达格列净联合二甲双胍治疗对2型糖尿病患者代谢指标的影响分析

Analysis of the effect of dapagliflozin combined with metformin on the metabolic indexes of type 2 diabetes mellitus patients

目的分析2型糖尿病(T2DM)患者采取达格列净联合二甲双胍治疗对其代谢指标的影响。方法100例T2DM患者,随机分为观察组和对照组,每组50例。对照组给予二甲双胍治疗,观察组给予二甲双胍联合达格列净治疗。比较两组患者不良反应(厌食、呕吐、便秘、尿路感染)发生情况以及治疗前后血脂[低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、总胆固醇(TC)]、血糖[餐后2 h血糖(2 h PG)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)]、血清指标[同型半胱氨酸(Hcy)、C反应蛋白(CRP)、尿微量白蛋白与肌酐比值(ACR)、胱抑素C(Cys-C)]水平。结果观察组不良反应发生率为6.00%,与对照组的16.00%比较,差异无统计学意义(P>0.05)。治疗后,观察组LDL-C(2.60±0.30)mmol/L、TG(1.44±0.53)mmol/L、TC(4.02±0.77)mmol/L低于对照组的(3.79±0.47)、(2.38±0.66)、(5.74±0.84)mmol/L,HDL-C(1.37±0.16)mmol/L高于对照组的(1.22±0.10)mmol/L,差异具有统计学意义(P<0.05)。治疗后,观察组2 h PG(6.10±1.08)mmol/L、FPG(5.13±1.31)mmol/L、HbA1c(6.20±0.85)%均低于对照组的(7.57±1.14)mmol/L、(6.68±1.42)mmol/L、(7.88±1.21)%,差异具有统计学意义(P<0.05)。治疗后,观察组Hcy(9.35±1.01)μmol/L、CRP(1.51±0.34)mg/L、ACR(19.81±2.74)mg/g、Cys-C(0.81±0.10)mg/L均低于对照组的(11.11±1.88)μmol/L、(2.00±0.43)mg/L、(21.32±2.76)mg/g、(0.87±0.12)mg/L,差异具有统计学意义(P<0.05)。结论T2DM患者使用二甲双胍+达格列净治疗可对血糖控制效果进一步提升,使机体微炎症状态有效减轻,使血脂水平有效改善,同时存在良好的安全性,在对适应证严格掌握的状态下可将其作为提升降糖效果的理想措施。

Objective To analyze the effect of dapagliflozin combined with metformin on the metabolic indexes of type 2 diabetes mellitus(T2DM)patients.Methods A total of 100 cases of T2DM patients were randomly divided into observation group and control group,with 50 cases in each group.The control group was treated with metformin,and the observation group was treated with metformin and dapagliflozin.Both groups were compared in terms of occurrence of adverse reactions(anorexia,vomiting,constipation,urinary tract infection),blood lipid[low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglyceride(TG),total cholesterol(TC)]and blood glucose[2 h postprandial glucose(2 h PG),fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),serum indicators[homocysteine(Hcy),C-reactive protein(CRP),albumin-to-creatinine ratio(ACR),cystatin C(Cys-C)]levels before and after treatment.Results There was no statistically significant difference in the incidence of adverse reactions between the observation group(6.00%)and the control group(16.00%)(P>0.05).After treatment,the observation group had LDL-C of(2.60±0.30)mmol/L,TG of(1.44±0.53)mmol/L and TC of(4.02±0.77)mmol/L,which were lower than those of(3.79±0.47),(2.38±0.66)and(5.74±0.84)mmol/L in the control group;HDL-C of(1.37±0.16)mmol/L in the observation group was higher than that of(1.22±0.10)mmol/L in the control group;the differences were statistically significant(P<0.05).After treatment,the observation group had 2 h PG of(6.10±1.08)mmol/L,FPG of(5.13±1.31)mmol/L,and HbA1c of(6.20±0.85)%,which were lower than those of(7.57±1.14)mmol/L,(6.68±1.42)mmol/L,and(7.88±1.21)%in the control group,and the differences were statistically significant(P<0.05).After treatment,the observation group had Hcy of(9.35±1.01)μmol/L,CRP of(1.51±0.34)mg/L,ACR of(19.81±2.74)mg/g and Cys-C of(0.81±0.10)mg/L,which were lower than those of(11.11±1.88)μmol/L,(2.00±0.43)mg/L,(21.32±2.76)mg/g and(0.87±0.12)mg/L in the control group,and the differences were statistically significant(P<0.05).Conclusion The combined treatment of metformin and dapagliflozin for T2DM patients can further improve the blood glucose control effect,effectively reduce the microinflammatory state of the body,and effectively improve the blood lipid level,with high safety.It can be used as an ideal measure to improve the hypoglycemic effect when the indications are strictly mastered.