利拉鲁肽联合替格瑞洛对2型糖尿病合并冠心病的疗效评价
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摘要
目的研究利拉鲁肽联合替格瑞洛治疗2型糖尿病合并冠心病患者的临床疗效,并对患者的生活质量进行评价。方法将87例2型糖尿病合并冠心病患者随机分为对照组(n=43)和观察组(n=44),2组患者均给予常规治疗;在常规治疗的基础上,对照组给予盐酸二甲双胍片和替格瑞洛片(口服),观察组给予利拉鲁肽注射液(皮下注射)和替格瑞洛片(口服)。比较2组患者治疗前后的血糖指标、血脂指标、心功能指标、血管内皮细胞相关因子和血清生物标志物的水平,并比较2组患者的临床疗效、不良反应和心血管不良事件的发生情况以及治疗后患者的生活质量。结果治疗后,观察组的血脂指标[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)]、心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室后壁厚度(LVPWT)、舒张末期室间隔厚度(IVST)、舒张早期/舒张晚期二尖瓣血流速度的比值(E/A)]水平、血管内皮细胞相关因子[内皮素-1(ET-1)、一氧化氮(NO)、髓过氧化物酶(MPO)、血管内皮细胞钙粘蛋白(VEC)、细胞间黏附因子-1(sICAM-1)]及血清生物标志物[亲环素A(Cyp A)、血清视黄醇结合蛋白4(RBP4)、人S100钙结合蛋白A12/钙粒蛋白C(S100A12)、几丁质酶-3样蛋白-1(YKL-40)、胱抑素C(Cys C)]等与对照组比较差异均有统计学意义(P<0.05),但2组患者治疗后的血糖指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)]水平则无明显差异。观察组心功能疗效的总有效率显著高于对照组(95.45%vs 81.40%,P<0.05)。2组患者的不良反应发生率无显著差异,但观察组患者的心血管不良事件总发生率显著低于对照组(P<0.05)。观察组治疗后的生活质量更佳。结论利拉鲁肽联合替格瑞洛治疗2型糖尿病合并冠心病能够明显提高临床疗效,改善心功能和血管内皮功能,调节血脂及相关血清生物标志物水平,降低心血管不良事件发生,提升患者的生活质量。
Objective To study the clinical efficacy of Liraglutide Injections combined with Ticagrelor Tablets in the treatment of type 2 diabetes with coronary heart disease,and to evaluate the quality of life of patients.Methods 87 cases of type 2 diabetes with coronary heart disease were randomly divided into the control group(n=43) and the observation group(n=44).The 2 groups of patients were given general basic treatment.The control group was given Metformin Hydrochloride Tablets and Ticagrelor Tablets(po),and the observation group was given Liraglutide Injections(ih) and Ticagrelor Tablets(po).The levels of blood glucose index,blood lipid index,cardiac function index and vascular endothelial cell related cytokines and the serum biomarkers of the 2 groups were compared.The clinical efficacy,adverse reactions and adverse events of cardiovascular events,and the quality of life of the 2 groups after treatment was compared.Results The levels of blood lipid indexes(TG,LDL-C and HDL-C),cardiac function indexes(LVEF,LVEDD,LVPWT,IVST and E/A) and vascular endothelial cell related cytokines(ET-1,NO,MPO,VEC,sICAM-1) and the serum biomarkers(CypA,RBP4,S100 A12,YKL-40 and CysC) in the observation group after treatment were significantly different from those in the control group after treatment(P<0.05).However,there was no significant difference in the level of blood glucose indexes(FPG,HbA1 c) after treatment between the 2 groups(P>0.05).The total effective rate of cardiac function in the observation group was significantly higher than that in the control group(95.45% vs 81.40%,P<0.05),but there was no significant difference in the curative effect between the 2 groups after treatment(P>0.05).There was no significant difference in the incidence of adverse reactions between the 2 groups(P>0.05),but the total incidence of cardiovascular adverse events in the observation group was significantly lower than that in the control group(P<0.05).The quality of life in the observation group was better after treatment.Conclusion Liraglutide Injections combined with Ticagrelor Tablets in the treatment of type 2 diabetes with coronary heart disease can significantly improve the clinical efficacy,improve `the cardiac function and vascular endothelial function,regulate blood lipid and related serum biomarkers,reduce the occurrence of adverse cardiovascular events and improve the quality of life.
