达格列净对高血压合并2型糖尿病患者经皮冠脉介入术后造影剂肾病的影响  

Effect of dapagliflozin on contrast induced nephropathy after percutaneous coronary intervention in patients with hypertension and type 2 diabetes

作　　者：杨世诚 马玉凤[2] 张鹏[1] 丛洪良 付乃宽 YANG Shicheng;MA Yufeng;ZHANG Peng;CONG Hongliang;FU Naikuan(Department of Cardiology,Tianjin University Chest Hospital,Tianjin 300222,China;Medical College of Tianjin Tianshi College)

机构地区：[1]天津大学胸科医院心内科,天津300222 [2]天津天狮学院医学院

出　　处：《中华高血压杂志(中英文)》2024年第12期1134-1140,共7页Chinese Journal of Hypertension

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);天津市医学重点建设学科(心血管病学,编号:TJYXZDXK-055B)。

摘　　要：目的探讨达格列净对高血压合并2型糖尿病患者行经皮冠脉介入术(PCI)后造影剂肾病的影响。方法回顾性分析2021年1月至2023年12月于天津大学胸科医院心内科行PCI治疗的高血压合并2型糖尿病患者资料,采用1∶1倾向性匹配评分,将入选患者分为达格列净组和对照组,比较匹配后2组患者PCI治疗前及治疗后72 h肾功能:血尿素氮、血肌酐、肌酐清除率、血β_(2)-微球蛋白、胱抑素-C、血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿NGAL、尿微量白蛋白的变化。记录2组患者PCI后造影剂肾病发生情况,应用logistic回归分析达格列净对造影剂肾病发生的影响。记录随访至少1年患者随访期间发生的主要不良心血管事件(MACE)。结果匹配后共入选496例行PCI治疗的2型糖尿病合并高血压患者,其中达格列净组248例,对照组248例,达格列净平均服用时间为(7.02±2.60)周。PCI后72 h,达格列净组血胱抑素-C、NGAL、β_(2)微球蛋白,尿NGAL、尿微量白蛋白水平低于对照组(均P<0.05)。达格列净组造影剂肾病发生率低于对照组(4.8%比10.1%,χ^(2)=4.936,P=0.039)。Logistic回归分析显示,达格列净是造影剂肾病的独立保护因素(OR=0.388,95%CI 0.175~0.858,P=0.019)。在中位随访15.2(12.0,16.8)月期间,达格列净组MACE发生率低于对照组(Log-rankχ^(2)=3.884,P=0.049)。结论达格列净可降低高血压合并2型糖尿病患者PCI后造影剂肾病发生率及MACE发生率,可能不增加急性肾损伤的发病风险。Objective To investigate the effect of dapagliflozin on contrast induced nephropathy after percutaneous coronary intervention(PCI)in patients with hypertension and type 2 diabetes mellitus(T2DM).Methods The patients with hypertension and T2DM who underwent PCI in the Department of Cardiology,Tianjin University Chest Hospital from January 2021 to December 2023 were retrospectively selected.Patients were allocated into the dapagliflozin group and the control group using a 1∶1 propensity score matching method.The renal function of patients from both groups,including parameters such as blood urea nitrogen(BUN),serum creatinine(Scr),creatinine clearance rate(Ccr),bloodβ_(2) microglobulin(β_(2)-MG),cystatin-C(Cys-C),blood neutrophil gelatinase-associated lipocalin(NGAL),urinary NGAL,and urinary microalbumin(mALB),were documented before and 72 hours after PCI.The incidence of contrast induced nephropathy in both groups were recorded,and the effect of dapagliflozin on the occurrence of contrast induced nephropathy was evaluated using logistic regression analysis.The incidence of major adverse cardiovascular events(MACE)during follow-up was recorded in patients who had been followed up for at least 1 year.Results After propensity score matching,a total of 496 patients with hypertension and T2DM who underwent PCI were enrolled in the study,248 patients in the dapagliflozin group and 248 in the control group.Dapagliflozin was administered for an average duration of(7.02±2.60)weeks.At 72 hours after PCI,the levels of serum Cys-C,NGAL,β_(2)-MG,urinary NGAL and mALB in the dapagliflozin group were significantly lower than those in the control group(all P<0.05).The incidence of contrast induced nephropathy in the dapagliflozin group was lower than that in the control group(4.8%vs 10.1%,χ^(2)=4.936,P=0.039).Logistic regression analysis indicated that dapagliflozin was an independent protective factor of contrast induced nephropathy(OR=0.388,95%CI 0.175-0.858,P=0.019).During a median follow-up period of 15.2(12.0,16.8)mont

关 键 词：达格列净 冠心病 2型糖尿病 造影剂肾病 高血压 

分 类 号：R544.1[医药卫生—心血管疾病] R541.4[医药卫生—内科学] R587.1[医药卫生—临床医学]