度拉糖肽对2型糖尿病合并冠心病患者心肌缺血总负荷及内皮功能的影响  

Effects of dulaglutide on total load of myocardial ischemia and endothelial function in patients with type 2 diabetes mellitus complicated with coronary heart disease

作　　者：王文琦 丁海霞[2] 张涛 WANG Wen-qi;DING Hai-xia;ZHANG Tao(Department of General Medicine,the First Affiliated Hospital of Jinzhou Medical University,Liaoning Province,Jinzhou 121001,China;Department of Endocrinology,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]锦州医科大学附属第一医院全科医学科,辽宁锦州121001 [2]河北医科大学第四医院内分泌科,河北石家庄050011

出　　处：《河北医科大学学报》2023年第5期521-525,共5页Journal of Hebei Medical University

基　　金：河北省医学科学研究课题计划(20211124)。

摘　　要：目的探讨胰高血糖素样肽1受体激动剂(glucagon-like peptide-1 receptor agonist,GLP-1RA)周制剂度拉糖肽对2型糖尿病(type 2 diabetes mellitus,T2DM)合并冠心病患者心肌缺血总负荷及内皮功能的影响。方法选择T2DM合并冠心病的患者112例,随机分为常规治疗组和度拉糖肽治疗组,每组56例。常规治疗组采用规范降糖、降压、调脂、抗血小板等治疗,度拉糖肽治疗组在常规治疗基础上加用度拉糖肽注射液1.5 mg,皮下注射,1次/周。分别于治疗前和治疗后3个月观察2组临床表现及体重指数(body mass index,BMI)、血压、空腹血糖(fasting blood glucose,FPG)、血脂、糖化血红蛋白(glycosylated hemoglobin,HbA 1c)等指标,同时检测心肌缺血总负荷及血管内皮功能和炎症指标[内皮素1(endothelin,ET-1)、一氧化氮(nitric oxide,NO)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)]。结果治疗后,2组FPG、LDL-C均低于治疗前,度拉糖肽治疗组BMI、HbA 1c、TG、ACR低于治疗前,度拉糖肽治疗组BMI、LDL-C、ACR低于常规治疗组(P<0.05)。度拉糖肽治疗组甘精胰岛素日用量和低血糖发生率低于常规治疗组(P<0.05)。2组心肌缺血总负荷均明显低于治疗前,度拉糖肽治疗组治疗后明显低于常规治疗组(P<0.05)。2组ET-1、hs-CRP水平低于治疗前,NO水平高于治疗前,度拉糖肽治疗组ET-1、hs-CRP水平低于常规治疗组,NO水平高于常规治疗组(P<0.05)。结论度拉糖肽通过降糖、调脂、减重等作用使T2DM患者多重获益;通过抗炎、保护内皮功能等起到心血管保护作用;通过降低和延缓T2DM合并冠心病患者冠状动脉粥样硬化进展改善心肌供血,降低心肌缺血总负荷,改善预后。Objective To investigate the effect of dulaglutide,glucagon-like peptide-1 receptor agonist(GLP-1RA)weekly preparation,on total load of myocardial ischemia and endothelial function in patients with type 2 diabetes mellitus(T2DM)complicated with coronary heart disease(CHD).Methods One hundred and twelve patients with T2DM complicated with CHD were randomly divided into two groups:conventional treatment group(n=56)and dulaglutide treatment group(n=56).The conventional treatment group was treated with standard hypoglycemic,hypotensive,lipid-lowering and antiplatelet therapy,while the dulaglutide treatment group was treated with dulaglutide injection(1.5 mg,subcutaneously,once a week)in addition to the conventional treatment.The clinical manifestations,body mass index(BMI),blood pressure,fasting blood glucose(FPG),blood lipids and glycosylated hemoglobin(HbA 1c)were observed before treatment and at 3 months after treatment in both groups respectively.In the meantime,the total load of myocardial ischemia,vascular endothelial function,and inflammatory indicators[endothelin-1(ET-1),nitric oxide(NO)and hypersensitive C-reactive protein(hs-CRP)]were measured.Results After treatment,FPG and LDL-C in both groups were lower than those before treatment.BMI,HbA 1c,TG,and ACR in the dulaglutide treatment group were lower than those before treatment,while BMI,LDL-C,and ACR in the dulaglutide treatment group were lower than those in the conventional treatment group(P<0.05).The daily dose of insulin glargine and the incidence of hypoglycemia in the conventional treatment group were lower than those in the conventional treatment group(P<0.05).The total load of myocardial ischemia in both groups was significantly lower than that before treatment,which was significantly lower in dulaglutide treatment group than that in conventional treatment group after treatment(P<0.05).The levels of ET-1 and hs-CRP in two groups were lower than those before treatment,while the levels of NO were higher than those before treatment.The levels of ET-1

关 键 词：糖尿病 2型 冠心病 度拉糖肽 

分 类 号：R587.1[医药卫生—内分泌]