二甲双胍改善2型糖尿病合并舒张性心力衰竭患者心功能的临床研究  

Metformin improves heart function in patients having type 2 diabetes mellitus complicated with diastolic heart failure

作　　者：苏勇[1] 王端[1] 龙军[1] 杨帆[1] 徐强[1] 司良毅[1] 

机构地区：[1]第三军医大学西南医院老年病科,重庆400038

出　　处：《第三军医大学学报》2013年第17期1862-1865,共4页Journal of Third Military Medical University

基　　金：重庆市科技攻关计划项目(CTSC2011AC5038)~~

摘　　要：目的研究二甲双胍对2型糖尿病合并舒张性心力衰竭患者心功能的影响。方法采用单中心前瞻、随机、双盲对照研究,按随机数字表法将170例2型糖尿病合并舒张性心力衰竭患者分为二甲双胍组和对照组。对照组采用常规治疗;二甲双胍组在对照组治疗的基础上给予二甲双胍1 000 mg/d联合治疗。两组患者均在治疗前、治疗后3、6、9、12个月检测6 min步行距离(6MWT),超声心动图检测二尖瓣舒张早期最大血流速度/舒张晚期最大血流速度(E/A)、舒张早期E峰的减速时间(DT)、左室质量指数(LVMI),酶联免疫吸附试验检测血清脑钠肽前体氨末端(NT-proBNP)、生长分化因子(GDF-15)浓度。结果随访12个月揭盲时,共失访12例,资料完整者158例,其中二甲双胍组80例,对照组78例。与治疗前相比,两组在治疗后3个月开始6-MWT增加而NT-proBNP明显下降(P<0.05),对照组在治疗后9个月,二甲双胍组在治疗后6个月E/A、DT有明显下降(P<0.05);与对照组相比,二甲双胍组在治疗后6个月开始6-MWT明显增加,治疗后9个月开始E/A、DT及NT-proBNP明显降低(P<0.05)。与治疗前相比,对照组在治疗后9个月开始LVMI、GDF-15明显降低(P<0.05),而二甲双胍组LVMI在治疗后6个月,GDF-15在治疗后3个月开始明显降低(P<0.05);与对照组比较,二甲双胍组在治疗后12个月开始LVMI明显降低(P<0.05),GDF-15在治疗后6个月开始明显降低(P<0.05)。结论二甲双胍可以通过增加2型糖尿病合并舒张性心力衰竭患者的左心室舒张早期的充盈量和改善左室重构程度而改善这类患者的心功能。Objective To investigate the effect of metformin on the heart function of patients having type 2 diabetes mellitus complicated with diastolic heart failure. Methods The study adopted a single-center, randomized, double-blind and prospective design, and a total of 170 patients with type 2 diabetes mellitus complicated with diastolic heart failure were randomized into an experimental group and a control group. Patients in the control group were given conventional treatment, and those in the experimental group were given metformin （1 000 mg/d） combined with conventional treatment. Six-min walk distance （6-MWT）, peak early filling velocity to peak late filling velocity （E/A）, E-wave deceleration time （DT）, left ventricular mass index （LVMI）, N-terminal pro-brain natriuretic peptide （NT-proBNP） and growth differentiation factor-15 （GDF-15） were determined at baseline and at 3, 6, 9, and 12 months of treatment. Results The follow-up at 12 months showed that a total of 12 cases were lost and 158 cases had complete data, including 80 cases in the experimental group and 78 cases in the control group. 6-MWT increased and NT-proBNP decreased significantly in the two groups after 3 months of treatment compared with those at baseline （P〈0.05）. E/A and DT decreased significantly （P〈0.05） at 9 months in the control group and at 6 months in the experimental group. Compared with the control group, 6-MWT increased significantly in the experimental group after 6 months of treatment, and E/A, DT, and NT-proBNP decreased significantly after treatment for 9 months （P〈0.05）. LVMI and GDF-15 decreased significantly in the control group after 9 months of treatment compared with those at baseline, whereas LVMI and GDF-15 in the experimental group decreased markedly after treatment for 6 months and 3 months, respectively （P〈0.05）. Compared with the control group, the experimental group showed LVMI significantly decreased at 12-month follow-up （P〈0.05） a

关 键 词：二甲双胍 2型糖尿病 舒张性心力衰竭 左室重构 

分 类 号：R541.6[医药卫生—心血管疾病] R587.1[医药卫生—内科学]