2021 年第 10 期 第 16 卷

达格列净联合胰岛素治疗2型糖尿病的临床效果及对肾功能的影响

Clinical effect of dapagliflozin combined with insulin on the treatment of type 2 diabetes mellitus and its influence on renal function

作者：谈玖婷1傅聿明1李春普2徐正龙3刘超4张真稳5

英文作者：Tan Jiuting1 Fu Yuming1 Li Chunpu2 Xu Zhenglong3 Liu Chao4 Zhang Zhenwen5

单位：1江苏省兴化市人民医院内分泌科225700;2江苏省兴化市人民医院心内科225700;3江苏省兴化市人民医院药剂科225700;4南京中医药大学附属中西医结合医院内分泌科210028;5苏北人民医院内分泌科，江苏省扬州市225001

英文单位：1Department of Endocrinology Xinghua People′s Hospital Jiangsu Province Xinghua 225700 China; 2Department of Cardiology Xinghua People′s Hospital Jiangsu Province Xinghua 225700 China; 3Department of Pharmacy Xinghua People′s Hospital Jiangsu Province Xinghua 225700 China; 4Department of Endocrinology Affiliated Hospital of Integrated Traditional Chinese and Western Medicine Nanjing University of Chinese Medicine Nanjing 210028 China; 5Department of Endocrinology Subei People′s Hospital Jiangsu Province Yangzhou 225001 China

关键词：2型糖尿病；达格列净；胰岛素；肾功能

英文关键词：Type2diabetesmellitus;Dapagliflozin;Insulin;Renalfunction

• 摘要：

• 目的  探讨达格列净联合胰岛素治疗2型糖尿病的临床效果及对肾功能的影响。方法 选取江苏省兴化市人民医院2019年1月至2020年6月收治的2型糖尿病患者82例。采用随机数字表法分为观察组和对照组，各41例。2组患者均接受相同的营养饮食和运动安排，对照组采用皮下注射胰岛素治疗，观察组在对照组治疗基础上口服达格列净片治疗。2组均持续治疗12周。比较2组治疗前后血糖、糖化血红蛋白（HbA1c）水平，肾功能，糖尿病生活质量量表（DQOL）评分以及治疗期间不良反应发生情况。结果 治疗后，2组空腹血糖、HbA1c、餐后2 h血糖、血尿素氮、血肌酐、尿微量白蛋白/尿肌酐比值水平和DQOL评分均低于治疗前，且观察组均低于对照组［(5.3±0.8)mmol/L比（5.8±0.8）mmol/L，（5.0±0.7）%比（7.2±1.0）%，（8.9±1.2）mmol/L比（16.1±2.3）mmol/L，（7.4±0.7）mmol/L比（8.1±1.0）mmol/L，（151±13）μmol/L比（158±14）μmol/L，（9.1±1.3）g/mol比（19.7±2.2）g/mol，（60±9）分比（77±12）分］，估算肾小球滤过率均高于治疗前，且观察组高于对照组［（81±14）ml/（min·1.73 m2)比（74±12）ml/（min·1.73 m2)］（均P＜0.05）。治疗期间2组不良反应发生率比较差异无统计学意义（P>0.05）。结论 达格列净联合胰岛素可有效改善2型糖尿病患者血糖水平及生活质量，对肾功能有较好的保护作用，且具有较高的安全性。

• Objective To investigate the clinical effect of dapagliflozin combined with insulin on the treatment of type 2 diabetes mellitus and its influence on renal function. Methods From January 2019 to June 2020, 82 patients with type 2 diabetes mellitus admitted to Xinghua People′s Hospital, Jiangsu Province were selected. They were randomly divided into observation group and control group, with 41 cases in each group. Both groups were treated by the same nutritional diet and exercise arrangements. In addition, the control group was treated with insulin subcutaneous injection and the observation group was treated with dapagliflozin tablets on the basis of the control group. The blood glucose, glycosylated hemoglobin (HbA1c) level, renal function, diabetes quality of life scale (DQOL) score before and after treatment and the incidence of adverse reactions during treatment were compared between the two groups. Results After treatment, the levels of fasting blood glucose, HbA1c, 2 h postprandial glucose, blood urea nitrogen, serum creatinine, urinary microalbumin-to-urinary creatinine ratio and DQOL score in both groups were lower than those before treatment, and those in the observation group were lower than those in the control group ［(5.3±0.8)mmol/L vs (5.8±0.8）mmol/L，（5.0±0.7)% vs (7.2±1.0）%，（8.9±1.2)mmol/L vs (16.1±2.3）mmol/L，（7.4±0.7)mmol/L vs (8.1±1.0）mmol/L，（151±13）μmol/L vs (158±14）μmol/L，（9.1±1.3)g/mol vs (19.7±2.2)g/mol, （60±9） vs （77±12）］; estimated glomerular filtration rate in both groups was higher than that before treatment, and that in the observation group was higher than that in the control group ［(81±14)ml/（min·1.73 m2) vs (74±12)ml/（min·1.73 m2)］(all P<0.05). There was no significant difference in the incidence of adverse reactions during treatment between the two groups (P>0.05). Conclusion Dapagliflozin combined with insulin can effectively improve the blood glucose level and quality of life in patients with type 2 diabetes mellitus, has a better protection effect on renal function and has high safety.