坎地沙坦酯联合二甲双胍对糖尿病性心肌病患者心脏重构及预后的影响
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摘要
目的研究坎地沙坦酯联合二甲双胍对糖尿病性心肌病患者心脏重构及预后的影响。方法选取我院2015年8月至2017年8月收治的80例糖尿病心肌病患者为研究对象,按照随机数表法将其分为观察组与对照组,各40例。对照组行常规治疗,观察组在对照组基础上给予坎地沙坦酯及二甲双胍治疗。比较两组治疗前、后左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、左心室收缩末期内径(LVESD)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)及糖化血红蛋白(HbAlc)水平,并比较两组不良反应发生情况及再入院率。结果治疗后,两组患者LVEDD、LVEDV、LVESD、LVESV水平显著降低,LVEF水平显著升高,且观察组显著优于对照组,差异具有统计学意义(P<0.05);治疗后,两组FBG、2 h PG、HbAlc水平均显著降低,差异具有统计学意义(P<0.05);但组间比较,差异无统计学意(P>0.05)。两组用药后未见明显不良反应,肝、肾功能检测无明显异常。观察组再入院率显著低于对照组(P<0.05)。结论坎地沙坦酯联合二甲双胍治疗糖尿病心肌病效果显著,可有效控制患者血糖,减轻心室负荷,抑制心脏重构,改善患者预后,且用药安全性较高,值得临床应用。
Objective To study the effect of candesartan combined with metformin on cardiac remodeling and prognosis in patients with diabetic cardiomyopathy. Methods Eighty patients with diabetic cardiomyopathy admitted in our hospital from August 2015 to August 2016 were selected as study objects. The patients were divided into observation group and control group by random number table method, with 40 cases in each group. The control group was given routine treatment,while the observation group was treated with candesartan combined with metformin on the basis of the control group. The levels of left ventricular end-diastolic diameter(LVEDD), left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic diameter(LVESD), left ventricular end-systolic volume(LVESV), left ventricular ejection fraction(LVEF),fasting plasma glucose(FPG), 2-hour postprandial plasma glucose(2 h PG), glycosylated hemoglobin(HbAlc) before and after treatment were compared between the two groups. The incidences of adverse reactions and readmission rates were compared between the two groups. Results After treatment, the levels of LVEDD, LVEDV, LVESD and LVESV in the two groups decreased significantly, while the levels of LVEF increased significantly, and those in the observation group were significantly better than the control group, the differences were statistically significant(P<0.05); after treatment, the levels of FBG, 2 h PG and HbAlc in the two groups significantly decreased, the differences were statistically significant(P<0.05),however there were no significant differences between the two groups(P>0.05). There were no obvious adverse reactions and no obvious abnormalities in liver and kidney function tests in the two groups. The readmission rate of the observation group was significantly lower than that of the control group, the difference was statistically significant(P<0.05). Conclusion Candesartan combined with metformin in the treatment of diabetic cardiomyopathy has a remarkable effect. It can effectively control blood sugar of patients, relieve ventricular load, inhibit cardiac remodeling, improve the prognosis of patients, with higher safety, which is worthy of clinical application.
Objective To study the effect of candesartan combined with metformin on cardiac remodeling and prognosis in patients with diabetic cardiomyopathy. Methods Eighty patients with diabetic cardiomyopathy admitted in our hospital from August 2015 to August 2016 were selected as study objects. The patients were divided into observation group and control group by random number table method, with 40 cases in each group. The control group was given routine treatment,while the observation group was treated with candesartan combined with metformin on the basis of the control group. The levels of left ventricular end-diastolic diameter(LVEDD), left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic diameter(LVESD), left ventricular end-systolic volume(LVESV), left ventricular ejection fraction(LVEF),fasting plasma glucose(FPG), 2-hour postprandial plasma glucose(2 h PG), glycosylated hemoglobin(HbAlc) before and after treatment were compared between the two groups. The incidences of adverse reactions and readmission rates were compared between the two groups. Results After treatment, the levels of LVEDD, LVEDV, LVESD and LVESV in the two groups decreased significantly, while the levels of LVEF increased significantly, and those in the observation group were significantly better than the control group, the differences were statistically significant(P<0.05); after treatment, the levels of FBG, 2 h PG and HbAlc in the two groups significantly decreased, the differences were statistically significant(P<0.05),however there were no significant differences between the two groups(P>0.05). There were no obvious adverse reactions and no obvious abnormalities in liver and kidney function tests in the two groups. The readmission rate of the observation group was significantly lower than that of the control group, the difference was statistically significant(P<0.05). Conclusion Candesartan combined with metformin in the treatment of diabetic cardiomyopathy has a remarkable effect. It can effectively control blood sugar of patients, relieve ventricular load, inhibit cardiac remodeling, improve the prognosis of patients, with higher safety, which is worthy of clinical application.
引文
[1]李淑华,刘月芬.格列美脲对胰岛素控制不佳的2型糖尿病患者胰岛素敏感性的影响[J].实用临床医药杂志,2016,20(3):146-147.
[2]CUSI K,ORSAK B,BRIL F,et al.Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2diabetes mellitus:a randomized,controlled Trial[J].Ann Intern Med,2016,165(5):305.
[3]袁婷,关晓菲,卢文冉,等.Toll样受体的内源性激活在糖尿病及糖尿病肾病中的作用-TLRs表达、激活促进DM和DN的发生、发展[J].中国免疫学杂志,2015,31(8):1124-1128.
[4]易偲,李俊明.ERK1/2在糖尿病心肌病发展中作用机制的研究进展[J].新医学,2017,48(11):757-760.
[5]吴越阳,赵威,张幼怡,等.二甲双胍对高血压合并2型糖尿病患者心室重塑的影响[J].中华医学杂志,2015,95(44):3570-3574.
