2023 年第 7 期 第 18 卷

利拉鲁肽对老年2型糖尿病患者左心室重构的影响及其与主要不良心脑血管事件的关系

Effect of liraglutide on left ventricular remodeling in elderly patients with type 2 diabetes mellitus and its relationship with major adverse cardiac and cerebrovascular events

作者：王洪霞1陈瞳1张利方1王燕1耿凡琪1王伟芹2刘化胜3张雪娟1

英文作者：Wang Hongxia1 Chen Tong1 Zhang Lifang1 Wang Yan1 Geng Fanqi1 Wang Weiqin2 Liu Huasheng3 Zhang Xuejuan1

单位：1青岛大学附属医院全科医学科，青岛266000；2山东省青岛市市立医院呼吸与危重症医学科，青岛266300；3青岛大学附属医院胃肠外科，青岛266000

英文单位：1Department of General Medicine the Affiliated Hospital of Qingdao University Qingdao 266000 China; 2Department of Respiratory and Critical Care Medicine Qingdao Municipal Hospital Shandong Province Qingdao 266300 China; 3Department of Gastrointestinal Surgery the Affiliated Hospital of Qingdao University Qingdao 266000 China

关键词：2型糖尿病；利拉鲁肽；心室重构；预后

英文关键词：Type2diabetesmellitus;Lilalutide;Ventricularremodeling;Prognosis

• 摘要：

• 目的  观察利拉鲁肽对老年2型糖尿病（T2DM）患者左心室重构的影响及其与主要不良心脑血管事件（MACCE）的关系。方法  收集2018年7月1日至2020年7月1日在青岛大学附属医院住院的237例T2DM患者的临床资料行回顾性分析。根据是否联合利拉鲁肽注射液分为观察组（121例，接受基础降糖联合利拉鲁肽治疗）和对照组（116例，接受基础降糖治疗）。比较2组一般资料及心室重构相关指标［左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）及左心室质量指数（LVMI）］、体质量、血压、心率、生化指标。分析MACCE的影响因素。结果  治疗12个月后，观察组LVESD、LVEDD、IVST、LVPWT、LVMI均低于治疗前及对照组［组间：（2.7±0.3）cm比（2.8±0.3）cm、（4.3±0.3）cm比（4.4±0.3）cm、（1.12±0.10）cm比（1.25±0.97）cm、（1.11±0.10）cm比（1.24±0.10）cm、（109±18）g/m2比（134±18）g/m2］，差异均有统计学意义（均P＜0.05）。治疗12个月后，2组高密度脂蛋白胆固醇均高于治疗前，体质量、血压、心率、空腹血糖、糖化血红蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇均低于治疗前，差异均有统计学意义（均P＜0.05）；组间比较各指标差异均无统计学意义（均P＞0.05）。二元Logistic回归分析发现年龄小、糖化血红蛋白水平低、应用钠-葡萄糖协同转运蛋白2抑制剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂、钙离子通道阻滞剂类药物、利拉鲁肽（比值比=0.075，95%置信区间：0.021～0.267）及LVMI小是MACCE的保护因素（均P＜0.05）。结论  利拉鲁肽可能通过减轻老年T2DM患者的左心室重构，从而预防和减少MACCE的发生。

• Objective  To observe the effect of liraglutide on left ventricular remodeling in elderly patients with type 2 diabetes mellitus (T2DM) and its relationship with major adverse cardiac and cerebrovascular events(MACCE). Methods  From July 1, 2018 to July 1, 2020, the clinical data of 237 T2DM patients admitted to the Affiliated Hospital of Qingdao University were collected and analyzed retrospectively. According to whether or not combined with liraglutide injection, they were divided into the observation group(121 cases, receiving basic hypoglycemic treatment combined with liraglutide) and the control group(116 cases, receiving basic hypoglycemic treatment). The general data and the indexes related to ventricular remodeling ［left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT) and left ventricular mass index (LVMI)］, body mass, blood pressure, heart rate and biochemical indexes were compared between the two groups. The influencing factors of MACCE were analyzed. Results  After 12 months of treatment, LVESD, LVEDD, IVST, LVPWT and LVMI in the observation group were lower than those before treatment and in the control group［between groups: (2.7±0.3)cm vs (2.8±0.3)cm, (4.3±0.3)cm vs (4.4±0.3)cm, (1.12±0.10)cm vs (1.25±0.97)cm, (1.11±0.10)cm vs (1.24±0.10)cm, (109±18)g/m2 vs (134±18)g/m2］(all P<0.05). After 12 months of treatment, levels of high-density lipoprotein cholesterol in both groups were higher than those before treatment, and body mass, blood pressure, heart rate, fasting blood glucose, glycosylated hemoglobin, total cholesterol, triacylglycerol and low-density lipoprotein cholesterol were lower than those before treatment (all P<0.05), while there were no statistically significant differences in each index between the two groups (all P>0.05). The binary Logistic regression analysis found that young age, low glycosylated hemoglobin level, application of sodium-glucose cotransporter 2 inhibitor, angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker, calcium channel blocker drugs, liraglutide(odds ratio=0.075, 95% confidence interval: 0.021-0.267) and low LVMI were the protective factors of MACCE(all P<0.05). Conclusion  Liraglutide can prevent and reduce the occurrence of MACCE by reducing left ventricular remodeling in elderly patients with T2DM.