西格列汀联合美托洛尔治疗2型糖尿病合并慢性心力衰竭患者临床疗效  

Clinical Efficacy of Sitagliptin Combined with Metoprolol in the Treatment of T2DM Patients with Chronic Heart Failure

作　　者：李晗 邓彧斐 刘肖肖 吴菲 LI Han;DENG Yupei;LIU Xiaoxiao;WU Fei(Department of Pharmacy,The Kangnam University Hospital(Wuxi No.2 People's Hospital),Wuxi 214000,China;Department of Cardiology,The Kangnam University Hospital(Wuxi No.2 People's Hospital),Wuxi 214000,China)

机构地区：[1]江南大学附属中心医院(无锡市第二人民医院)药学部,无锡214000 [2]江南大学附属中心医院(无锡市第二人民医院)心内科,无锡214000

出　　处：《微循环学杂志》2025年第1期39-44,共6页Chinese Journal of Microcirculation

摘　　要：目的:探讨西格列汀联合美托洛尔治疗2型糖尿病(T2DM)合并慢性心力衰竭(CHF)患者的临床效果。方法:选取98例T2DM合并CHF患者,采用随机数字表法分为观察组(n=49)和对照组(n=49)。对照组采用二甲双胍联合美托洛尔治疗,观察组在此基础上增加西格列汀治疗。比较两组临床疗效、不良反应发生率及治疗前和治疗3个月后血糖指标[空腹血糖(FBG)、2h餐后血糖(2hPBG)、糖化血红蛋白(HbA1c)]、空腹C肽、餐后2hC肽、尿微量白蛋白、胰岛素相关指标[胰岛素抵抗指数(HOMA-IR)、β细胞胰岛素分泌功能(HOMA-β)、空腹胰岛素(FINS)、餐后2h胰岛素(2hPINS)]、心功能[左心室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)]、肾素-血管紧张素-醛固酮系统(RAAS)相关指标[血浆醛固酮(ALD)、血浆肾素活性(PRA)、血管紧张素(AngⅡ)]、N-末端脑钠肽前体(NT-proBNP)、可溶性生长刺激表达基因2蛋白(sST2)、血清分化生长因子15(GDF-15)水平。结果:观察组总有效率(91.84%)高于对照组(75.51%)(P<0.05);观察组不良反应发生率(8.16%)与对照组(14.29%)比较无统计学差异(P>0.05);治疗后,两组FBG、2hPBG、HbA1c、空腹C肽、餐后2hC肽、尿微量白蛋白、HOMA-IR、LVESD、LVEDD、IVST、LVPWT、ALD、PRA、AngⅡ、NT-proBNP、sST2、GDF-15水平均下降,而HOMA-β、FINS、2hPINS、LVEF水平均上升(P<0.05),且观察组各指标较对照组改善更明显(P<0.05)。结论:西格列汀联合美托洛尔治疗T2DM合并CHF患者临床疗效显著,能够有效改善患者心功能。Objective:To investigate the clinical effect of sitagliptin combined with metoprolol in the treatment of type 2 diabetes mellitus(T2DM)with chronic heart failure(CHF).Method:98 patients with T2DM complicated with CHF were randomly divided into observation group and control group.The control group was treated with metformin combined with metoprolol,and the observation group was additionally treated with sitagliptin.The clinical efficacy,blood glucose(FBG,2h PBG,HbA1c),fasting C-peptide,2h postprandial C-peptide,urinary microalbumin,insulin-related indicators(HOMA-IR,HOMA-β,FINS,2h Cardiac function),Cardiac function(LVEF,LVESD,LVEDD,IVST,LVPWT),RAAS indicators(ALD,PRA,AngⅡ),N-terminal brain natriuretic peptide precursor(NT-proBNP),soluble growth stimulation expression gene 2 protein(sST2),serum differentiation growth factor 15(GDF-15)levels were compared between the two groups before and 3 months after treatment.Results:The total effective rate of observation group(91.84%)was higher than that of control group(75.51%)(P<0.05).There was no significant difference in the incidence of adverse reactions between observation group(8.16%)and control group(14.29%)(P>0.05).After treatment,the levels of FBG,2hPBG,HbA1c,fasting C-peptide,2h postprandial C-peptide,urinary microalbumin,HOMA-IR,LVESD,LVEDD,IVST,LVPWT,ALD,PRA,AngⅡ,NT-proBNP,sST2 and GDF-15 were decreased in both groups.The levels of HOMA-β,FINS,2hPINS and LVEF were increased(P<0.05).The improvement of all indexes in the observation group was more obvious than that in the control group(P<0.05).Conclusion:Sitagliptin combined with metoprolol has significant clinical efficacy in the treatment of T2DM patients with CHF,and can improve cardiac function.

关 键 词：西格列汀 美托洛尔 2型糖尿病 慢性心力衰竭 

分 类 号：R587.1[医药卫生—内分泌]