达格列净对糖尿病合并急性冠脉综合征患者预后的影响

Effect of dapagliflozin on the prognosis of patients with diabetes mellitus and acute coronary syndrome

目的分析达格列净对老年急性冠脉综合征(ACS)合并2型糖尿病(T2DM)患者预后的影响。方法纳入2019年1月至2021年6月于联勤保障部队解放军第九六〇医院心内科诊断为ACS合并T2DM的老年患者80例为研究对象,随机分为观察组(n=40)和对照组(n=40)。观察组出院后服用钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)药物达格列净(口服,10 mg,qd)或联合其他降糖药物[二甲双胍,口服,500 mg,bid;糖苷酶抑制剂如阿卡波糖,口服,50 mg,tid;格列奈类如格列齐特缓释片,口服,90 mg,gd;DPP-4抑制剂如维格列汀,口服,50 mg,bid;胰岛素,皮下注射,0.2U/kg•d],对照组出院后服用除SGLT2i以外的其他降糖药物(药物及用法用量同观察组),所有患者进行为期1年的随访。在随访均结束后统计比较两组患者临床基本信息、心功能指标、心血管结局及并发症情况。结果两组患者入院年龄、性别、体质指数(BMI)、吸烟、收缩压、舒张压、心率、糖尿病病程、慢性病史、ACS分型、血生化指标及超声心动图指标比较,差异均无统计学意义(P>0.05)。除观察组加用达格列净外,两组患者住院治疗方案、心血管用药和其他降糖用药比较差异亦均无统计学意义(P>0.05)。观察组患者随访BMI增量、收缩压增量、空腹血糖增量、糖化血红蛋白增量、血浆N末端脑钠肽前体增量、左室收缩末期内径增量较对照组下降(P<0.05),而估算肾小球滤过率增量和左室射血分数增量较对照组升高,差异有统计学意义(P<0.05);观察组患者随访心血管原因死亡与非致命性心肌梗死发生率、因心力衰竭(心衰)与心绞痛再住院率均低于对照组,差异有统计学意义(P<0.05);观察组患者随访严重低血糖发生率低于对照组,差异有统计学意义(P<0.05)。结论达格列净可以改善老年ACS合并T2DM患者预后,降低心衰与心绞痛再住院,且具有较高安全性。

Objective To analyze the effect of dagliflozin on the prognosis of elderly patients with acute coronary syndrome(ACS)combined with type 2 diabetes mellitus(T2DM).Methods Eighty elderly patients diagnosed with ACS combined with T2DM in the Department of Cardiology of the 960th Hospital of the People's Liberation Army of the Joint Logistics Support Force from January 2019 to June 2021 were included in the study.They were randomly divided into the observation group(n=40)and the control group(n=40).The observation group was discharged from the hospital with the sodium-glucose co-transporter protein 2 inhibitor(SGLT2i)drug dagliflozin(oral,10 mg,1 time/day)or in combination with other glucose-lowering medications(metformin,oral,500 mg,2 times/day;glycosidase inhibitors(acarbose),oral,50 mg,3 times/day;glargine(glarginezide extendedrelease tablets),oral,90 mg,1 time/day;DPP-4 inhibitor(viglitin),oral,50 mg,2 times/day;insulin,subcutaneous,0.2 U/kg•day),and a control group discharged from the hospital on glucose-lowering medications other than SGLT2i(metformin,oral,500 mg,2 times/day;glucosidase inhibitor(acarbose),oral 50 mg,3 times/day;glinides(gliclazide extended-release tablets),oral,90 mg,1 time/day;DPP-4 inhibitors(vinogliptin),oral,50 mg,2 times/day;and insulin,subcutaneous,0.2 U/kg•day),and all patients were followed up for 1 year.The primary clinical information,cardiac function indexes,cardiovascular outcomes and complications of the two groups were statistically compared at the end of the follow-up of all patients.Results The differences between the two groups were not statistically significant when comparing age at admission,gender,body mass index(BMI),smoking,systolic blood pressure,diastolic blood pressure,heart rate,duration of diabetes mellitus,history of chronic disease,ACS typing,blood biochemical indexes,and echocardiographic indexes(P>0.05).In comparing inpatient treatment programs,cardiovascular medication,and hypoglycemic medication between the two groups of patients,the differences were also not statistically significant(P>0.05).The incremental BMI,incremental systolic blood pressure,incremental fasting blood glucose,incremental glycated hemoglobin,incremental plasma N-terminal brain natriuretic peptide precursor,and incremental left ventricular end-systolic internal diameter of the patients in the observation group decreased compared with that of the control group(P<0.05),In contrast,the incremental estimated glomerular filtration rate and the incremental left ventricular ejection fraction increased compared with that of the control group,and the difference was statistically significant(P<0.05).The incidence of death from cardiovascular causes and non-fatal myocardial infarction,and the rate of re-hospitalization due to heart failure and angina pectoris were lower in the observation group than in the control group,and the difference was statistically significant(P<0.05).The incidence of severe hypoglycemia in the follow-up of patients in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Dagliflozin can improve the prognosis of elderly patients with ACS combined with T2DM,reduce heart failure and angina rehospitalization,and have high safety.