恩格列净对老年T2DM并心力衰竭患者心肌能量代谢的影响  

Influence of empagliflozin on myocardial energy metabolism in elderly patients with T2DM complicated with heart failure

作　　者：唐春梅[1] 蔡竹清 崔辉斌 杨兴 刘丽[1] TANG Chunmei;CAI Zhuqing;CUI Huibin;YANG Xing;LIU Li(Department of General Medicine,Suining Central Hospital,Suining 629000,Sichuan,China;Department of Anesthesiology,Shehong Municipal Hospital of TCM,Suining 629299,Sichuan,China)

机构地区：[1]遂宁市中心医院全科医学科,四川遂宁629000 [2]射洪市中医院麻醉科,四川遂宁629299

出　　处：《西部医学》2025年第3期398-402,共5页Medical Journal of West China

基　　金：四川省卫生健康委员会科研课题(19PJ148);遂宁市中心医院科研项目(2019y39)。

摘　　要：目的探讨恩格列净(EMPA)在老年2型糖尿病(T2DM)合并心力衰竭(HF)中的治疗效果及对患者心肌能量代谢的影响。方法回顾性分析2019年7月—2022年6月遂宁市中心医院全科医学科收治的116例老年T2DM合并HF患者的临床资料,采用单双球法随机分为常规组(常规治疗)和EMPA组(EMPA治疗),每组58例。比较两组患者治疗前和治疗12周后糖脂代谢[空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)]、胰岛素抵抗[空腹胰岛素(FINS)、胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)]、心功能[左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)]、心肌损伤及心肌能量代谢[B型钠尿肽(BNP)、肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、血清游离脂肪酸(FFA)]水平,统计不良反应情况。结果治疗后,EMPA组FPG、HbA1c、TC、TG、HOMA-IR、LVESD、LVEDD、BNP、cTnI、CK-MB和FFA水平低于常规组(均P<0.05);HOMA-β、LVEF水平高于常规组(均P<0.05);EMPA组不良反应发生率(3.45%)与常规组(10.34%)比较,差异无统计学意义(P>0.05)。结论EMPA治疗老年T2DM合并HF效果显著,可对患者糖脂代谢进行调控,从而缓解其胰岛素抵抗,改善其心功能及心肌能量代谢,且不增加不良反应发生率。Objective To observe the therapeutic effect of empagliflozin(EMPA)on elderly patients with type 2 diabetes mellitus(T2DM)and heart failure(HF)and its influence on myocardial energy metabolism of patients.Methods The clinical data of 116 elderly patients with T2DM complicated with HF treated in the Department of General Medicine of Suining Central Hospital were retrospectively analyzed from July 2019 to June 2022,and the patients were randomly divided into conventional group(conventional treatment)and EMPA group(EMPA treatment)by single-double ball method,with 58 cases in each group.Before treatment and after 12 weeks of treatment,the two groups of patients were compared in terms of glucolipid metabolism,insulin resistance,cardiac function,myocardial injury and myocardial energy metabolism,and the adverse reactions were statistically analyzed.Results The levels of FPG,HbA1c,TC,TG,HOMA-IR,LVESD,LVEDD,BNP,cTnI,CK-MB and FFA in EMPA group were lower than those in conventional group(all P<0.05).HOMA-βand LVEF were higher in EMPA group compared to conventional group(all P<0.05).The total incidence rate of adverse reactions with 3.45% in EMPA group was not statistically different from 10.34% in conventional group(P>0.05).Conclusion EMPA has a significant effect in the treatment of T2DM with HF in elderly patients,and it can regulate glucolipid metabolism,alleviate insulin resistance,and improve cardiac function and myocardial metabolism.In addition,it does not increase the incidence rates of adverse reactions.

关 键 词：恩格列净 2型糖尿病 心力衰竭 心功能 心肌能量代谢 糖脂代谢 

分 类 号：R587.2[医药卫生—内分泌]