基于MARCH试验数据的降糖治疗前后心血管评分变化及其影响因素研究

The changes in cardiovascular score values and their influencing factors after 24 weeks of treatment with acarbose and metformin based on the MARCH data

目的:分析MARCH(二甲双胍和阿卡波糖在中国作为初始降糖治疗)试验中应用阿卡波糖和二甲双胍治疗24周时心血管评分值的变化及其影响因素。方法:录入MARCH数据库共784例患者,排除指标信息不全的152例,选取数据库中随机接受阿卡波糖(n=325)和二甲双胍(n=307)治疗24周的患者进行心血管评分,计算其基线时和治疗24周时的ADVANCE 4年心血管事件风险评分值及改善程度,应用单因素、多因素线性回归分析来确定与评分值变化率(△score%)相关的影响因素。结果:632例患者治疗24周后,心血管评分值较基线皆有所改善,差异有统计学意义(P<0.05),2组患者之间差异无统计学意义(P>0.05),基线时的甘油三酯值显著影响△score%(P<0.05)。结论:阿卡波糖和二甲双胍均可以显著改善中国2型糖尿病患者的4年心血管风险评分值,2组效果相似。甘油三酯值可显著影响评分值变化率。

Objective:To analyze the changes in cardiovascular score values and their influencing factors af⁃ter 24 weeks of treatment with acarbose and metformin in the MARCH(Metformin and AcaRbose in Chinese as the initial Hypoglycaemic treatment)study.Methods:A total of 784 patients were entered into the MARCH database,and 152 patients with incomplete index information were excluded.In this study,632 patients in the database who were randomized to receive acarbose(n=325)and metformin(n=307)for 24 weeks were selected to have cardiovascular scores,and their ADVANCE 4-year cardiovascular event risk score values at baseline and at 24 weeks of treatment were calculated and the degree of improvement,and univariate and multivariate linear regression analyses were applied to determine the influencing factors associated with the rate of change in score values(Δscore%).Results:After 24 weeks of treatment in 632 patients,the score values of both groups improved from baseline(P<0.05),with no statistical difference between the two groups(P>0.05),and the triglyceride values at baseline significantly affected△score%(P<0.05).Conclusion:Both acarbose and metformin can significantly improve the 4-year cardiovascular risk score values of Chinese patients with type 2 diabetes mellitus,and the effects were similar in both groups.Triglyceride values can significantly affect the rate of change of score values.