沙格列汀对老年糖尿病伴冠心病患者心功能的影响

发布时间：2018-06-19 22:03

本文选题：冠心病 + 型糖尿病　；参考：《临床心血管病杂志》2017年12期

【摘要】：目的:观察伴冠心病的老年2型糖尿病患者被给予沙格列汀治疗后,血浆糖化血红蛋白(HbA1c)、心肌损伤及心力衰竭相关标记物的水平变化,以及心功能是否有所改善。方法:入选2型糖尿病并伴有明确冠心病病史患者120例,按1∶1随机分为沙格列汀组、安慰剂组。对2组患者采用酶速率法检测血浆肌酸激酶同工酶(CK-MB),电化学发光法测定心肌肌钙蛋白T(cTnT)和氨基末端脑钠肽前体(NT-proBNP),免疫比浊法检测超敏C反应蛋白(hs-CRP),高效液相色谱法测定血浆HbA1c,心脏超声测定左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)、每搏输出量(SV)、左室射血分数(LVEF)、舒张早期二尖瓣最大血流速度(E)、舒张晚期二尖瓣最大血流速度(A)、组织多普勒二尖瓣环处舒张早期最大运动速度(e)、组织多普勒二尖瓣环处舒张晚期最大运动速度(a)。共随访12个月。结果:沙格列汀组治疗3个月后其血浆HbA1c水平较基线下降(P0.01),治疗第6个月和第12个月时降低血糖与安慰剂组比较差异有统计学意义(P0.01)。与基线相比较,沙格列汀组血浆NT-proBNP水平在治疗后第1个月即出现下降(P0.01),降幅超过30%,维持至随访12个月结束时;而安慰剂组患者血浆NT-proBNP在随访过程中无明显下降(P0.05)。与安慰剂组比较,沙格列汀组血浆NT-proBNP浓度在治疗后第1、3、6、12个月明显降低,差异均有统计学意义(P0.01)。2组患者治疗后其血浆心肌损伤标记物CK-MB、cTnT、hs-CRP浓度均无明显变化(P0.05)。超声心动图结果显示,2组患者入组时左室收缩功能正常、舒张功能均减退,至12个月随访结束时,沙格列汀组LVEF值略高于安慰剂组(P0.01),伴随着其LVESV值略低于安慰剂组(P0.05),差异均有统计学意义。而2组间LVEDV、SV、E/A值、e峰值、e/a值、E/e值比较,均差异无统计学意义(P0.05)。结论:沙格列汀治疗伴有冠心病的老年2型糖尿病患者,可改善血糖控制,增加LVEF水平、增强心脏泵血功能,从而减少心力衰竭代偿性的NT-proBNP合成与释放。
[Abstract]:Aim: to observe the changes of plasma glycosylated hemoglobin (HbA1cN), myocardial injury and related markers of heart failure in elderly patients with type 2 diabetes mellitus with coronary heart disease (CHD), and whether the heart function has been improved. Methods: 120 patients with type 2 diabetes with definite history of coronary heart disease were randomly divided into two groups according to 1:1: salgletine group and placebo group. Plasma creatine kinase isoenzyme (CK-MBN) was detected by enzyme rate method, cardiac troponin TnTnTnTand NT-proBNPP were detected by electrochemiluminescence (ECL), hypersensitive C-reactive protein (hs-CRPN) was detected by immunoturbidimetry, and high performance liquid chromatography (HPLC) was performed. Methods Plasma HbA1c, left ventricular end-systolic volume (LVESVN), left ventricular end-diastolic volume (LVEDVV), left ventricular ejection fraction (LVEF), peak mitral flow velocity in early diastolic phase and maximal mitral valve flow in late diastolic period were measured by echocardiography. The maximal early diastolic velocity of mitral annulus and the late diastolic velocity of tissue Doppler mitral annulus were observed. They were followed up for 12 months. Results: after 3 months of treatment, the plasma HbA1c level in the salgletine group was significantly lower than that in the baseline group (P 0.01), and at the 6th and 12th month after treatment, there was a significant difference between the control group and the control group. Compared with baseline, plasma NT-proBNP levels in the salgletine group decreased by more than 30% at the first month after treatment, and remained at the end of the 12 months follow-up, while in the placebo group there was no significant decrease in plasma NT-proBNP levels during the follow-up (P 0.05). Compared with the placebo group, the plasma NT-proBNP concentration in the salgletine group was significantly lower than that in the control group at 6 and 12 months after treatment, and there was no significant change in the plasma myocardial injury marker CK-MBcTnTnTnTnTnTnThs-CRP after treatment. The results of echocardiography showed that left ventricular systolic function was normal and diastolic function was decreased at the end of 12 months follow-up. The LVEF in the salgletine group was slightly higher than that in the placebo group (P 0.01), and the LVESV value was slightly lower than that in the placebo group (P 0.05). However, there was no significant difference between the two groups in the peak value of E / A and the value of E / P / a in the two groups (P < 0.05). Conclusion: the treatment of elderly type 2 diabetes patients with coronary heart disease can improve blood glucose control, increase LVEF level, enhance cardiac pump function and reduce the synthesis and release of NT-proBNP in patients with congestive heart failure.
【作者单位】：南京市中心医院老年科;南京市中心医院检验科;南京市中心医院心功能室;
【基金】：南京市医学科技发展项目(No:YKK15227)
【分类号】：R541.4;R587.1

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