[6]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,30(8):893-942.
[7]刘海霞.超声技术在糖尿病性心肌病诊断中的应用[J].中国医疗设备,2010,25(6):138-139.
[8]周宇,李晶,鲍翠玉.内质网应激在糖尿病心肌病中的研究进展[J].中国药理学通报,2017,33(9):1200-1203.
[9]刘超,杜万红.糖尿病患者心血管疾病发病机制的研究进展[J].医学综述,2015,21(1):103-105.
[10]简春燕,吴铿.糖尿病性心肌病发病机制和治疗的研究现状[J].中华临床医师杂志:电子版,2012,6(1):164-167.
[11]米红,林绍霞,吴志福.坎地沙坦联合氨氯地平阿托伐他汀钙对原发性高血压合并颈动脉粥样硬化病人降压疗效及心脏重构的影响[J].中西医结合心脑血管病杂志,2018,16(6):763-763.
[12]KJELDSEN SE,CHA G,VILLA G,et al.Nifedipine GITS/Candesartan combination therapy lowers blood pressure across different baseline systolic and diastolic blood pressure categories:DISTINCT study subanalyses[J].J Clin Pharmacol,2016,56(9):1120-1129.
[13]宋玉明.二甲双胍干预治疗糖尿病前期冠心病患者的疗效评价[J].实用临床医药杂志,2015,19(s1):166-167.
[14]张四青,习燕华,钟树妹,等.格列美脲联合二甲双胍对新诊断2型糖尿病伴非酒精性脂肪肝病患者胰岛素抵抗和胰岛β细胞功能的影响[J].中国全科医学,2016,19(5):525-528.
[15]陈永衡,李建明.格列美脲对于2型糖尿病合并非酒精性脂肪肝患者胰岛素抵抗及胰岛β细胞的影响[J].糖尿病新世界,2017,20(1):77-78.
[16]张坤,任巧华,吴韬,等.西格列汀联合二甲双胍对血糖升高代谢综合征的干预作用[J].解放军预防医学杂志,2016,34(3):364-366.
[17]贾真,何旺,张渭涛,等.二甲双胍联合维格列汀对初治Ⅱ型糖尿病患者血糖的控制效果及安全性[J].现代生物医学进展,2017,17(25):4900-4903.
[18]辛彩虹,李峥,洛伟光,等.维格列汀联合二甲双胍对超重2型糖尿病患者心血管疾病危险因素的干预作用[J].解放军医药杂志,2015,27(8):83-87.
[2]CUSI K,ORSAK B,BRIL F,et al.Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2diabetes mellitus:a randomized,controlled Trial[J].Ann Intern Med,2016,165(5):305.
[3]袁婷,关晓菲,卢文冉,等.Toll样受体的内源性激活在糖尿病及糖尿病肾病中的作用-TLRs表达、激活促进DM和DN的发生、发展[J].中国免疫学杂志,2015,31(8):1124-1128.
[4]易偲,李俊明.ERK1/2在糖尿病心肌病发展中作用机制的研究进展[J].新医学,2017,48(11):757-760.
[5]吴越阳,赵威,张幼怡,等.二甲双胍对高血压合并2型糖尿病患者心室重塑的影响[J].中华医学杂志,2015,95(44):3570-3574.
[6]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,30(8):893-942.
[7]刘海霞.超声技术在糖尿病性心肌病诊断中的应用[J].中国医疗设备,2010,25(6):138-139.
[8]周宇,李晶,鲍翠玉.内质网应激在糖尿病心肌病中的研究进展[J].中国药理学通报,2017,33(9):1200-1203.
[9]刘超,杜万红.糖尿病患者心血管疾病发病机制的研究进展[J].医学综述,2015,21(1):103-105.
[10]简春燕,吴铿.糖尿病性心肌病发病机制和治疗的研究现状[J].中华临床医师杂志:电子版,2012,6(1):164-167.
[11]米红,林绍霞,吴志福.坎地沙坦联合氨氯地平阿托伐他汀钙对原发性高血压合并颈动脉粥样硬化病人降压疗效及心脏重构的影响[J].中西医结合心脑血管病杂志,2018,16(6):763-763.
[12]KJELDSEN SE,CHA G,VILLA G,et al.Nifedipine GITS/Candesartan combination therapy lowers blood pressure across different baseline systolic and diastolic blood pressure categories:DISTINCT study subanalyses[J].J Clin Pharmacol,2016,56(9):1120-1129.
[13]宋玉明.二甲双胍干预治疗糖尿病前期冠心病患者的疗效评价[J].实用临床医药杂志,2015,19(s1):166-167.
[14]张四青,习燕华,钟树妹,等.格列美脲联合二甲双胍对新诊断2型糖尿病伴非酒精性脂肪肝病患者胰岛素抵抗和胰岛β细胞功能的影响[J].中国全科医学,2016,19(5):525-528.
[15]陈永衡,李建明.格列美脲对于2型糖尿病合并非酒精性脂肪肝患者胰岛素抵抗及胰岛β细胞的影响[J].糖尿病新世界,2017,20(1):77-78.
[16]张坤,任巧华,吴韬,等.西格列汀联合二甲双胍对血糖升高代谢综合征的干预作用[J].解放军预防医学杂志,2016,34(3):364-366.
[17]贾真,何旺,张渭涛,等.二甲双胍联合维格列汀对初治Ⅱ型糖尿病患者血糖的控制效果及安全性[J].现代生物医学进展,2017,17(25):4900-4903.
[18]辛彩虹,李峥,洛伟光,等.维格列汀联合二甲双胍对超重2型糖尿病患者心血管疾病危险因素的干预作用[J].解放军医药杂志,2015,27(8):83-87.