达格列净联合其他降糖药物治疗老年糖尿病肾脏病患者的效果及对胰岛β细胞功能的影响  

Effects of dapagliflozin combined with other hypoglycemic drugs on elderly patients with diabetic kidney disease and function of pancreatic isletβ-cells

作　　者：高健 缪娴静 陈宇 周永华 景鑫 王艳 王德琴 Gao Jian;Miao Xianjing;Chen Yu;Zhou Yonghua;Jing Xin;Wang Yan;Wang Deqin(Department of Nephrology,People's Hospital of Hai an City,Nantong,Jiangsu,226600,P.R.China)

机构地区：[1]海安市人民医院肾内科,江苏南通226000

出　　处：《老年医学与保健》2024年第2期440-444,共5页Geriatrics & Health Care

基　　金：江苏省卫生健康委科研课题(H2018053);南通市科技局科研课题(MSZ20083)。

摘　　要：目的观察达格列净联合其他降糖药物治疗老年糖尿病肾脏病(DKD)患者的效果及对胰岛β细胞功能的影响。方法选取2020年10月-2023年5月海安市人民医院住院且资料完整的DKD老年患者100例,采用随机数字表法分为观察组和对照组,每组50例。对照组接受二甲双胍缓释片、阿卡波糖片和厄贝沙坦片治疗;观察组在对照组治疗基础上加用达格列净治疗。观察并比较2组血糖水平[空腹血糖(FBG)、餐后2 h血糖(2 h PBG)和糖化血红蛋白A1c(HbA1c)]、肾功能指标值[24 h尿蛋白定量(24-UP)、尿素氮(BUN)、肾小球滤过率(GFR)]、胰岛β细胞功能评估值[腹C肽(C-peptide)、稳态模型IR指数、胰岛β细胞功能指数(HOMA-β)]及不良心血管事件(MACE)发生情况[心力衰竭再住院(HFR)、非致死性心肌梗死、心绞痛]。结果治疗后,2组血糖水平均显著低于同组治疗前,但观察组显著低于对照组,差异均有统计学意义(P<0.05);2组24-UP、BUN、C-peptide和HOMA-IR指数值较同组治疗前降低,且观察组显著低于对照组,差异均有统计学意义(P<0.05);2组HOMA-β值较同组治疗前显著上升,且观察组显著高于对照组,差异均有统计学意义(P<0.05);治疗前后,2组GFR值差异,差异均无统计学意义(P>0.05);观察组的MACE发生率显著低于对照组(P<0.05)。结论达格列净与其他降糖药物联合治疗可改善老年DKD患者的肾功能、血糖指标和胰岛β细胞功能,减少不良心血管事件的发生风险。Objective To explore the effects of dapagliflozin combined with other hypoglycemic drugs on elderly patients with diabetic kidney disease(DKD)and the function of pancreatic isletβ-cells.Methods 100 elderly DKD patients with complete data who were hospitalized in People's Hospital of Hai an City from October 2020 to May 2023 were selected and divided into observation group and control group by random number table method,with 50 cases in each group.The control group was treated with metformin extended-release tablets,acarbose tablets and irbesartan tablets,while the observation group was treated with dapagliflozin on the basis of the control group.The blood glucose levels[fasting blood glucose(FBG),2-hour postprandial blood glucose(2-hour PBG),and glycated hemoglobin A1c(HbA1c)],renal function index values[24-hour urinary protein quantification(24-UP),blood urea nitrogen(BUN),glomerular filtration rate(GFR)],and pancreatic isletβ-cell function evaluation values[C-peptide,homeostasis model of IR index,homeostasis model of isletβ-cell function index(HOMA-β)],and the incidence of major adverse cardiovascular events(MACE)[heart failure readmission(HFR),non-fatal myocardial infarction,angina]were observed and compared between the two groups.Results After treatment,the blood glucose levels of the two groups were significantly lower than those of the same group before treatment,and the observation group was significantly lower than the control group,with statistical significance(P<0.05);the levels of 24-UP,BUN,C-peptide and HOMA-IR of the two groups were lower than those of the same group before treatment,and the observation group was significantly lower than the control group,with statistical significance(P<0.05);the HOMA-βof the two groups were significantly higher than those of the same group before treatment,and the observation group was significantly higher than the control group,with statistical significance(P<0.05).There was no significant difference in GFR between the two groups before and after treatment(P>0

关 键 词：老年 达格列净 糖尿病肾脏病 心血管事件 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]