达格列净对老年2型糖尿病患者介入治疗术后造影剂肾病的发生及心血管预后的影响  

Impact of dapagliflozin on incidence of contrast-induced nephropathy and cardiovascular prognosis in elderly T2DM patients after PCI

作　　者：杨世诚 张鹏[1] 丛洪良 付乃宽 Yang Shicheng;Zhang Peng;Cong Hongliang;Fu Naikuan(Department of Cardiology,Tianjin University Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津大学胸科医院心内科,300222

出　　处：《中华老年心脑血管病杂志》2024年第6期632-636,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：天津市卫生健康委员会天津市中医药管理局中医中西医结合科研课题(2021205)。

摘　　要：目的探讨达格列净对老年(年龄>60岁)2型糖尿病(T2DM)患者行经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)的发生及预后的影响。方法回顾性选取2021年1月至2022年6月于天津大学胸科医院心内科行PCI老年T2DM患者296例,应用倾向性评分匹配以1:1比例进行分组,根据是否应用达格列净分为达格列净组148例和对照组148例。匹配后记录2组PCI术前、PCI术后72 h肾功能,包括血尿素、血清肌酐、估算肾小球滤过率、β_(2)微球蛋白(β_(2)-MG)、胱抑素C(Cys C)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)的变化;记录2组CIN发生率,应用二元logistic回归分析达格列净对CIN发生率的影响;记录2组随访期间主要不良心脏事件(MACE)发生情况,应用Kaplan-Meier曲线分析和log rank检验比较2组MACE发生的差异。结果2组一般临床资料比较无显著差异(P>0.05);PCI术后72 h,2组血清Cys C、β_(2)-MG、NGAL水平均高于PCI治疗前,且达格列净组Cys C、β_(2)-MG、NGAL水平均低于对照组,差异有统计学意义(P<0.05,P<0.01)。达格列净组CIN发生率低于对照组(4.7%vs 12.2%,P=0.035)。二元logistic回归分析显示,达格列净是CIN的独立保护因素(OR=0.256,95%CI:0.083~0.796,P=0.019)。平均随访(14.25±2.15)个月,达格列净组MACE发生率低于对照组(χ_(Log rank)~2=5.257,P=0.022;HR=0.460,95%CI:0.237~0.893)。结论达格列净可能减少老年T2DM患者PCI术后CIN及MACE的发生。Objective To investigate the impact of dapagliflozin on the incidence of contrast-induced nephropathy(CIN)and prognosis in elderly patients(>60 years old)with type 2 diabetes mellitus(T2DM)undergoing percutaneous coronary intervention(PCI).Methods A retrospective study was conducted on 296 elderly T2DM patients who underwent PCI in our department from January 2021 to June 2022.With a propensity score matching at a ratio of 1:1,according to administration of dapagliflozin or not,they were divided into a dapagliflozin group(148 cases)and a control group(148 cases).Changes in renal function,including blood urea nitrogen(BUN),serum creatinine(Cr),estimated glomerular filtration rate(eGFR),β_(2)-microglobulin(β_(2)-MG),cystatin C(Cys C),and neutrophil gelatinase-associated lipocalin(NGAL),were detected and calculated in both groups before and in 72 h after PCI.The incidence of CIN was recorded in the two groups,and logistic regression analysis was used to determine the effect of dapagliflozin on the occurrence of CIN.The occurrence of major adverse cardiac events(MACE)was observed in the two groups during follow-up period,and Kaplan-Meier curve analysis and Log-rank test were applied to compare the differences in the occurrence.Results There were no significant differences in the general clinical data between the two groups(P>0.05).Serum levels of Cys C,β_(2)-MG,and NGAL were increased in both groups in 72 h after PCI,with these levels obviously lower in the dapagliflozin group than the control group(P<0.05,P<0.01).The dapagliflozin group experienced a lower incidence of CIN than the control group(4.7%vs 12.2%,P=0.035).Logistic regression analysis indicated that dapagliflozin was an independent protective factor for CIN(OR=0.256,95%CI:0.083-0.796,P=0.019).In a follow-up period of 14.25±2.15 months,a lower incidence rate of MACE was observed in the dapagliflozin group than the control group(Log rankχ~2=5.257,P=0.022;HR=0.460,95%CI:0.237-0.893).Conclusion Dapagliflozin may reduce the occurrence of CIN and MACE in e

关 键 词：糖尿病 2型 经皮冠状动脉介入治疗 预后 造影剂肾病 不良心脏事件 达格列净 

分 类 号：R587.2[医药卫生—内分泌] R692[医药卫生—内科学]