瑞舒伐他汀联合达格列净治疗2型糖尿病合并冠心病的临床效果

Clinical effect of rosuvastatin combined with dapagliflozin in the treatment of type 2 diabetes mellitus with coronary heart disease

目的探究对2型糖尿病(T2DM)合并冠心病患者应用瑞舒伐他汀联合达格列净联合治疗的临床效果。方法本研究为随机对照试验。前瞻性随机选取2020年3月至2022年2月间在济南市第二人民医院治疗的92例T2DM合并冠心病患者为研究对象,用随机数字表法将其分为两组,各46例。对照组中男21例、女25例,年龄(61.24±8.75)岁,用达格列净治疗;联合组中男24例、女22例,年龄(59.73±8.53)岁,用达格列净联合瑞舒伐他汀治疗。比较两组疗效、血糖、血脂、炎症水平及用药不良反应发生情况。统计学方法采用χ^(2)检验和t检验。结果联合组患者的总有效率明显高于对照组[97.83%(45/46)比82.61%(38/46)],差异有统计学意义(χ^(2)=4.434,P=0.035)。治疗后,联合组患者的空腹血糖(FPG)、糖化血红蛋白(HbA1c)水平均明显低于对照组[(5.47±1.09)mmol/L比(6.58±1.32)mmol/L、(7.34±1.47)%比(8.14±1.63)%],差异均有统计学意义(t=4.398、2.472,均P<0.05)。治疗后,联合组患者的三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平均明显低于对照组[(1.46±0.29)mmol/L比(1.87±0.37)mmol/L、(3.21±0.64)mmol/L比(3.54±0.71)mmol/L、(2.11±0.42)mmol/L比(2.36±0.47)mmol/L],联合组患者的高密度脂蛋白胆固醇(HDL-C)水平明显高于对照组[(1.57±0.31)mmol/L比(1.42±0.28)mmol/L],差异均有统计学意义(t=5.915、2.341、2.690、2.435,均P<0.05)。治疗后,联合组患者的C反应蛋白(CRP)、白细胞介素-6(IL-6)水平均明显低于对照组[(5.32±1.06)mg/L比(7.58±1.52)mg/L、(58.47±6.51)ng/L比(65.48±7.28)ng/L],差异均有统计学意义(t=8.272、4.868,均P<0.001)。联合组患者的不良反应发生率与对照组比较差异无统计学意义[10.85%(5/46)比4.34%(2/46)](χ^(2)=0.618,P=0.432)。结论对T2DM合并冠心病患者临床应用瑞舒伐他汀与达格列净联合治疗,患者临床疗效有显著提高,血糖、血脂水平得到有效控制,炎症因子水平有效下调,同时用药较为安全,不会增加不良反应,临床综合疗效较好。

Objective To investigate the clinical effect of rosuvastatin combined with dapagliflozin in patients with type 2 diabetes mellitus(T2DM)and coronary heart disease(CHD).Methods It was a randomized controlled trial.Ninety-two patients with T2DM and CHD who were treated in Jinan Second People's Hospital from March 2020 to February 2022 were prospectively randomly selected as the research objects,and they were divided into two groups by the random number table method,with forty-six patients in each group.In the control group,21 males and 25 females,aged(61.24±8.75)years,were treated with dapagliflozin;in the combination group,24 males and 22 females,aged(59.73±8.53)years,were treated with dapagliflozin combined with rosuvastatin.The efficacy,blood glucose,blood lipid,and inflammation levels,and occurrence of adverse drug reactions were compared between the two groups.χ^(2) test and t test were used.Results The overall response rate of the combination group was significantly higher than that of the control group[97.83%(45/46)vs.82.61%(38/46)],with a statistically significant difference(χ^(2)=4.434,P=0.035).After treatment,the levels of fasting plasma glucose(FPG)and glycosylated hemoglobin(HbA1c)in the combination group were significantly lower than those in the control group[(5.47±1.09)mmol/L vs.(6.58±1.32)mmol/L,(7.34±1.47)%vs.(8.14±1.63)%],with statistically significant differences(t=4.398 and 2.472;both P<0.05).After treatment,the levels of triglyceride(TG),total cholesterol(TC),and low density lipoprotein cholesterol(LDL-C)in the combination group were significantly lower than those in the control group[(1.46±0.29)mmol/L vs.(1.87±0.37)mmol/L,(3.21±0.64)mmol/L vs.(3.54±0.71)mmol/L,(2.11±0.42)mmol/L vs.(2.36±0.47)mmol/L],but the level of high density lipoprotein cholesterol(HDL-C)in the combination group was significantly higher than that in the control group[(1.57±0.31)mmol/L vs.(1.42±0.28)mmol/L],with statistically significant differences(t=5.915,2.341,2.690,and 2.435;all P<0.05).After treatment,the levels of C-reactive protein(CRP)and interleukin-6(IL-6)in the combination group were significantly lower than those in the control group[(5.32±1.06)mg/L vs.(7.58±1.52)mg/L,(58.47±6.51)ng/L vs.(65.48±7.28)ng/L],with statistically significant differences(t=8.272 and 4.868;both P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the combination group and the control group[10.85%(5/46)vs.4.34%(2/46)](χ^(2)=0.618,P=0.432).Conclusions The clinical application of rosuvastatin combined with dapagliflozin in T2DM patients with CHD can significantly improve the clinical efficacy,effectively control the blood glucose and lipid levels,and effectively lower the levels of inflammatory factors.At the same time,it is safer to use the drug without increasing adverse reactions,and the clinical comprehensive efficacy is good.