2022 年第 12 期 第 17 卷

达格列净联合美托洛尔治疗2型糖尿病合并慢性心力衰竭的临床效果

Clinical effect of dapagliflozin combined with metoprolol in the treatment of type 2 diabetes mellitus complicated with chronic heart failure

作者：沈祎玲1祁春梅2

英文作者：Shen Yiling1 Qi Chunmei2

单位：1徐州医科大学临床学院，徐州221000；2徐州矿务集团总医院心内科，徐州221000

英文单位：1Clinical Medical College Xuzhou Medical University Xuzhou 221000 China; 2Department of Cardiology General Hospital of Xuzhou Mining Group Xuzhou 221000 China

关键词：2型糖尿病；慢性心力衰竭;达格列净；美托洛尔

英文关键词：Type2diabetesmellitus;Chronicheartfailure;Dapagliflozin;Metoprolol

• 摘要：

• 目的  探讨达格列净联合美托洛尔治疗2型糖尿病（T2DM）合并慢性心力衰竭的临床效果。方法  选取2020年2月至2021年12月徐州矿务集团总医院心内科收治的128例T2DM合并慢性心力衰竭患者作为研究对象，按照随机数字表法分为对照组和观察组，各64例。对照组采用美托洛尔及其他常规西药治疗，观察组在对照组基础上加用达格列净治疗。2组均治疗6个月。比较2组患者治疗前后血糖指标［空腹血糖、餐后2 h血糖（2 hPG）、糖化血红蛋白（HbA1c）］、心室重构参数［左心室射血分数（LVEF）、左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）］、血管内皮功能指标［血流介导的血管舒张功能（FMD）、血清内皮素1、一氧化氮］、收缩压、舒张压和静息心率。比较2组临床疗效及治疗期间不良反应发生情况。结果  治疗后，2组空腹血糖、2 hPG、HbA1c、LVESD、LVEDD及内皮素1均低于治疗前，且观察组均低于对照组，2组LVEF、FMD、一氧化氮均高于治疗前，且观察组均高于对照组（均P＜0.05）。治疗后，2组收缩压、舒张压、静息心率均低于治疗前，且观察组收缩压、舒张压均低于对照组（均P＜0.05）。观察组T2DM及慢性心力衰竭总有效率均高于对照组［93.8%(60/64)比81.2%(52/64)、92.2%(59/64)比79.7%(51/64)］（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  达格列净联合美托洛尔治疗T2DM合并慢性心力衰竭患者能有效降低血糖水平，抑制心室重构进程，改善血管内皮功能，调节血压，效果显著且安全性良好。

• Objective  To explore the clinical effect of dapagliflozin combined with metoprolol in the treatment of type 2 diabetes mellitus (T2DM) complicated with chronic heart failure. Methods  Totally 128 patients with T2DM complicated with chronic heart failure were enrolled in General Hospital of Xuzhou Mining Group from February 2020 to December 2021. They were divided into control group and observation group according to the random number table method, with 64 cases in each group. The control group was treated with metoprolol and other conventional western medicine, while the observation group was treated with dapagliflozin on the basis of the control group. Both groups were treated for 6 months. The blood glucose indexes ［fasting blood glucose (FBG), 2 h postprandial blood glucose (2 hPG), glycosylated hemoglobin (HbA1c)］, ventricular remodeling parameters ［left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD)］, vascular endothelial function indexes ［flow mediated vasodilation function (FMD), serum endothelin-1 (ET-1), nitric oxide (NO)］, systolic blood pressure (SBP), diastolic blood pressure (DBP) and resting heart rate were compared between the two groups before and after treatment. The clinical efficacy after treatment and the incidence of adverse reactions during treatment were compared between the two groups. Results  After treatment, the FBG, 2 hPG, HbA1c, LVESD, LVEDD and ET-1 in the two groups were lower than those before treatment, and the above indexes in observation group were lower than those in control group; LVEF, FMD and NO in the two groups were higher than those before treatment, and LVEF, FMD and NO in observation group were higher than those in control group (all P＜0.05). After treatment, SBP, DBP and resting heart rate in the two groups were lower than those before treatment, SBP and DBP in observation group were lower than those in control group (all P＜0.05). The total effective rates of T2DM and chronic heart failure in the observation group were higher than those in the control group［93.8%(60/64) vs 81.2%(52/64), 92.2%(59/64) vs 79.7%(51/64)］(both P＜0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P＞0.05). Conclusion  Dapagliflozin combined with metoprolol can effectively reduce the blood glucose level in T2DM patients with chronic heart failure, inhibit the process of ventricular remodeling, improve vascular endothelial function and regulate blood pressure, which has significant curative effect and good safety.