恩格列净联合治疗老年2型糖尿病合并急性心力衰竭的效果观察  

Effect of Empagliflozin Combination Therapy on Elderly Patients with Type 2 Diabetes Mellitus Complicated with Acute Heart Failure

作　　者：吴佳宏 王韬[2] 张友涛 左丽 杨晓敏 张倩 董利平[1] WU Jiahong;WANG Tao;ZHANG Youtao;ZUO Li;YANG Xiaomin;ZHANG Qian;DONG Liping(Department of Geriatrics,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China;Department of Orthopedics,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China;Department of Geriatrics,the First Hospital of Zhangjiakou City,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院老年科,河北张家口075000 [2]河北北方学院附属第一医院骨科,河北张家口075000 [3]张家口市第一医院老年科,河北张家口075000

出　　处：《临床误诊误治》2025年第8期39-45,共7页Clinical Misdiagnosis & Mistherapy

基　　金：河北省2023年度医学科学研究课题计划项目(20230197)。

摘　　要：目的探讨恩格列净联合治疗老年2型糖尿病(T2DM)合并急性心力衰竭(AHF)的效果。方法选取2023年1月至2023年7月就诊的老年T2DM合并AHF患者166例,采用随机数字表法分为2组各83例,对照组给予常规治疗,观察组在对照组基础上联合恩格列净治疗,2组均治疗1周。比较2组临床疗效,治疗前后血糖水平[空腹血糖(FBG)、餐后2 h血糖(2 h PG)]、心功能指标[心输出量(CO)、左心室射血分数(LVEF)、B型利钠肽(BNP)、左心室舒张末期内径(LVDD)]、肾功能指标[尿白蛋白与肌酐比值(UACR)、肾小球滤过率(eGFR)、呋塞米使用量]、P38 MAPK信号通路相关蛋白表达,以及应用安全性、随访1年预后。结果观察组治疗总有效率为96.39%(80/83)高于对照组的87.95%(73/83),差异有统计学意义(P<0.05)。治疗后2组2 h PG、FBG水平均降低,且观察组低于对照组(P<0.05,P<0.01)。治疗后2组LVEF、CO升高,LVDD、BNP降低,且观察组LVEF、CO升高及LVDD、BNP降低程度大于对照组(P<0.05,P<0.01)。治疗后2组UACR降低、eGFR升高,且观察组eGFR高于对照组、UACR及呋塞米使用量低于对照组(P<0.05,P<0.01)。治疗后2组p-ERK、p-P38、p-JNK均低于治疗前,且观察组低于对照组(P<0.05,P<0.01)。治疗期间观察组急性肾损伤发生率低于对照组(P<0.05),尿路感染、低血压发生率比较差异无统计学意义(P>0.05)。随访1年,2组生存率比较差异无统计学意义(P>0.05),观察组心力衰竭再住院率低于对照组(P<0.05)。结论恩格列净联合治疗老年T2DM合并AHF效果显著,可降低患者血糖水平,减轻肾功能损伤,改善心功能及近期预后,抑制P38 MAPK信号通路相关蛋白表达,且安全性高。Objective To investigate the effect of Empagliflozin combination therapy on elderly patients with type 2 diabetes mellitus(T2DM)complicated with acute heart failure(AHF).Methods A total of 166 elderly patients with T2DM and AHF from January 2023 to July 2023 were selected and randomly divided into two groups,with 83 patients in each group.The control group was given conventional treatment,and the observation group was treated with Empagliflozin on the basis of the control group.Both groups were treated for one week,and the clinical efficacy of the two groups was compared.Blood glucose levels[fasting plasma glucose(FBG),2-hour postprandial plasma glucose(2 h PG)],cardiac function indexes[cardiac output(CO),left ventricular ejection fraction(LVEF),B-type natriuretic peptide(BNP),left ventricular end-diastolic diameter(LVDD)],renal function indexes[urinary albumin to creatinine ratio(UACR),estimated glomerular filtration rate(eGFR),dosage of Furosemide],P38 MAPK signaling pathway-related protein expression before and after treatment,application safety,and prognosis at 1-year follow-up were compared between the two groups.Results The total effective rate of the observation group was 96.39%(80/83),which was higher than 87.95%(73/83)of the control group,showing significant difference(P<0.05).After treatment,the 2 h PG and FBG levels of the two groups were decreased,which were lower in the observation group than in the control group(P<0.05,P<0.01).After treatment,LVEF and CO were increased,LVDD and BNP were decreased in the two groups,and the increase of LVEF and CO and the decrease of LVDD and BNP in the observation group were greater than those in the control group(P<0.05,P<0.01).After treatment,UACR was decreased,while eGFR was increased in the two groups;eGFR in the observation group was higher than that in the control group,while UACR and dosage of Furosemide were lower than those in the control group(P<0.05,P<0.01).After treatment,the levels of p-ERK,p-P38 and p-JNK in the two groups were lower than those before t

关 键 词：糖尿病 2型 心力衰竭 急性 恩格列净 血糖 左室射血分数 肾小球滤过率 P38MAPK信号通路 药物毒性 预后 

分 类 号：R541.6[医药卫生—心血管疾病]