Objective To study the clinical efficacy of Liraglutide Injections combined with Ticagrelor Tablets in the treatment of type 2 diabetes with coronary heart disease,and to evaluate the quality of life of patients.Methods 87 cases of type 2 diabetes with coronary heart disease were randomly divided into the control group(n=43) and the observation group(n=44).The 2 groups of patients were given general basic treatment.The control group was given Metformin Hydrochloride Tablets and Ticagrelor Tablets(po),and the observation group was given Liraglutide Injections(ih) and Ticagrelor Tablets(po).The levels of blood glucose index,blood lipid index,cardiac function index and vascular endothelial cell related cytokines and the serum biomarkers of the 2 groups were compared.The clinical efficacy,adverse reactions and adverse events of cardiovascular events,and the quality of life of the 2 groups after treatment was compared.Results The levels of blood lipid indexes(TG,LDL-C and HDL-C),cardiac function indexes(LVEF,LVEDD,LVPWT,IVST and E/A) and vascular endothelial cell related cytokines(ET-1,NO,MPO,VEC,sICAM-1) and the serum biomarkers(CypA,RBP4,S100 A12,YKL-40 and CysC) in the observation group after treatment were significantly different from those in the control group after treatment(P<0.05).However,there was no significant difference in the level of blood glucose indexes(FPG,HbA1 c) after treatment between the 2 groups(P>0.05).The total effective rate of cardiac function in the observation group was significantly higher than that in the control group(95.45% vs 81.40%,P<0.05),but there was no significant difference in the curative effect between the 2 groups after treatment(P>0.05).There was no significant difference in the incidence of adverse reactions between the 2 groups(P>0.05),but the total incidence of cardiovascular adverse events in the observation group was significantly lower than that in the control group(P<0.05).The quality of life in the observation group was better after treatment.Conclusion Liraglutide Injections combined with Ticagrelor Tablets in the treatment of type 2 diabetes with coronary heart disease can significantly improve the clinical efficacy,improve `the cardiac function and vascular endothelial function,regulate blood lipid and related serum biomarkers,reduce the occurrence of adverse cardiovascular events and improve the quality of life.
引文
[1] 杨天,王莉娜,智宏,等.冠心病合并糖尿病与单纯冠心病危险因素及临床特点比较研究[J].南京医科大学学报:自然科学版,2014,34(9):1218-1223.
[2] 洪天配,母义明,纪立农,等.2型糖尿病合并动脉粥样硬化性心血管疾病患者降糖药物应用专家共识[J].中国糖尿病杂志,2017,25(6):481-492.
[3] 吴龙梅,李幸洲,田新利,等.替格瑞洛在冠心病治疗中的研究进展[J].中国循证心血管医学杂志,2015,7(1):142-144.
[4] 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].中国医学前沿杂志:电子版,2015,7(3):26-89.
[5] 葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:227-228.
[6] 王山,樊文洁,俞婉琦,等.SF-36量表应用于城市化居民生命质量评价的信度和效度分析[J].中华流行病学杂志,2016,37(3):344-347.
[7] 龙志伟,廖彧,巫建芳,等.阿托伐他汀钙治疗糖尿病合并冠心病的效果及对患者生活质量的影响[J].白求恩医学杂志,2015,13(3):240-242.
[8] 孟宪杰,李莉,李会,等.六味地黄丸联合地特胰岛素对2型糖尿病合并冠心病病人的血糖控制及心血管事件的影响[J].中西医结合心脑血管病杂志,2016,14(18):2134-2136.
[9] 曲莲莲,陶晶晶,代雅琪,等.银丹心脑通联合瑞舒伐他汀钙对冠心病伴高脂血症患者的疗效[J].西北药学杂志,2017,32(6):775-779.
[10] 陈群峰,王永祥.利拉鲁肽临床研究进展[J].世界临床药物,2013,34(5):312-315.
[11] 章霞,柯永胜.新型P2Y12受体抑制剂替格瑞洛临床研究进展[J].中国临床药理学与治疗学,2014,19(4):459-464.
[12] 张政祥,冯茜,张敏慧.血管内皮功能与冠心病、糖尿病相关性研究进展及临床观察[J].中西医结合心血管病杂志,2015,3(6):186-187.
[13] 钟明,黄国鸿.缬沙坦在冠心病伴糖尿病患者中的应用[J].西北药学杂志,2015,30(3):292-295.
[14] 常青青.血管内皮细胞钙粘蛋白在2型糖尿病合并冠心病患者中的变化及意义[D].苏州:苏州大学,2012.
[15] 刘贝.VE-cadherin及sICAM-1水平在2型糖尿病下肢动脉病变患者介入前后的变化及意义[D].石家庄:河北医科大学,2017.
[16] 刘志广.冠心病合并2型糖尿病患者血清CypA水平变化及其与冠脉病变的关系[D].郑州:郑州大学,2014.
[17] 张敏,唐荣珍,曹晓红,等.冠心病合并2型糖尿病血清视黄醇结合蛋白4水平与冠状动脉病变程度的相关性研究[J].华西医学,2011,26(12):1818-1821.
