达格列净对2型糖尿病合并急性冠脉综合征患者PCI后急性肾损伤及预后的影响  

Dapagliflozin on acute kidney injury and prognosis in patients with diabetes mellitus type 2 and acute coronary syndrome after percutaneous coronary intervention

作　　者：郝慧芳[1] 窄秀凤 李青[1] 杨世诚[3] 张鹏[3] HAO Huifang;ZHAI Xiufeng;LI Qing;YANG Shicheng;ZHANG Peng(Dept.of Nephrology,Tianjin TEDA Hospital,Tianjin 300451,China;Tianjin Rehabilitation and Recuperation Center,Joint Logistics Support Force,Tianjin 300381,China;Dept.of Cardiology,Tianjin Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津市泰达医院肾内科,天津300451 [2]联勤保障部队天津康复疗养中心,天津300381 [3]天津市胸科医院心内科,天津300222

出　　处：《中国药房》2025年第4期469-474,共6页China Pharmacy

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(No.2021205)。

摘　　要：目的探讨达格列净对2型糖尿病(T2DM)合并急性冠脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)后造影剂诱导的急性肾损伤(CIAKI)以及预后的影响。方法回顾性收集2021年1月1日至2022年12月31日于天津市胸科医院心内科行PCI治疗的T2DM合并ACS患者资料,根据患者有无应用达格列净,分为达格列净组(96例)和对照组(148例)。记录所有患者PCI前及PCI后48 h、1周的肾功能指标,包括血尿素氮(BUN)、血肌酐(Scr)、估算的肾小球滤过率(e GFR)、胱抑素C(Cys-C)、肾损伤分子1(KIM-1)、β2微球蛋白(β2-MG)。所有患者至少随访1年。记录2组患者CIAKI及随访期间主要心血管不良事件(MACE)的发生情况。应用Logistic回归分析使用达格列净对CIAKI发生情况的影响,应用Log-rank检验比较2组之间MACE发生情况的差异,应用Cox回归分析使用达格列净对患者预后的影响。结果PCI后48 h及1周,达格列净组患者血Cys-C、KIM-1、β2-MG水平均显著低于对照组(P<0.05)。达格列净组患者CIAKI的发生率显著低于对照组(6.25%vs.14.86%,P=0.042);Logistic回归分析结果显示,使用达格列净是CIAKI的独立保护因素(OR=0.280,95%CI为0.101~0.780,P=0.015)。随访期间达格列净组患者MACE的发生率显著低于对照组(7.29%vs.17.57%,P=0.049);Cox回归分析结果显示,达格列净可减少PCI后MACE的发生(HR=0.374,95%CI为0.161~0.866,P=0.022)。结论在水化基础上,使用达格列净并不会增加T2DM合并ACS患者PCI后CIAKI的发生风险。OBJECTIVE To investigate the impact of dapagliflozin on contrast-induced acute kidney injury(CIAKI)and prognosis in patients with diabetes mellitus type 2(T2DM)and acute coronary syndrome(ACS)who underwent percutaneous coronary intervention(PCI).METHODS Retrospective selection of data on T2DM patients with ACS who underwent PCI treatment in the Cardiology Department of Tianjin Chest Hospital from January 1st 2021 to December 31st 2022.The patients were divided into dapagliflozin group(96 cases)and control group(148 cases)based on whether they received dapagliflozin or not.Renal function indicators were measured for all enrolled patients before PCI and at 48 h and 1 week after PCI,including blood urea nitrogen(BUN),serum creatinine(Scr),estimated glomerular filtration rate(eGFR),cystatin-C(Cys-C),kidney injury molecule-1(KIM-1)andβ2-microglobulin(β2-MG).All patients were followed up for at least 1 year.The incidence of CIAKI and major adverse cardiac event(MACE)during follow-up were recorded for both groups.Logistic regression was used to analyze the impact of dapagliflozin on the occurrence of CIAKI,while the Log-rank test was applied to compare the incidence of MACE between the two groups.Cox regression was employed to analyze the impact of dapagliflozin on prognosis.RESULTS At 48 h and 1 week after PCI,serum levels of Cys-C,KIM-1 andβ2-MG were significantly lower in the dapagliflozin group compared to the control group(P<0.05).The incidence of CIAKI was lower in the dapagliflozin group compared to the control group(6.25%vs.14.86%,P=0.042).Logistic regression analysis revealed that dapagliflozin was an independent protective factor against CIAKI(OR=0.280,95%CI 0.101-0.780,P=0.015).During the follow-up period,the incidence of MACE was lower in the dapagliflozin group compared to the control group(7.29%vs.17.57%,P=0.049).Cox regression analysis indicated that dapagliflozin reduced the occurrence of MACE after PCI(HR=0.374,95%CI 0.161-0.866,P=0.022).CONCLUSIONS With adequate hydration,the use of dapagliflozin do

关 键 词：达格列净 急性冠脉综合征 2型糖尿病 经皮冠状动脉介入治疗 造影剂 急性肾损伤 预后 

分 类 号：R969.4[医药卫生—药理学]