾功能及造影剂肾病的影响

Effect of Dapagliflozin on Renal Function and Contrast-Induced Nephropathy in Patients with Coronary Heart Disease Complicated with Type 2 Diabetes Mellitus after PCI

目的探讨达格列净对冠心病合并2型糖尿病患者PCI后肾功能及造影剂肾病(CIN)的影响。方法选取2021年于河北医科大学第二医院心内科行择期PCI的冠心病合并2型糖尿病患者59例,按照随机数字表法将患者分为研究组(n=36)和对照组(n=23)。研究组采用标准冠心病治疗方案联合达格列净治疗,对照组采用标准冠心病治疗方案联合阿卡波糖治疗。比较两组术后48 h CIN发生率、基线资料、术前和术后48 h肾功能指标〔血肌酐(Scr)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、胱抑素C(Cys-C)、估算肾小球滤过率(eGFR)〕。采用多因素Logistic回归分析探讨达格列净对冠心病合并2型糖尿病患者PCI后发生CIN的影响。观察患者住院期间严重不良事件、达格列净或阿卡波糖相关不良反应、急性肾损伤发生情况。结果研究组CIN发生率为5.6%(2/36),对照组CIN发生率为13.0%(3/23)。两组CIN发生率比较,差异无统计学意义(P>0.05)。两组术后48 h Scr、NGAL、Cys-C分别高于本组术前,eGFR分别低于本组术前,且研究组术前与术后48 h Scr、NGAL、Cys-C、eGFR的差值小于对照组(P<0.05)。多因素Logistic回归分析结果显示,使用达格列净不是冠心病合并2型糖尿病患者PCI后发生CIN的影响因素(P>0.05)。所有患者住院期间无严重不良事件发生。所有患者未出现达格列净或阿卡波糖相关不良反应及急性肾损伤。结论达格列净对冠心病合并2型糖尿病患者肾功能的改善作用优于阿卡波糖,但其不是患者PCI后发生CIN的影响因素。

Objective To investigate the effect of dapagliflozin on renal function and contrast-induced nephropathy(CIN)in patients with coronary heart disease complicated with type 2 diabetes mellitus after PCI.Methods A total of 59 patients with coronary heart disease complicated with type 2 diabetes mellitus undergoing elective PCI in the Department of Cardiology of the Second Hospital of Hebei Medical University in 2021 were selected and divided into study group(n=36)and control group(n=23)according to the random number table method.The study group received standard coronary heart disease regimen combined with dapagliflozin,while the control group received standard coronary heart disease regimen combined with acarbose.The incidence of CIN at 48 h after operation,baseline data,renal function indicators[serum creatinine(Scr),neutrophil gelatinase-associated lipocalin(NGAL),cystatin C(Cys-C),estimated glomerular filtration rate(eGFR)]before operation and 48 h after operation were compared between the two groups.Multivariate Logistic regression analysis was used to investigate the effect of dapagliflozin on CIN in patients with coronary heart disease complicated with type 2 diabetes mellitus after PCI.Serious adverse events,adverse reactions related to dagliazine or acarbose,and acute kidney injury were observed during hospitalization.Results The incidence of CIN was 5.6%(2/36)in the study group and 13.0%(3/23)in the control group.There was no significant difference in the incidence of CIN between the two groups(P>0.05).The Scr,NGAL and Cys-C of the two groups at 48 h after operation were higher than those before operation,and the eGFR of the two groups was lower than that before operation,respectively(P<0.05).The difference of Scr,NGAL,Cys-C and eGFR before operation and 48 h after operation of the study group was lower than that of the control group(P<0.05).Multivariate Logistic regression analysis showed that dapagliflozin was not the influencing factor of CIN in patients with coronary heart disease complicated with type 2 diabetes mellitus after PCI(P>0.05).No serious adverse events occurred in all patients during hospitalization.No dagliazine or acarbose related adverse reactions or acute kidney injury occurred in all patients.Conclusion The improvement effect of dagliazine on renal function in patients with coronary heart disease complicated with type 2 diabetes mellitus is better than acarbose,but it is not the influencing factor of CIN in patients after PCI.