利拉鲁肽对2型糖尿病伴冠状动脉微血管疾病患者心脏代谢危险因素的临床分析  

Effect of early liraglutide administration on cardiometabolic risk factors in T2DM patients with coronary microvascular disease

作　　者：张洪旭 陈瞳[1] 张利方[1] 耿凡琪 李钊[1] 张雪娟[1] Zhang Hongxu;Chen Tong;Zhang Lifang;Geng Fanqi;Li Zhao;Zhang Xuejuan(Department of General Medicine,Affiliated Hospital of Qingdao University,Qingdao 266003,Shandong Province,China)

机构地区：[1]青岛大学附属医院全科医学科,266003

出　　处：《中华老年心脑血管病杂志》2024年第8期892-897,共6页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨早期联合应用利拉鲁肽对2型糖尿病伴冠状动脉微血管疾病(coronary microvascular disease,CMVD)患者心脏代谢危险因素的影响及其预后。方法选取2021年5月至2023年6月于青岛大学附属医院诊治的2型糖尿病伴CMVD患者124例,根据是否应用利拉鲁肽治疗分为利拉鲁肽组59例和非利拉鲁肽组65例。比较2组治疗前后心脏代谢危险因素[同型半胱氨酸(homocysteine,Hcy)、尿酸(uric acid,UA)、空腹血糖(fasting plasma glucose,FPG)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、糖化血红蛋白(hemoglobin Alc,HbA1c)、高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、腰围、体质量指数(body mass index,BMI)、体质量调整腰围指数]、心脏超声参数[左心房内径(left atrial dimension,LAD)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)、室间隔厚度(interventricular septum thickness,IVST)、舒张早期二尖瓣血流峰值速度/舒张早期二尖瓣瓣环峰值速度(E/e′)、e′、左心室射血分数(left ventricular ejection fraction,LVEF),计算左心房容积指数(left atrial volume index,LAVI)、左心室质量指数(left ventricle mass index,LVMI)、相对室壁厚度(relative wall thickness,RWT)],同时评估随访期间不良反应及再入院率。结果利拉鲁肽组治疗后Hcy、UA、FPG、HbA1c、hs-CRP、腰围、BMI、体质量调整腰围指数、E/e′、LAVI、LVMI、RWT、LA前后径、LA横径、LA长径、IVST、LVPWT较治疗前降低,eGFR、e′较治疗前升高(P<0.05,P<0.01),LVEF、LVEDD与治疗前比较无显著差异(P>0.05);非利拉鲁肽组治疗后HbA1c、FPG、BMI、E/e′、LAVI、LA横径较治疗前降低,e′、LVPWT较治疗前升高(P<0.05,P<0.01),Hcy、UA、eGFR、hs-CRP、腰围、体质量调整腰围指数、BMI、LVEF、LVMI、RWT、LA前后径、LA长径、LVEDD、IVST与治疗前比较无显著差异(P>0.05)Objective To investigate the effect of early combined use of liraglutide on cardiometabolic risk factors and prognosis in patients with T2DM and CMVD.Methods A total of 124 T2DM patients with concomitant CMVD admitted in our hospital from May 2021 to June 2023 were enrolled,and divided into the liraglutide group(n=59)and the non-liraglutide group(n=65)according to taking liraglutide or not.The main observation indicators were compared between the two groups,including cardiometabolic risk factors,such as Hcy,UA,FPG,eGFR,HbA1c,hs-CRP,WC,BMI,WWI,and echocardiographic indicators,such as LAD,LVEDD,LVPWT,IVST,E/e′,e′,LVEF,LAVI,LVMI,and RWT.And the incidence of adverse reactions and readmission rates were recorded during follow-up.Results After treatment,in the liraglutide group,Hcy,UA,FPG,HbA1c,hs-CRP,WC,BMI,WWI,E/e′,LAVI,LVMI,RWT,IVST and LVPWT values,and anteroposterior,transverse and long diameters of left atrium were all lower than before treatment,and eGFR and e′value were increased(P<0.05,P<0.01),and no significant difference was seen in LVEF and LVEDD(P>0.05).The non-liraglutide group obtained lower HbA1c,FPG,BMI,E/e′and LAVI values,and transverse diameter of left atrium,elevated LVPWT and e′value(P<0.05,P<0.01),and no obvious changes in Hcy,UA,eGFR,hs-CRP,WC,WWI,BMI,LVEF,LVMI,RWT,LVEDD,IVST,and anteroposterior and long diameters of left atrium when compared with the indicators before treatment(P>0.05).At the end of the follow-up,when compared with the non-liraglutide group,the liraglutide group had more significant decreases in E/e′,LAVI,LVMI and RWT values and increase in e′value(P<0.05,P<0.01),and higher total effective rates(94.92%vs 72.31%,P<0.01).What's more,the readmission rate due to adverse cardiovascular events was notably lower in the liraglutide group and the non-liraglutide group(3.39%vs 15.38%,P<0.05).Conclusion Compared with BMI,WWI may be more sensitive in reflecting changes in cardiometabolic risk factors in T2DM patients with CMVD;Early combined application of liraglutide has go

关 键 词：糖尿病 2型 利拉鲁肽 心脏代谢风险因素 预后 

分 类 号：R587.2[医药卫生—内分泌] R541.4[医药卫生—内科学]