司美格鲁肽对2型糖尿病患者心肌损伤标志物和心脑血管事件的影响

Effect of semaglutide on myocardial injury markers and cardiovascular and cerebrovascular events in patients with type 2 diabetes mellitus

目的探讨司美格鲁肽对2型糖尿病(T2DM)患者心肌损伤标志物和心脑血管事件发生的影响。方法选择2021年1至12月邢台市第三医院收治的100例T2DM患者为研究对象,按照随机数字表法将患者分为对照组和观察组,每组50例。2组患者均给予生活方式干预,包括合理饮食、适度运动、戒烟限酒等。在此基础上,对照组患者给予常规降糖药物二甲双胍治疗,观察组患者给予二甲双胍和司美格鲁肽注射液治疗,2组患者均治疗12个月。分别于治疗前后采集2组患者的空腹静脉血,应用高效液相色谱法测定糖化血红蛋白(HbA1c)水平,葡萄糖氧化酶法测定空腹血糖(FPG)、餐后2 h血糖(2hPG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,电化学发光法或酶联免疫吸附法测定2组患者血清心肌肌钙蛋白I(cTnI)、肌红蛋白(Myo)和乳酸脱氢酶(LDH)水平;应用电子血压计测定2组患者右上臂的收缩压(SBP)和舒张压(DBP)。记录2组患者治疗期间心肌梗死、不稳定型心绞痛、心力衰竭、心源性休克、心律失常、缺血性卒中、出血性卒中等心脑血管事件。结果治疗前,2组患者的FPG、2hPG、HbA1c水平比较差异无统计学意义(P>0.05)。治疗后,2组患者的FPG、2hPG、HbA1c水平显著低于治疗前(P<0.05);且观察组患者的FPG、2hPG、HbA1c水平显著低于对照组(P<0.05)。治疗前,2组患者的SBP和DBP比较差异无统计学意义(P>0.05)。对照组患者治疗前后SBP和DBP比较差异无统计学意义(P>0.05);治疗后,观察组患者的SBP和DBP显著低于治疗前和对照组(P<0.05)。治疗前,2组患者的TC、TG、LDL-C和HDL-C水平比较差异无统计学意义(P>0.05)。对照组患者治疗前后的TC、TG、LDL-C和HDL-C水平比较差异无统计学意义(P>0.05);观察组患者治疗后的TC、TG、LDL-C水平均显著低于治疗前,HDL-C水平显著高于治疗前(P<0.05)。治疗后,观察组患者的TC、TG、LDL-C水平显著低于对照组,HDL-C水平显著高于对照组(P<0.05)。治疗期间,对照组和观察组患者的心脑血管事件发生率分别为18.0%(9/50)、4.0%(2/50);观察组患者的心脑血管事件发生率显著低于对照组(χ^(2)=4.320,P<0.05)。治疗前,2组患者的cTnI、Myo和LDH水平比较差异无统计学意义(P>0.05)。对照组患者治疗前后的cTnI、Myo和LDH水平比较差异无统计学意义(P>0.05);治疗后,观察组患者的cTnI、Myo和LDH水平显著低于治疗前和对照组(P<0.05)。结论司美格鲁肽对T2DM患者具有明显的降糖、降压、改善血脂作用,能够有效降低心脑血管事件发生率,减轻心肌损伤程度。

Objective To explore the effect of semaglutide on myocardial injury markers and cardiovascular and cerebrovascular events in patients with type 2 diabetes mellitus(T2DM).Methods A total of 100 patients with T2DM admitted to Xingtai Third Hospital from January to December 2021 were selected as the research subjects,and they were divided into the control group and the observation group by using the random number table,with 50 patients in each group.The patients in both groups were given lifestyle interventions,including reasonable diet,moderate exercise,smoking cessation and alcohol restriction.On this basis,the patients in the control group were given the conventional hypoglycemic drug metformin,and the patients in the observation group were given metformin and semaglutide injection.The patients in both groups were treated for 12 months.Before and after treatment,fasting venous blood was collected from the patients in the two groups,and the levels of glycated hemoglobin(HbA1c)were measured by high-performance liquid chromatography,the fasting plasma glucose(FPG),2-hour postprandial glucose(2hPG),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)were measured by using the glucose oxidase method,and the levels of serum cardiac troponin I(cTnI),myoglobin(Myo),and lactate dehydrogenase(LDH)were measured by using the electrochemiluminescence or enzyme-linked immunosorbent assay.The systolic blood pressure(SBP)and diastolic blood pressure(DBP)in the right upper arm of patients were measured by using an electronic blood pressure monitor.The cardiovascular and cerebrovascular events such as myocardial infarction,unstable angina,heart failure,cardiogenic shock,arrhythmia,ischemic stroke,and hemorrhagic stroke during treatment of patients in two groups were recorded.Results Before treatment,there was no statistically significant difference in the levels of FPG,2hPG,and HbA1c of patients between the two groups(P>0.05).After treatment,the levels of FPG,2hPG,and HbA1c of patients in the two groups were significantly lower than those before treatment(P<0.05);and the levels of FPG,2hPG,and HbA1c of patients in the observation group were significantly lower than those in the control group(P<0.05).Before treatment,there was no statistically significant difference in SBP and DBP of patients between the two groups(P>0.05).There was no statistically significant difference in SBP and DBP of patients before and after treatment in the control group(P>0.05);after treatment,the SBP and DBP of patients in the observation group were significantly lower than those before treatment and in the control group(P<0.05).Before treatment,there was no statistically significant difference in the levels of TC,TG,LDL-C,and HDL-C of patients between the two groups(P>0.05).There was no statistically significant difference in the levels of TC,TG,LDL-C,and HDL-C of patients before and after treatment in the control group(P>0.05);after treatment,the levels of TC,TG,and LDL-C of patients in the observation group were significantly lower than those before treatment,while the level of HDL-C was significantly higher than that before treatment(P<0.05);after treatment,the levels of TC,TG,and LDL-C of patients in the observation group were significantly lower than those in the control group,while the level of HDL-C was significantly higher than that in the control group(P<0.05).During the treatment period,the incidence of cardiovascular and cerebrovascular events of patients in the control and observation groups was 18.0%(9/50)and 4.0%(2/50),respectively;the incidence of cardiovascular and cerebrovascular events of patients in the observation group was significantly lower than that in the control group(χ^(2)=4.320,P<0.05).Before treatment,there was no statistically significant difference in levels of cTnI,Myo,and LDH of patients between the two groups(P>0.05).There was no statistically significant difference in the levels of cTnI,Myo,and LDH of patients before and after treatment in the control group(P>0.05);after treatment,the levels of cTnI,Myo,and LDH of patients in the observation group were significantly lower than those before treatment and in the control group(P<0.05).Conclusion Semaglutide can obviously reduce blood glucose and pressure,improve blood lipids,reduce the incidence of cardiovascular and cerebrovascular events,and alleviate the degree of myocardial injury in patients with T2DM.