达格列净对2型糖尿病肾脏病合并高血压患者左心室质量指数的影响

Effect of Dapagliflozin on left ventricular mass index in patients with type 2 diabetic kidney disease complicated with hypertension

目的探讨达格列净对糖尿病肾脏病(DKD)合并高血压患者左心室质量指数(LVMI)的影响,分析达格列净对左心室肥厚(LVH)的作用。方法选取2020年10月至2022年3月于泰州市人民医院就诊,接受达格列净和其他降糖药物连续治疗6个月且治疗前后资料完整的DKD合并高血压患者,通过倾向性评分匹配,筛选出196例患者,分为达格列净组和对照组,每组98例。比较两组患者治疗前后血压、血糖、肾功能及左心室功能等指标的差异。根据LVH诊断标准,将达格列净组患者进一步分为LVH患者(36例)和非LVH患者(62例),比较两组患者治疗前后LVMI水平的差异。结果与治疗前比较,达格列净组治疗后BMI、SBP、DBP、FPG、HbA1c、BUN、Scr、UA、UACR、IVS、LVPW、LVMI水平显著降低(P<0.05),对照组治疗后SBP、FPG、HbA1c、BUN、UACR、LVMI水平显著降低(P<0.05)。与对照组治疗后相比,达格列净组治疗后BMI、SBP、BUN、Scr、UA、UACR、IVS、LVPW、LVMI显著降低(P<0.05)。与非LVH患者相比,LVH患者经达格列净治疗后LVMI水平降低更显著(P<0.05)。结论达格列净可显著降低DKD合并高血压患者BMI、SBP、DBP、FPG、Scr、UACR等,具有肾脏保护作用。此外,达格列净可显著降低DKD合并高血压患者的LVMI,改善LVH。

Objective To investigate the effects of Dapagliflozin on left ventricular mass index(LVMI)in patients with diabetic kidney disease(DKD)and hypertension,and to analyze the effects of Dapagliflozin on left ventricular hypertrophy(LVH).Methods From October 2020 to March 2022,patients with DKD combined with hypertension who received continuous treatment with Dapagliflozin and other hypoglycemic drugs for 6 months and had complete data before and after treatment were selected.Totally,196 patients were screened out by propensity score matching and divided into Dapagliflozin group and control group with 98 patients in each group.The differences of blood pressure,blood glucose,renal function and left ventricular function before and after treatment were compared between the two groups.According to the diagnostic criteria for LVH,patients in Dapagliflozin group were further divided into LVH patients(n=36)and non-LVH patients(n=62),and the difference of LVMI level between the two sub-groups before and after treatment was compared.Results Compared to those before treatment,the levels of BMI,SBP,DBP,FPG,HbA1c,BUN,Scr,UA,UACR,IVS,LVPW and LVMI in Dapagliflozin group were significantly decreased after treatment,and the levels of SBP,FPG,HbA1c,BUN,UACR and LVMI in control group were significantly decreased after treatment(P<0.05).Compared to those in control group,the levels of BMI,SBP,BUN,Scr,UA,UACR,IVS,LVPW and LVMI were significantly decreased after treatment in Dapagliflozin group(P<0.05).Compared with non-LVH patients,LVH patients had significantly decreased LVMI after treatment with Dapagliflozin(P<0.05).Conclusion Dapagliflozin can significantly reduce BMI,SBP,DBP,FPG,Scr,UACR levels in DKD patients with hypertension,and has a protective effect on kidney.In addition,Dapagliflozin can significantly reduce LVMI and improve left ventricular hypertrophy in patients with DKD and hypertension.