达格列净治疗糖尿病冠心病合并心功能不全的疗效观察

Therapeutic effect of dagliazine in the treatment of diabetic coronary heart disease complicated with cardiac insufficiency

目的 探讨在常规治疗基础上,达格列净对糖尿病冠心病合并心功能不全患者心脏功能和疗效的影响。方法 选取2018年5月—2021年6月我院收治的糖尿病冠心病合并心功能不全患者134例为研究对象,采用随机数字表通过简单随机的方法将其分为观察组与对照组,每组67例。两组均给予基础降糖治疗、基础心力衰竭治疗以及冠心病治疗,观察组在上述治疗基础上,给予达格列净治疗,两组均连续治疗6个月,比较两组治疗前后心功能指标[N末端脑钠素前体(NT-proBNP)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)以及纽约心脏病协会(NYHA)分级及6 min步行测试],血糖指标[空腹血糖(FPG)及餐后2 h血糖(2 h FPG)、糖化血红蛋白(HbA1c)]、不良反应情况,随访180 d,比较两组不良心血管事件发生率。结果 治疗后,观察组各项指标均较治疗前有明显改善(P<0.05),对照组仅NT-proBNP和6 min步行距离较治疗前明显改善,且治疗后观察组LVEF、6 min步行距离高于对照组,LVEDD、NT-proBNP低于对照组(P<0.05);观察组治疗后FPG、2 h FPG、HbA1c均低于对照组(P<0.05),两组不良反应无显著差异(P>0.05),对照组1例发生心源性死亡,观察组无死亡病例,观察组严重心律失常发生率低于对照组(P<0.05)。结论 在常规治疗基础上,达格列净治疗糖尿病冠心病合并心功能不全疗效显著,在降低血糖、改善患者心功能方面效果明显,对于降低不良心血管事件发生率有重要应用价值,可在临床推广运用。

Objective To investigate the effect of dapagliflozin on cardiac function and curative effect in patients with diabetic coronary heart disease complicated with cardiac insufficiency on the basis of conventional treatment.Methods 134 patients with diabetic coronary heart disease and cardiac insufficiency admitted to our hospital from May 2018 to June 2021 were selected for study.They were randomly divided into study group and control group with 67 patients in each group by simple random method using random number table.Both groups were given basic hypoglycemic treatment,and basic cardiac failure treatment and coronary heart disease treatment.On the basis of the above treatment,the study group was given dagglinide treatment,and both groups were treated continuously for 6 months,the cardiac function indexes [NT proBNP,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),NYHA classification and 6-minute walk test],blood glucose indexes [fasting blood glucose(FPG),2-hour postprandial blood glucose(2 h FPG),glycosylated hemoglobin(HbA1c)] and adverse reactions were compared between the two groups before and after treatment.The patients were followed up for 180 days to compare the incidence of adverse cardiovascular events between the two groups.Results After treatment,all indexes in the study group were significantly improved compared with those in the group before treatment(P<0.05).In the control group,only NT-proBNP and 6 min walking distance were significantly improved compared with those before treatment in the study group.The 6 min walking distance was higher than that of the control group,LVEDD and NT-proBNP were lower than those of the control group,and the difference was statistically significant(P<0.05),and there was no significant difference in adverse reactions between the two groups(P>0.05).There was 1 case of cardiac death in the control group and no death in the study group.The incidence of severe arrhythmia in the study group was lower than that in the control group(P<0.05).Conclusion On the basis of conventional treatment,dapagliflozin has significant curative effect in the treatment of diabetic coronary heart disease complicated with cardiac insufficiency,and has obvious effect in reducing blood sugar and improving cardiac function of patients.