西格列汀对糖尿病患者心脏舒张功能和心肌纤维化的影响  

Effects of Sitagliptin on cardiac diastolic function and myocardial fibrosis in patients with diabetes mellitus

作　　者：王小芳[1] 杨露露[1] 李文书[1] 赵晓燕[1] 张金盈[1] WANG Xiaofang;YANG Lulu;LI Wenshu;ZHAO Xiaoyan;ZHANG Jinying(Department of Cardiology, First Affiliated Hospital, College of Medicine, Zhengzhou University, Zhengzhou, 450052, Chin)

机构地区：[1]郑州大学第一附属医院心内科,郑州450052

出　　处：《临床心血管病杂志》2018年第4期376-380,共5页Journal of Clinical Cardiology

基　　金：国家自然科学基金(No:81400323);河南省医学科技攻关计划项目(No:201403064)

摘　　要：目的:探讨西格列汀对糖尿病患者左室舒张功能及心肌纤维化的影响。方法:纳入新诊断为2型糖尿病且心脏收缩功能正常的患者117例,随机分为西格列汀组(58例)和非西格列汀组(59例)。西格列汀组单独服用西格列汀或西格列汀联合其他口服降糖药,非西格列汀组单独或联合应用除DPP4抑制剂以外的其他口服降糖药。一级终点为:全因死亡,心源性死亡,心脏收缩功能不全,新发心肌梗死,心绞痛;二级终点为:治疗前及治疗后12个月超声心动图及心脏磁共振显示心脏舒张功能变化。比较治疗前及治疗后3、6、12个月时空腹血糖(FBG)、糖化血红蛋白(HbA1C)、B型脑钠肽(BNP)、组织金属蛋白酶抑制剂-1(TIMP-1)、半乳糖凝集素-3(Gal-3)等指标变化。结果:超声心动图显示西格列汀组E/A、DT、E/E'和左心房容积指数显著改善(均P<0.05)。心脏磁共振显示西格列汀组的高峰充盈率(PFR)、高峰充盈时间(TPFR)以及T1弛豫时间有明显改善(均P<0.05)。和非西格列汀组相比,西格列汀组BNP与Gal-3水平较基线水平显著降低,TIMP-1水平显著升高(均P<0.05)。结论:西格列汀可显著延缓糖尿病患者的左室舒张功能不全和心肌僵硬度的发生发展。Objective：To illustrate effects of Sitagliptin on left ventricular diastolic function and myocardial fibrosis in patients with diabetes mellitus.Method：A total of 117 patients who were newly diagnosed with 2 type diabetes mellitus and had a normal cardiac systolic function were included and randomly divided into Sitaglipti group（n=58）and non-Sitaglipti group（n=59）.Patients in Sitaglipti group received Sitagliptin either alone or in combination with any other oral hypoglycemic medications,while patients in non-Sitaglipti group received other oral hypoglycemic medications excluding DPP4 i.Primary endpoints included all cause of death,heart failure,new myocardial infarction and unstable angina pectoris.Secondary endpoints included changes of cardiac diastolic function measured by echocardiography and cardiac magnetic resonance before and after 12 months of treatment.Fast blood glucose（FBG）,glycosylated hemoglobin A1 C（HbA1 C）,B-type natriuretic peptides（BNP）,tissue inhibitor metalloproteinase-1（TIMP-1）and galectin-3（Gal-3）were measured before and after 3,6 and 12 months of treatment.Result：Echocardiography showed that E/A,DT,E/E＇and left atrial volume index in Sitagliptin group were significantly improved（all P〈0.05）.Cardiac magnetic resonance showed that peak filling rate（PFR）,time of peak filling rate（TPFR）and T1 relaxation time in Sitagliptin group were significantly improved（all P〈0.05）.Compared with non-sitagliptin group,BNP and Gal-3 levels were significantly lower while TIMP-1 level was significantly higher than baseline levels（all P〈0.05）.Conclusion：Sitagliptin significantly postpone left ventricular diastolic dysfunction and myocardial stiffness in patients with diabetes mellitus.

关 键 词：西格列汀 糖尿病 舒张功能 心肌纤维化 

分 类 号：R542.2[医药卫生—心血管疾病]