阿托伐他汀联合苯那普利治疗冠心病合并2型糖尿病心功能不全者56例疗效观察
摘要
目的探讨阿托伐他汀联合苯那普利治疗冠心病(CHD)合并2型糖尿病(T2DM)心功能不全患者的临床疗效。方法选取111例CHD合并T2DM心功能不全患者,随机分为观察组(n=56)与对照组(n=55)。常规治疗基础上,对照组给予阿托伐他汀治疗,观察组给予阿托伐他汀+苯那普利治疗。对比两组治疗前后血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白-胆固醇(LDL-C)、高密度脂蛋白-胆固醇(HDL-C)]水平、血糖[空腹血糖(FBG)、餐后2小时血糖(2hPG)、糖化血红蛋白(HbA1c)]水平、心功能[左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)],随访1年,统计两组不良事件发生率。结果血脂水平:治疗前两组TC、TG、LDL-C、HDL-C水平比较差异无显著性(P>0.05),治疗后两组血脂水平较治疗前均有改善(P<0.05),观察组TC、TG、LDL-C低于对照组,HDL-C高于对照组(P<0.05);血糖水平:治疗前两组FBG、2hPG、HbA1 c水平比较差异无显著性(P>0.05),治疗后两组血糖水平较治疗前均有改善(P<0.05),观察组FBG、2hPG、HbA1c水平低于对照组(P<0.05);心功能:治疗前两组LVESD、LVEDD、LVEF比较差异无显著性(P>0. 05),治疗后两组心功能指标较治疗前均有改善(P<0.05),观察组LVESD、LVEDD低于对照组,LVEF高于对照组(P<0.05);预后:随访1年,观察组不良事件发生率[12.50%(7/56) VS 29.09%(16/55)]较对照组低(P<0.05)。结论给予CHD合并T2DM心功能不全患者阿托伐他汀联合苯那普利治疗,可有效改善患者血糖和血脂水平及心功能,有利于减少不良事件发生,对改善患者近中期预后具有重要意义。
引文
[1]李维.短期胰岛素泵强化治疗难治性2型糖尿病的临床疗效观察[J].中国临床医生杂志,2017,45(4):40-42.
[2]Heidari B,Nargesi AA,Hafezi-Nejad N,et al. Assessment of serum25-hydroxy vitamin D improves coronary heart disease risk stratification in patients with type 2 diabetes[J]. American heart journal,2015,170(3):573-579.
[3]郜琳,张鹏宇,杨志宏,等.高龄冠心病合并2型糖尿病患者空腹血糖水平与心血管事件的相关性研究[J].中国实验诊断学,2014,18(1):458-459.
[4]李振杰,彭焱.老年冠心病合并糖尿病患者血脂及尿酸水平[J].中国老年学杂志,2015,35(21):6125-6126.
[5]刘晓宇,袁托亚,王悦喜,等.冠心病合并2型糖尿病患者临床表现及冠状动脉病变特点分析[J].疑难病杂志,2014,11(2):114-117.
[6]Liu J,Cai X,Xie L,et al. Circulating Cell Free Mitochondrial DNA is a Biomarker in the Development of Coronary Heart Disease in the Patients with Type 2 Diabetes[J]. Clinical laboratory,2015,61(7):661-667.
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[8]朱青,彭建强,谢琼.糖化血红蛋白水平对冠心病合并2型糖尿病患者冠脉病变及急性心肌梗死发生率的影响[J].医学临床研究,2015,32(3):417-420.
[9]郭靖涛,周江,罗东雷,等.冠心病合并2型糖尿病患者冠状动脉粥样硬化斑块分布情况及钙化特征分析[J].河北医学,2015,21(9):1502-1504.
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[11]Arnold SV, McGuire DK, Spertus JA, et al. Glucose-Lowering Medications and Angina Burden in Patients with Stable Coronary Disease:results from the Type 2 Diabetes Evaluation of Ranolazine in Subjects With Chronic Stable Angina(TERISA)Trial[J]. American heart journal,2015,170(4):753-759.
[12]王晓红.2型糖尿病患者血清脂联素及C反应蛋白与心脑血管病变的关系[J].中国医刊,2017, 52(10):92-95.
[13]刘丽华,罗培.冠心病合并2型糖尿病患者主要生理指标分析及阿托伐他汀钙的应用价值[J].现代中西医结合杂志,2015,24(16):1756-1758.
[14]Laxy M, Stark R,Meisinger C,et al. The effectiveness of German disease management programs(DMPs)in patients with type 2 diabetes mellitus and coronary heart disease:results from an observational longitudinal study[J]. Diabetology&metabolic syndrome,2015,7(1):77.
[15]李长伟,王卫民,杨庭树,等.阿托伐他汀钙降脂治疗的临床疗效观察[J].中国循证心血管医学杂志,2014,12(6):760-761.
[16]常快乐,付清海,韩雪玲,等.苯那普利联合氯沙坦治疗早期糖尿病肾病的临床研究[J].现代生物医学进展,2014,14(9):1716-1718.
