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)患者经皮冠脉介入术(PCI)后心功能和支架内再狭窄(ISR)情况的影响。方法回顾性分析2018年1月至2019年12月于郑州大学第一附属医院因ACS接受PCI治疗的55例合并T2DM的患者的临床资料。根据术后是否服用达格列净将患者分为观察组(接受达格列净或联合其他降糖药物治疗,27例)和对照组[未接受钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂治疗,28例]。比较观察组与对照组治疗前后心功能和靶血管狭窄程度。根据术后6~12个月冠脉造影情况将患者分为再狭窄组(14例)和未狭窄组(41例)。分析ISR的影响因素。结果用药前,观察组与对照组心功能差异无统计学意义(P>0.05);用药6~12个月后,观察组氨基末端脑钠肽前体(NT-proBNP)、左室舒张末期内径(LVEDD)低于对照组(P<0.05)。术前及术后即刻,观察组与对照组靶血管狭窄程度差异无统计学意义(P>0.05);用药6~12个月后,观察组支架内狭窄程度低于对照组(P<0.01)。再狭窄组达格列净应用比例低于未狭窄组(P<0.05),支架长度长于未狭窄组(P<0.05)。多因素logistic回归分析结果显示,达格列净是ISR的保护因素(OR=0.058,95%CI:0.007~0.480),支架长度是ISR的危险因素(OR=1.029,95%CI:1.001~1.057)。结论对于T2DM合并ACS并接受PCI治疗的患者,相较于其他降糖药物,在同等降糖效果下,达格列净可起到保护心功能的作用,减少ISR的发生。
Objective To investigate the effects of dapagliflozin on the cardiac function and in-stent restenosis(ISR)of patients with type 2 diabetes(T2DM)combined with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods The clinical data of 55 patients with T2DM who received PCI treatment for ACS from January 2018 to December 2019 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.According to whether the patients took dapagliflozin after the operation,they were divided into observation group(27 cases)and control group(28 cases).The patients in observation group received dapagliflozin or combined with other hypoglycemic drugs,and patients in control group didn’t receive sodium-glucose contransporter-2(SGLT2)inhibitor.The heart function and the degree of target vessel stenosis of patients in observation group and control group were compared before and after treatment.The patients were divided into restenosis group(14 cases)and non-stenosis group(41 cases)according to the coronary angiography 6-12 months after the surgery.The influencing factors of ISR were analyzed.Results Before medication,there was no statistical difference in cardiac function between observation group and control group(P>0.05).After 6-12 months of treatment,amino-terminal pro-brain natriuretic peptide(NT-proBNP)and left ventricular end diastolic diameter(LVEDD)in observation group were lower than those in control group(P<0.05).Before and immediately after the operation,there was no statistical difference in the degree of target vessel stenosis between observation group and control group(P>0.05).After 6-12 months of medication,the degree of stenosis in the stent in observation group was lighter than that in control group(P<0.01).The application rate of dapagliflozin in restenosis group was lower than that in non-stenosis group(P<0.05),and the length of the stent in restenosis group was longer than that in non-stenosis group(P<0.05).Multivariate logistic regression analysis showed that dapagliflozin was a protective factor for ISR(OR=0.058,95%CI:0.007-0.480),and stent length was a risk factor for ISR(OR=1.029,95%CI:1.001-1.057).Conclusion For patients with ACS and T2DM who have received PCI treatment,compared with other hypoglycemic drugs,under the same hypoglycemic effect,dapagliflozin could protect the heart function and reduce the occurrence of ISR.
作者
任园园
洪晋
黄玉起
冯蕊涵
王玮
张晓
REN Yuanyuan;HONG Jin;HUANG Yuqi;FENG Ruihan;WANG Wei;ZHANG Xiao(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《河南医学研究》
CAS
2021年第17期3117-3122,共6页
Henan Medical Research
