恩格列净对2型糖尿病合并高血压患者血压变异性和左心室质量指数的影响  

Effects of empagliflozin on blood pressure variability and left ventricular mass index in patients with type 2 diabetes mellitus and hypertension

作　　者：韦琬 郭延云[1] 杜益君[1] 潘天荣[1] 钟兴[1] Wei Wan;Guo Yanyun;Du Yijun;Pan Tianrong;Zhong Xing(Department of Endocrinology,Second Affiliated Hospital of Anhui Medical University,Hefei 230601,Chin)

机构地区：[1]安徽医科大学第二附属医院内分泌科,合肥230601

出　　处：《中华糖尿病杂志》2022年第4期329-336,共8页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：安徽医科大学校级科学基金项目(2020xkj200);安徽省高校自然科学研究重点项目(kj2018A0202)。

摘　　要：目的探讨恩格列净对2型糖尿病(T2DM)合并高血压患者血压变异性(BPV)和左心室质量指数(LVMI)的影响。方法采用前瞻性平行对照研究设计,选取2020年10月至2021年4月在安徽医科大学第二附属医院内分泌科住院的90例血糖控制欠佳的T2DM合并高血压患者作为研究对象,均为使用1种或以上降糖药物血糖仍未达标者。采用随机数字表法将患者分为对照组和恩格列净组,对照组调整原有降糖药物剂量或加用其他降糖药物(除外钠-葡萄糖共转运蛋白2抑制剂和胰高糖素样肽-1受体激动剂),恩格列净组维持原有降糖方案加用恩格列净(10 mg/d),连续观察48周。收集患者治疗前后的体重指数(BMI)、收缩压(SBP)、舒张压(DBP)等临床资料。检测空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)以及血脂。使用24 h动态血压监测仪监测24hDBP、日间SBP(dSBP)、日间DBP(dDBP)、24 h SBP标准差(24hSBPSD)等BPV指标。通过超声心动图测量左心室内径(LVDd)、室间隔厚度(IVS)等指标,并计算LVMI。观察治疗过程中不良反应等情况。采用t检验、χ^(2)检验、非参数检验对各组间指标的差异进行比较。结果90例患者中,恩格列净组有2例因经济因素退出研究、3例失访,对照组中5例失访,最终各组均有40例患者顺利完成随访观察。基线状态下,两组患者年龄、性别、BMI、糖尿病病程、LVMI、BPV差异无统计学意义(P>0.05)。与治疗前比较,治疗48周后,恩格列净组FPG、HbA1c、BMI、LVMI、24hSBP、24hDBP、dSBP、dDBP水平[分别为(5.78±0.84)和(7.96±1.45)mmol/L、(6.30±0.72)%和(9.06±1.76)%、(24.39±2.52)和(26.97±2.71)kg/m^(2)、(80.80±10.78)和(92.96±11.19)g/m^(2)、(125±7)和(132±12)mmHg(1 mmHg=0.133 kPa)、(78±11)和(81±10)mmHg、(123±7)和(131±11)mmHg、(79±12)和(83±10)mmHg]均降低,杓型血压占比增高[分别为10.0%(4/40)和35.0%(14/40)],差异均具有统计学意义(P<0.05)。与对照组治疗48�Objective To investigate the effects of empagliflozin on blood pressure variability(BPV)and left ventricular mass index(LVMI)in patients with type 2 diabetes mellitus(T2DM)and hypertension.Methods This was a prospective parallel control study.A total of 90 patients who were hospitalized in the Department of Endocrinology,the Second Affiliated Hospital of Anhui Medical University from October 2020 to April 2021 were recruited.They all had used one or more hypoglycemic agents with poor blood glucose,and hypertension control were basically stable.Study subjects were divided into the control group and empaglliflozin group by random number table.The control group regulated the original dose of hypoglycemic agents or added others(sodium-glucose cotransporter 2 receptor inhibitors and glucagon-like peptide-1 receptor agonists were excepted),the empagliflozin group maintained the original hypoglycemic scheme and added empagliflozin(10 mg per day)for 48 weeks of continuous observation.Before and after treatment,clinical data such as body mass index(BMI),systolic blood pressure(SBP),and diastolic blood pressure(DBP)were collected;fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),glycated hemoglobin A1c(HbA1c),and serum lipid were detected.24hDBP,daytime SBP(dSBP),daytime DBP(dDBP)and 24hSBP standard deviation(24hSBPSD)were monitored by a 24-h ambulate blood pressure monitor.Left ventricular inner diameter(LVDd)and ventricular septal thickness(IVS)were measured by echocardiography,and LVMI was calculated.The adverse reactions during therapy were observed.The differences among the groups were compared using t test,χ^(2)test,and nonparametric test.Results Among the 90 patients,2 patients in the empagliflozin group withdrew from the study due to economic factors,3 patients were lost to follow-up,5 patients in the control group were lost to follow-up,and 40 patients in each group successfully completed the follow-up observation.There was no difference in age,sex,BMI,duration of diabetes,LVMI and BPV between th

关 键 词：糖尿病 2型 恩格列净 血压变异性 左心室质量指数 

分 类 号：R544.1[医药卫生—心血管疾病] R587.2[医药卫生—内科学]