[17]Son JW,Kim S. Dipeptidyl Peptidase 4 Inhibitors and the Risk of Cardiovascular Disease in Patients with Type 2 Diabetes:A Tale of Three Studies[J]. Diabetes&metabolism journal, 2015,39(5):373-383.
[18]唐晓斌,郭金琢,曹秋生.活血益肾汤加苯那普利治疗糖尿病肾病临床疗效观察[J].河北医学,2014,20(9)1569-1570.
[19]吴迦勒,牟芸,胡申江.苯那普利对糖尿病大鼠心功能的保护作用[J].医学研究杂志,2016,45(6):146-149.
[20]Ye W, Brandle M, Brown MB, et al. The Michigan Model for Coronary Heart Disease in Type 2 Diabetes:Development and Validation[J]. Diabetes technology&therapeutics,2015,17(10):701-711.
[2]Heidari B,Nargesi AA,Hafezi-Nejad N,et al. Assessment of serum25-hydroxy vitamin D improves coronary heart disease risk stratification in patients with type 2 diabetes[J]. American heart journal,2015,170(3):573-579.
[3]郜琳,张鹏宇,杨志宏,等.高龄冠心病合并2型糖尿病患者空腹血糖水平与心血管事件的相关性研究[J].中国实验诊断学,2014,18(1):458-459.
[4]李振杰,彭焱.老年冠心病合并糖尿病患者血脂及尿酸水平[J].中国老年学杂志,2015,35(21):6125-6126.
[5]刘晓宇,袁托亚,王悦喜,等.冠心病合并2型糖尿病患者临床表现及冠状动脉病变特点分析[J].疑难病杂志,2014,11(2):114-117.
[6]Liu J,Cai X,Xie L,et al. Circulating Cell Free Mitochondrial DNA is a Biomarker in the Development of Coronary Heart Disease in the Patients with Type 2 Diabetes[J]. Clinical laboratory,2015,61(7):661-667.
[7]李彦芳,沈小梅.老年冠心病合并2型糖尿病患者临床及冠状动脉病变特点分析[J].中西医结合心脑血管病杂志,2014,12(11):1319-1321.
[8]朱青,彭建强,谢琼.糖化血红蛋白水平对冠心病合并2型糖尿病患者冠脉病变及急性心肌梗死发生率的影响[J].医学临床研究,2015,32(3):417-420.
[9]郭靖涛,周江,罗东雷,等.冠心病合并2型糖尿病患者冠状动脉粥样硬化斑块分布情况及钙化特征分析[J].河北医学,2015,21(9):1502-1504.
[10]葛均波,徐永健.内科学[M].第8版.北京:人民卫生出版社,2013:227-255,741-742.
[11]Arnold SV, McGuire DK, Spertus JA, et al. Glucose-Lowering Medications and Angina Burden in Patients with Stable Coronary Disease:results from the Type 2 Diabetes Evaluation of Ranolazine in Subjects With Chronic Stable Angina(TERISA)Trial[J]. American heart journal,2015,170(4):753-759.
[12]王晓红.2型糖尿病患者血清脂联素及C反应蛋白与心脑血管病变的关系[J].中国医刊,2017, 52(10):92-95.
[13]刘丽华,罗培.冠心病合并2型糖尿病患者主要生理指标分析及阿托伐他汀钙的应用价值[J].现代中西医结合杂志,2015,24(16):1756-1758.
[14]Laxy M, Stark R,Meisinger C,et al. The effectiveness of German disease management programs(DMPs)in patients with type 2 diabetes mellitus and coronary heart disease:results from an observational longitudinal study[J]. Diabetology&metabolic syndrome,2015,7(1):77.
[15]李长伟,王卫民,杨庭树,等.阿托伐他汀钙降脂治疗的临床疗效观察[J].中国循证心血管医学杂志,2014,12(6):760-761.
[16]常快乐,付清海,韩雪玲,等.苯那普利联合氯沙坦治疗早期糖尿病肾病的临床研究[J].现代生物医学进展,2014,14(9):1716-1718.
[17]Son JW,Kim S. Dipeptidyl Peptidase 4 Inhibitors and the Risk of Cardiovascular Disease in Patients with Type 2 Diabetes:A Tale of Three Studies[J]. Diabetes&metabolism journal, 2015,39(5):373-383.
[18]唐晓斌,郭金琢,曹秋生.活血益肾汤加苯那普利治疗糖尿病肾病临床疗效观察[J].河北医学,2014,20(9)1569-1570.
[19]吴迦勒,牟芸,胡申江.苯那普利对糖尿病大鼠心功能的保护作用[J].医学研究杂志,2016,45(6):146-149.
[20]Ye W, Brandle M, Brown MB, et al. The Michigan Model for Coronary Heart Disease in Type 2 Diabetes:Development and Validation[J]. Diabetes technology&therapeutics,2015,17(10):701-711.