利拉鲁肽对2型糖尿病伴冠状动脉微血管疾病患者心脏代谢危险因素的临床分析

Effect of early liraglutide administration on cardiometabolic risk factors in T2DM patients with coronary microvascular disease

目的探讨早期联合应用利拉鲁肽对2型糖尿病伴冠状动脉微血管疾病(coronary microvascular disease,CMVD)患者心脏代谢危险因素的影响及其预后。方法选取2021年5月至2023年6月于青岛大学附属医院诊治的2型糖尿病伴CMVD患者124例,根据是否应用利拉鲁肽治疗分为利拉鲁肽组59例和非利拉鲁肽组65例。比较2组治疗前后心脏代谢危险因素[同型半胱氨酸(homocysteine,Hcy)、尿酸(uric acid,UA)、空腹血糖(fasting plasma glucose,FPG)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、糖化血红蛋白(hemoglobin Alc,HbA1c)、高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、腰围、体质量指数(body mass index,BMI)、体质量调整腰围指数]、心脏超声参数[左心房内径(left atrial dimension,LAD)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)、室间隔厚度(interventricular septum thickness,IVST)、舒张早期二尖瓣血流峰值速度/舒张早期二尖瓣瓣环峰值速度(E/e′)、e′、左心室射血分数(left ventricular ejection fraction,LVEF),计算左心房容积指数(left atrial volume index,LAVI)、左心室质量指数(left ventricle mass index,LVMI)、相对室壁厚度(relative wall thickness,RWT)],同时评估随访期间不良反应及再入院率。结果利拉鲁肽组治疗后Hcy、UA、FPG、HbA1c、hs-CRP、腰围、BMI、体质量调整腰围指数、E/e′、LAVI、LVMI、RWT、LA前后径、LA横径、LA长径、IVST、LVPWT较治疗前降低,eGFR、e′较治疗前升高(P<0.05,P<0.01),LVEF、LVEDD与治疗前比较无显著差异(P>0.05);非利拉鲁肽组治疗后HbA1c、FPG、BMI、E/e′、LAVI、LA横径较治疗前降低,e′、LVPWT较治疗前升高(P<0.05,P<0.01),Hcy、UA、eGFR、hs-CRP、腰围、体质量调整腰围指数、BMI、LVEF、LVMI、RWT、LA前后径、LA长径、LVEDD、IVST与治疗前比较无显著差异(P>0.05);随访结束时,与非利拉鲁肽组比较,利拉鲁肽组E/e′、LAVI、LVMI、RWT降低,e′升高,差异有统计学意义(P<0.05,P<0.01)。利拉鲁肽组治疗后总有效率高于非利拉鲁肽组(94.92%vs 72.31%,P<0.01);利拉鲁肽组因不良心血管事件再入院率低于非利拉鲁肽组(3.39%vs 15.38%,P<0.05)。结论与BMI比较,体质量调整腰围指数可能在反映2型糖尿病伴CMVD患者心脏代谢风险因素变化方面更敏感;早期联合应用利拉鲁肽有效性和安全性好,并且有多重心血管保护作用,包括降低2型糖尿病伴CMVD患者心脏代谢危险因素、改善心脏舒张功能和肾脏功能、抑制糖尿病慢性炎症和减少不良心血管事件发生。

Objective To investigate the effect of early combined use of liraglutide on cardiometabolic risk factors and prognosis in patients with T2DM and CMVD.Methods A total of 124 T2DM patients with concomitant CMVD admitted in our hospital from May 2021 to June 2023 were enrolled,and divided into the liraglutide group(n=59)and the non-liraglutide group(n=65)according to taking liraglutide or not.The main observation indicators were compared between the two groups,including cardiometabolic risk factors,such as Hcy,UA,FPG,eGFR,HbA1c,hs-CRP,WC,BMI,WWI,and echocardiographic indicators,such as LAD,LVEDD,LVPWT,IVST,E/e′,e′,LVEF,LAVI,LVMI,and RWT.And the incidence of adverse reactions and readmission rates were recorded during follow-up.Results After treatment,in the liraglutide group,Hcy,UA,FPG,HbA1c,hs-CRP,WC,BMI,WWI,E/e′,LAVI,LVMI,RWT,IVST and LVPWT values,and anteroposterior,transverse and long diameters of left atrium were all lower than before treatment,and eGFR and e′value were increased(P<0.05,P<0.01),and no significant difference was seen in LVEF and LVEDD(P>0.05).The non-liraglutide group obtained lower HbA1c,FPG,BMI,E/e′and LAVI values,and transverse diameter of left atrium,elevated LVPWT and e′value(P<0.05,P<0.01),and no obvious changes in Hcy,UA,eGFR,hs-CRP,WC,WWI,BMI,LVEF,LVMI,RWT,LVEDD,IVST,and anteroposterior and long diameters of left atrium when compared with the indicators before treatment(P>0.05).At the end of the follow-up,when compared with the non-liraglutide group,the liraglutide group had more significant decreases in E/e′,LAVI,LVMI and RWT values and increase in e′value(P<0.05,P<0.01),and higher total effective rates(94.92%vs 72.31%,P<0.01).What's more,the readmission rate due to adverse cardiovascular events was notably lower in the liraglutide group and the non-liraglutide group(3.39%vs 15.38%,P<0.05).Conclusion Compared with BMI,WWI may be more sensitive in reflecting changes in cardiometabolic risk factors in T2DM patients with CMVD;Early combined application of liraglutide has good efficacy and safety,and exerts multiple cardiovascular protective effects,including reducing cardiometabolic risk factors,improving cardiac diastolic function and renal function,inhibiting chronic inflammation and decreasing the occurrence of adverse cardiovascular events in the patients.