摘要
目的探讨恩格列净联合治疗对老年2型糖尿病(T2DM)并急性心力衰竭(AHF)患者心功能、肾功能和预后的影响。方法选取2023年1至7月收治的160例T2DM并AHF患者为研究对象,采用随机数字表法分为观察组与对照组各80例。对照组予常规降糖和抗AHF治疗,观察组在对照组基础上加用恩格列净治疗,两组均持续治疗6个月。比较两组治疗前后心功能指标[左心室射血分数(LVEF)、6 min步行距离(6MWD)、N末端脑钠肽前体(NT-proBNP)]、肾功能指标[血尿素(BUN)、尿白蛋白肌酐比率(UACR)、肾小球滤过率(eGFR)]、血糖控制情况[空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)],并评估两组治疗安全性。随访1年,比较两组主要不良心血管事件(MACE)发生情况及治疗后1、3、6和12个月世界卫生组织生活质量量表(QQL-100)评分。结果治疗后,两组LVEF、6MWD均高于治疗前,且观察组更高(P<0.05,P<0.01);治疗后,两组NT-proBNP均低于治疗前,且观察组更低(P<0.05,P<0.01)。治疗后,观察组eGFR高于治疗前,且观察组高于对照组(P<0.05,P<0.01);治疗后,观察组BUN、UACR低于治疗前,且观察组低于对照组(P<0.05,P<0.01)。治疗后,两组FBG、2 h PBG和HbA1c均低于治疗前,且观察组更低(P<0.05,P<0.01)。两组不良反应发生率比较差异无统计学意义(P>0.05)。随访1年,观察组MACE总发生率低于对照组(P<0.05)。观察组治疗后1、3、6、12个月QQL-100评分均高于对照组(P<0.05)。结论恩格列净联合治疗可以有效改善老年T2DM并AHF患者心功能、肾功能和血糖水平,降低MACE发生率,并提高生活质量,且安全性较好。
Objective To investigate the effects of Empagliflozin combination therapy on cardiac function,renal function and prognosis in elderly patients with type 2 diabetes mellitus(T2DM)complicated with acute heart failure(AHF).Methods A total of 160 patients with T2DM and AHF admitted from January to July 2023 were selected as the research subjects and divided into the observation group(n=80)and the control group(n=80)by the random number table method.The control group was given conventional hypoglycemic and anti-AHF treatment,while the observation group was supplemented with Empagliflozin on the basis of the control group.Both groups were treated continuously for 6 months.The cardiac function indicators of the two groups before and after treatment[left ventricular ejection fraction(LVEF),6-minute walking distance(6MWD),N-terminal pro-brain natriuretic peptide(NT-proBNP)],renal function parameters[blood urea nitrogen(BUN),urinary albumin-to-creatinine ratio(UACR),estimated glomerular filtration rate(eGFR)],blood glucose control status[fasting blood glucose(FBG),2-hour postprandial blood glucose(2 h PBG),glycated hemoglobin(HbA1c)]before and after treatment were compared between the two groups,and the treatment safety of the two groups was evaluated.The patients were followed up for one year.The occurrence of major adverse cardiovascular events(MACE)and the scores of the World Health Organization Quality of Life Scale(QQL-100)at 1,3,6 and 12 months after treatment were recorded in both groups.Results After treatment,the LVEF and 6MWD in both groups were higher than those before treatment,notably in the observation group(P<0.05,P<0.01),while the NT-proBNP in both groups was lower after treatment than that before treatment,notably in the observation group(P<0.05,P<0.01).After treatment,the eGFR in the observation group was higher than that before treatment,and also higher in the observation group than in the control group(P<0.05,P<0.01).After treatment,BUN and UACR in the observation group were lower than those before treatment,and lower in the observation group than in the control group(P<0.05,P<0.01).After treatment,FBG,2 h PBG and HbA1c in both groups were lower than those before treatment,and even lower in the observation group(P<0.05,P<0.01).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).The total incidence of MACE in the observation group was lower than that in the control group at 1-year follow-up(P<0.05),while the QL-100 scores of the observation group at 1,3,6 and 12 months after treatment were all higher than those of the control group(P<0.05).Conclusion Empagliflozin combination therapy can effectively ameliorate cardiac function,renal function and blood glucose level in elderly patients with T2DM and AHF,reduce the incidence of MACE,improve the quality of life,and has good safety.
作者
吴佳宏
王韬
张友涛
王宏
杨晓敏
张倩
董利平
WU Jiahong;WANG Tao;ZHANG Youtao;WANG Hong;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 General Medicine,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)
出处
《临床误诊误治》
2025年第23期31-37,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)。
关键词
2型糖尿病
急性心力衰竭
老年人
恩格列净
左心室射血分数
肾小球滤过率
空腹血糖
主要不良心血管事件
type 2 diabetes
acute heart failure
elderly
Empagliflozin
left ventricular ejection fraction
estimated glomerular filtration rate
fasting blood glucose
major adverse cardiovascular events
