2021 年第 6 期 第 16 卷

达格列净联合二肽基肽酶4抑制剂和二甲双胍治疗血糖控制不佳2型糖尿病的效果分析

Curative effect of dapagliflozin combined with dipeptidyl peptidase-4 inhibitors and metformin on type 2 diabetes mellitus with poor glucemic control

作者：曲建昌1弓月2王彤1梁艳玲1王莉莎1徐锌1赵红玉1岳小伟1赵强3

英文作者：Qu Jianchang1 Gong Yue2 Wang Tong1 Liang Yanling1 Wang Lisha1 Xu Xin1 Zhao Hongyu1 Yue Xiaowei1 Zhao Qiang3

单位：1中国人民解放军第三〇五医院内分泌科，北京100017；2中国人民解放军第三〇五医院皮肤科，北京100017；3中国人民解放军第三〇五医院药局，北京100017

英文单位：1Department of Endocrinology the 305th Hospital of the Chinese People′s Liberation Army Beijing 100017 China; 2Department of Dermatology the 305th Hospital of the Chinese People′s Liberation Army Beijing 100017 China; 3Department of Pharmacy the 305th Hospital of the Chinese People′s Liberation Army Beijing 100017 China

关键词：2型糖尿病；达格列净；二肽基肽酶4抑制剂

英文关键词：Type2diabetesmellitus;Dapagliflozin;Dipeptidylpeptidase-4inhibitor

• 摘要：

• 目的 观察达格列净联合二肽基肽酶4（DPP-4）抑制剂与二甲双胍治疗2型糖尿病患者的效果。方法 选取2018年2月至2019年8月于中国人民解放军第三〇五医院接受DPP-4抑制剂联合二甲双胍且血糖控制不佳的52例2型糖尿病患者，根据随机数字表法分为对照组和观察组，各26例。对照组二甲双胍剂量统一调整为1 g/次、2次/d，DPP-4抑制剂用量不变；观察组在原有治疗方案基础上联合达格列净10 mg/次、1次/d口服，2组均连续治疗12周。比较治疗前后2组体重指数、血压、糖化血红蛋白（HbA1c）、空腹血糖、餐后2 h血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、血尿酸等2型糖尿病相关指标的变化，并记录不良反应。结果 对照组23例、观察组21例完成治疗。治疗后，观察组体重指数、收缩压、舒张压、三酰甘油、血尿酸水平均低于治疗前，且均低于对照组，差异均有统计学意义（均P＜0.05）。治疗后，2组HbA1c、空腹血糖、餐后2 h血糖水平均低于治疗前，且观察组均低于对照组［（7.1±0.9）%比（7.5±1.0）%、（7.3±1.0）mmol/L比（8.0±1.1）mmol/L、（10.4±1.8）mmol/L比（11.3±2.1）mmol/L］，差异均有统计学意义（均P＜0.05）。2组不良反应发生率比较差异无统计学意义(P＞0.05)。结论 达格列净可改善DPP-4抑制剂联合二甲双胍治疗效果欠佳的2型糖尿病患者的血糖水平、减轻体质量、控制血压，有一定安全性。

• Objective To observe the curative effect of dapagliflozin combined with dipeptidyl peptidase-4 (DPP-4) inhibitor and metformin on the patients with type 2 diabetes mellitus (T2DM). Methods From February 2018 to August 2019, 52 cases of T2DM who treated with DPP-4 inhibitors and metformin and had poor blood glucose control in the 305th Hospital of the Chinese People′s Liberation Army were selected. They were randomly divided into control group and observation group, with 26 cases in each group. The dose of metformin in control group was adjusted to 1 g a time, twice a day, and the dose of DDP-4 inhibitor maintained. The observation group was given dapagliflozin with 10 mg a time, once a day orally on the basis of original treatment regimen. Both groups were treated for 12 weeks. The levels of body mass index, blood pressure, glycosylated hemoglobin (HbA1c), fasting plasma glucose, 2 h postprandial glucose, total cholesterol, triacylglycerols, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), serum uric acid and other indicators related to T2DM were compared between the two groups before and after treatment, and the adverse reactions were recorded. Results There were 23 cases in control group and 21 cases in observation group who completed treatment. After treatment, the levels of body mass index, systolic pressure, diastolic pressure, triacylglycerols, and serum uric acid in observation group were lower than those in control group, and the differences were statistically significant(all P<0.05). After treatment, The levels of HbA1c, fasting plasma glucose and 2 h postprandial glucose in both groups were lower than those before treatment, and those in observation group were lower than those in control group［（7.1±0.9）% vs （7.5±1.0）%,（7.3±1.0）mmol/L vs （8.0±1.1）mmol/L,（10.4±1.8）mmol/L vs （11.3±2.1）mmol/L］(all P<0.05). There was no difference in the incidence of adverse reactions (P>0.05). Conclusion Dapagliflozin can improve blood glucose level, reduce body weight, and control blood pressure in T2DM patients with poor curative effect of DPP-4 inhibitor combined with metformin. It has certain safety.