达格列净联合美托洛尔治疗2型糖尿病合并阵发性心房颤动的临床观察

Clinical study of dagglizin combined with metoprolol in the treatment of type 2 diabetes with paroxysmal atrial fibrillation

目的观察达格列净联合美托洛尔对2型糖尿病(T2DM)合并阵发性心房颤动(PAF)的临床疗效,及对患者P波离散度、心房电生理参数的影响。方法90例T2DM合并PAF患者随机分为对照组及观察组各45例。对照组患者在基础疾病治疗后给予口服美托洛尔,观察组在对照组基础上再口服达格列净,两组均治疗6个月。观察两组患者治疗前后的PAF发作次数、持续时间、平均心率、空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c),以及最长P波、最短P波、P波离散度、心房电生理参数(心房相对不应期、心房有效不应期)等指标变化,比较两组PAF临床疗效、总有效率及药品不良反应。结果两组总有效率差异无统计学意义(P>0.05),但观察组临床疗效优于对照组(P<0.01)。治疗后,两组患者的PAF发作次数均较前减少(P<0.01),PAF持续时间、最长P波、最短P波、P波离散度均较前缩短(P<0.05),平均心率和FPG、2hPG及HbA1c水平较前降低(P<0.01),心房相对不应期与心房有效不应期较前延长(P<0.01);除最短P波外,观察组上述各项指标均明显优于对照组(P<0.05)。两组不良反应均较轻微,差异无统计学意义(P>0.05)。结论达格列净联合美托洛尔可改善T2DM合并PAF临床症状,其机制可能与改善患者P波离散度及心房电生理参数有关。

Objective To observe the clinical effect of dagglizin combined with metoprolol on patients with type 2 diabetes mellitus(T2DM)complicated with paroxysmal atrial fibrillation(PAF)and its effect on P wave dispersion and atrial electrophysiological parameters.Methods 90 patients with T2DM and PAF were randomly divided into control group and observation group,with 45 cases in each group.Patients in the control group were given oral metoprolol after treatment of basic diseases,and patients in the observation group were given oral dagglizin on the basis of the control group.Both groups were treated for 6 months.The number of PAF episodes,duration,average heart rate,fasting blood glucose(FPG),postprandial 2h blood glucose(2hPG),glycosylated hemoglobin(HbA1c),as well as the longest P wave,shortest P wave,P wave dispersion,atrial electrophysiological parameters(atrial relative refractory period,atrial effective refractory period)and other indicators were observed before and after treatment in the two groups,and the clinical efficacy,total effective rate,and adverse drug reactions of PAF in the two groups were compared.Results There was no significant difference in the total effective rate between the two groups(P>0.05),but the clinical efficacy of the observation group was better than that of the control group(P<0.01).After treatment,the number of PAF episodes in both groups decreased compared to the previous period(P<0.01),the duration of PAF,the longest P wave,the shortest P wave,and the dispersion of P wave were shortened compared to the previous period(P<0.05),the average heart rate and the levels of FPG,2hPG,and HbA1c were decreased compared to the previous period(P<0.01),and the relative and effective atrial refractory periods were prolonged compared to the previous period(P<0.01).Except for the shortest P wave,the above indicators in the observation group were significantly better than those in the control group(P<0.05).The adverse reactions in both groups were slight,with no statistically significant difference(P>0.05).Conclusion Dagglizin combined with metoprolol can improve the clinical symptoms of T2DM patients with PAF.The mechanism may be related to the improvement of P wave dispersion and atrial electrophysiological parameters.