[18] 赵鹏.血清 S100A12水平与2 型糖尿病患者冠状动脉病变严重程度的相关性研究[D].西安:第四军医大学,2015.
[19] 郭艳歌.冠心病合并糖尿病患者血清YKL-40水平变化及其与冠脉病变的关系[D].郑州:郑州大学,2012.
[20] 赖杰.2型糖尿病患者冠状动脉病变严重程度与血清胱抑素C相关性研究[J].中国心血管病研究,2014,12(7):595-597.
[21] 王红雷,韩延辉,贾静静,等.利拉鲁肽降低心肌微循环内皮细胞缺血再灌注损伤的机制研究[J].中华老年心脑血管病杂志,2017,19(8):858-866.
[22] 张颖,胡舜英,尹彤利,等.利拉鲁肽通过PI3K/Akt和MAPK/ERK通路促进心肌微血管内皮细胞的增殖和迁移[J].南方医科大学学报,2015,35(9):1221-1226.
[2] 洪天配,母义明,纪立农,等.2型糖尿病合并动脉粥样硬化性心血管疾病患者降糖药物应用专家共识[J].中国糖尿病杂志,2017,25(6):481-492.
[3] 吴龙梅,李幸洲,田新利,等.替格瑞洛在冠心病治疗中的研究进展[J].中国循证心血管医学杂志,2015,7(1):142-144.
[4] 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].中国医学前沿杂志:电子版,2015,7(3):26-89.
[5] 葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:227-228.
[6] 王山,樊文洁,俞婉琦,等.SF-36量表应用于城市化居民生命质量评价的信度和效度分析[J].中华流行病学杂志,2016,37(3):344-347.
[7] 龙志伟,廖彧,巫建芳,等.阿托伐他汀钙治疗糖尿病合并冠心病的效果及对患者生活质量的影响[J].白求恩医学杂志,2015,13(3):240-242.
[8] 孟宪杰,李莉,李会,等.六味地黄丸联合地特胰岛素对2型糖尿病合并冠心病病人的血糖控制及心血管事件的影响[J].中西医结合心脑血管病杂志,2016,14(18):2134-2136.
[9] 曲莲莲,陶晶晶,代雅琪,等.银丹心脑通联合瑞舒伐他汀钙对冠心病伴高脂血症患者的疗效[J].西北药学杂志,2017,32(6):775-779.
[10] 陈群峰,王永祥.利拉鲁肽临床研究进展[J].世界临床药物,2013,34(5):312-315.
[11] 章霞,柯永胜.新型P2Y12受体抑制剂替格瑞洛临床研究进展[J].中国临床药理学与治疗学,2014,19(4):459-464.
[12] 张政祥,冯茜,张敏慧.血管内皮功能与冠心病、糖尿病相关性研究进展及临床观察[J].中西医结合心血管病杂志,2015,3(6):186-187.
[13] 钟明,黄国鸿.缬沙坦在冠心病伴糖尿病患者中的应用[J].西北药学杂志,2015,30(3):292-295.
[14] 常青青.血管内皮细胞钙粘蛋白在2型糖尿病合并冠心病患者中的变化及意义[D].苏州:苏州大学,2012.
[15] 刘贝.VE-cadherin及sICAM-1水平在2型糖尿病下肢动脉病变患者介入前后的变化及意义[D].石家庄:河北医科大学,2017.
[16] 刘志广.冠心病合并2型糖尿病患者血清CypA水平变化及其与冠脉病变的关系[D].郑州:郑州大学,2014.
[17] 张敏,唐荣珍,曹晓红,等.冠心病合并2型糖尿病血清视黄醇结合蛋白4水平与冠状动脉病变程度的相关性研究[J].华西医学,2011,26(12):1818-1821.
[18] 赵鹏.血清 S100A12水平与2 型糖尿病患者冠状动脉病变严重程度的相关性研究[D].西安:第四军医大学,2015.
[19] 郭艳歌.冠心病合并糖尿病患者血清YKL-40水平变化及其与冠脉病变的关系[D].郑州:郑州大学,2012.
[20] 赖杰.2型糖尿病患者冠状动脉病变严重程度与血清胱抑素C相关性研究[J].中国心血管病研究,2014,12(7):595-597.
[21] 王红雷,韩延辉,贾静静,等.利拉鲁肽降低心肌微循环内皮细胞缺血再灌注损伤的机制研究[J].中华老年心脑血管病杂志,2017,19(8):858-866.
[22] 张颖,胡舜英,尹彤利,等.利拉鲁肽通过PI3K/Akt和MAPK/ERK通路促进心肌微血管内皮细胞的增殖和迁移[J].南方医科大学学报,2015,35(9):1221-1226.