恩格列净降低糖尿病合并动脉粥样硬化患者主要心血管事件风险价值的长期队列观察研究  

Long-term cohort study on the value of engligliflozin in reducing the risk of major adverse cardiovascular events in the patients with diabetes mellitus and atherosclerosis

作　　者：李转霞[1] 贺钰梅[1] LI Zhuanxia;HE Yumei(Department of General Medicine,Hospital of Cardiovascular and Cerebrovascular Diseases,Affiliated Hospital of Yan’an University,Shaanxi Yan’an 716000,China)

机构地区：[1]延安大学附属医院心脑血管病医院全科医学科,陕西延安716000

出　　处：《药学服务与研究》2022年第1期18-23,共6页Pharmaceutical Care and Research

摘　　要：目的:观察和分析恩格列净降低糖尿病(DM)合并动脉粥样硬化(AS)患者主要心血管事件风险的价值。方法:选取2016年9月至2019年12月延安大学附属医院心脑血管病医院收治的136例DM合并AS患者。根据降糖治疗方案,将86例使用恩格列净的患者纳入观察组,50例未使用恩格列净的患者纳入对照组。采取常规降糖及对症治疗,两组患者随访15~33个月,中位随访时间17个月。收集患者治疗前及治疗6个月后的临床数据及三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、糖化血红蛋白(HbA1C)及颈动脉内膜中层厚度(CIMT)检测结果并进行比较。分析两组患者治疗前后、停药访视期间关键临床指标的变化情况。采用Logistic回归分析患者心血管事件再发风险因素。结果:治疗前,两组患者基线资料无显著差异(P>0.05)。经6个月治疗后,观察组患者的TG、TC、HDL-C、LDL-C、FPG、HbA1C及CIMT水平均显著改善,而对照组患者仅TG、LDL-C及FPG水平明显降低(P<0.05),观察组患者的HDL-C、LDL-C、HbA1C及CIMT治疗前后变化值显著大于对照组(P<0.05)。观察组患者停药后6个月内HDL-C水平有所下降,随访结束时保持相对稳定,但仍较治疗前升高,而对照组的HDL-C水平变化幅度较小。两组患者的LDL-C水平自停药后未出现明显波动。两组患者的HbA1C停药后均有所回升,且观察组回升更加明显。两组患者停药后的CIMT水平未出现明显变化。两组患者均未在6个月治疗期间出现心血管事件。截至随访终点,观察组9例(10.46%)发生心血管事件,而对照组为13例(26.00%),两组相比具有显著性差异(χ^(2)=5.627,P=0.018)。Logistic回归分析结果显示,HDL-C、CIMT及治疗方案与患者再次出现心血管事件风险相关。结论:DM合并AS患者口服恩格列净短期治疗,能够改善血脂和AS状态,并能显著降低其再发心血管事件Objective:To observe and analyze the value of engligliflozin in reducing the risk of major cardiovascular events in the patients with diabetes mellitus(DM)and atherosclerosis(AS).Methods:136 patients with DM and AS treated in Hospital of Cardiovascular and Cerebrovascular Diseases,Affiliated Hospital of Yan’an University from Septemper 2016 to December 2019 were recruited as study subjects.Depending on hypogluycemic treatment profile,86 cases treated with engligliflozin were designiated as the observation group,and 50 patients without engligliflozin treatment were assigned as the control group.The patients in both groups received routine hypoglycemic and symptomatic treatment and had medical follow-ups for 15 to 33 months,with a median follow-up time of 17 months.The clinical data,as well as the levels of triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),fasting blood glucose(FPG),glycosylated hemoglobin(HbA1C)and carotid intima media thickness(CIMT)were collected and compared,before treatment and 6 month after treatment.The changes of key clinical indicators before and after treatment and during drug withdrawal visit were analyzed in the patients of the 2 groups,and recurrence risk factor of cardiovascular events was analyzed by Logistic regression.Results:Before treatment,there were no significant differences in baseline data in the patients of the 2 groups(P>0.05).After 6 months of treatment,the levels of TG,TC,HDL-C,LDL-C,FPG,HbA1C and CIMT in the patients of the observation group significantly improved,while the levels of only TG,LDL-C and FPG in the patients of the control group obviously reduced(P<0.05).The changes of HDL-C,LDL-C,HbA1C and CIMT in the patients of the observation group before and after treatment were significantly greater than those in the control group(P<0.05).6 months after drug withdrawal,the HDL-C level in the patients of the observation group decreased to a certain extent,and remained relatively stable at the

关 键 词：恩格列净 糖尿病 动脉粥样硬化 心血管事件 

分 类 号：R977.15[医药卫生—药品] R969.4[医药卫生—药学]