达格列净对不同体质量指数老年2型糖尿病合并高血压患者的心脏保护作用  

Cardioprotective effect of dapagliflozin on elderly T2DM and hypertension patients with different body mass index

作　　者：吕文旭 陈瞳[1] 丁巍[1] 李钊[1] 张雪娟[1] LüWenxu;Chen Tong;Ding Wei;Li Zhao;Zhang Xuejuan(Department of General Medicine,Affiliated Hospital of Qingdao University,Qingdao 266000,Shandong Province,China)

机构地区：[1]青岛大学附属医院全科医学科,266000

出　　处：《中华老年心脑血管病杂志》2024年第4期389-394,共6页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨达格列净对不同体质量指数(BMI)老年2型糖尿病合并高血压患者的心脏保护作用。方法选取2021年1月至2023年1月青岛大学附属医院全科医学科住院的老年2型糖尿病合并高血压患者338例,根据用药情况分为达格列净组170例,对照组168例。达格列净组又根据BMI分为正常体质量组34例,超重组83例,肥胖组53例。收集治疗前、治疗后6个月的一般临床资料,体质量、BMI、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、左心房内径(LAD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室舒张早期二尖瓣血流最大速度(E)/舒张早期二尖瓣环峰值速度(e′)、左心室质量指数(LVMI),评估药物不良反应及随访期间不良事件发生情况。结果与治疗前比较,2组治疗后FPG、HbA1c、IVST、LVPWT、LVMI水平显著降低,差异有统计学意义(P<0.05)。与对照组比较,达格列净组治疗后体质量、BMI、LAD、IVST、LVPWT、E/e′、LVMI水平显著降低,差异有统计学意义(P<0.01)。Kaplan-Meier生存分析显示,达格列净组与对照组不良事件累积生存率比较,差异有统计学意义(P_(log rank)=0.038)。多因素Cox分析显示,达格列净(HR=0.218,95%CI:0.076~0.626,P=0.005)、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂/血管紧张素受体脑啡肽酶抑制剂(HR=0.364,95%CI:0.143~0.927,P=0.034)是总纳入人群主要不良事件的保护因素,女性(HR=3.881,95%CI:1.241~12.135,P=0.020)、高血压病程(HR=1.054,95%CI:1.000~1.110,P=0.049)、体质量(HR=1.055,95%CI:1.005~1.108,P=0.030)、年龄(HR=1.103,95%CI:1.022~1.190,P=0.012)、LVMI(HR=1.029,95%CI:1.001~1.058,P=0.039)是总纳入人群主要不良事件的危险因素。与正常体质量组比较,超重组ΔIVST、ΔLVPWT、ΔE/e′、ΔLVMI显著改善,肥胖组ΔLAD、ΔIVST、ΔLVPWT、ΔE/e′、ΔLVMI显著改善,差异有统计学意义(P<0.05);与超重组比较,肥胖组ΔLAD、ΔIVST、ΔLVPWT、ΔE/e′、ΔLVMI显著改善,差异有统�Objective To investigate the cardioprotective effect of dapagliflozin on elderly type 2 di-abetes mellitus(T2DM)patients with concomitant hypertension with different body mass index(BMI).Methods A total of 338 elderly T2DM patients with concomitant hypertension admitted to our department from January 2021 to January 2023 were recruited and divided into two groups based on their medication regimen:the dapagliflozin group(170 patients)and the control group(168 patients).According to their BMI,the patients of the dapagliflozin group were further as-signed into the normal body mass subgroup(34 cases),overweight subgroup(83 cases),and obese subgroup(53 cases).General clinical data were collected before and in 6 months after treat-ment,including body weight,BMI,FPG,glycosylated hemoglobin(HbA1c),left atrium diameter(LAD),inter ventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPWT),maximum mitral flow velocity during early diastolie period divided by peak mitral ring velocity during early diastolic period(E/e'),and left ventricular mass index(LVMI)and as-sessed adverse drug reactions as well as the incidence of adverse events during follow-up.Results Compared with before treatment,the levels of FPG,HbAle,IVST,LVPWT and LVMI were sig-nificantly decreased in both groups after 6 months of treatment(P<0.05).The dapagliflozin group obtained significantly decreased body mass,BMI,LAD,IVST,LVPWT,E/e'and LVMI levels than the control group(P<0.01).Kaplan-Meier survival analysis revealed a statistically significant difference in cumulative survival rate of adverse events between the two groups(P_(log rank)=0.038).Multivariate Cox analysis demonstrated that both dapagiflozin(HR=0.218,95%CI:0.076-0.626,P=0.005)and ACEI/ARB/ARNI(HR=0.364,95%CI:0.143-0.927,P=0.034)were protective factors,while,female(HR=3.881,95%CI:1.241-12.135,P=0.020),duration of hypertension(HR=1.054,95%CI:1.000-1.110,P=0.049),body mass(HR=1.055,95%CI:1.005-1.108,P=0.030),age(HR=1.103,95%CI:1.022-1.190,P=0.012),and LVMI(HR=1.029,95%C1:1

关 键 词：糖尿病 2型 高血压 人体质量指数 达格列净 

分 类 号：R587.2[医药卫生—内分泌] R544.1[医药卫生—内科学]