达格列净对2型糖尿病患者血、尿电解质的影响

目的 观察单用二甲双胍血糖控制不佳（糖化血红蛋白，HbA1c＞7.5%）的2型糖尿病（T2DM）患者，应用达格列净后对血电解质（血钠、血钾、血钙）、尿电解质（24小时尿钠、24小时尿钾、24小时尿钙）、尿渗透浓度及其他代谢指标的影响，评估用药后的安全性。方法 选取在2017年9月至2019年4月期间，于沧州市人民医院本部院区内分泌门诊及住院部就诊的103例T2DM患者，按照随机抽样法分成对照组（55例）和试验组（48例）。对照组给予二甲双胍治疗，试验组给予二甲双胍联合达格列净治疗。观察用药24周后患者血电解质、尿电解质、尿渗透浓度及其他代谢指标较基线和对照组的变化以及评估用药的安全性。结果 治疗24周后，试验组的尿电解质、尿渗透浓度水平较基线及对照组均有所升高，差异有统计学意义(P＜0.05)；试验组的血糖参数、总胆固醇（TC）、甘油三酯（TG）、24小时尿蛋白、体重指数（BMI）、体重水平较基线及对照组降低，差异存在统计学意义(P＜0.05)；血电解质、尿pH、低密度脂蛋白胆固醇（LDL C）、高密度脂蛋白胆固醇（HDL C）、估算的肾小球滤过率（eGFR）水平较基线及对照组无明显变化，差异无统计学意义(P＞0.05)。结论 在单用二甲双胍控制不佳的T2DM患者中联合应用达格列净治疗，可有降低血糖、改善血脂、减轻体重、减少尿蛋白等多重获益，虽然会引起尿电解质增多及尿渗透浓度升高，但血电解质水平无明显改变，无严重不良事件发生，使用上更安全。

Effect of dapagliflozin on electrolytes in hematuria in patients with type 2 diabetes

Objective To observe the patients with type 2 diabetes mellitus (T2DM) who had poor glycemiccontrol (glycosylated hemoglobin, HbA1c>7.5%) with metformin alone and the application effects of dapagliflozinon blood electrolytes (serum sodium, serum potassium, serum calcium), urinary electrolytes(24 hours urinary sodium, 24 hours urinary potassium, 24 hours urinary calcium), urine osmolality and other metabolic indicators were evaluated for safety after administration.Methods During the period from September 2017 to April 2019, 103 patients with T2DM who were treated in the hospital were randomly divided into control group (n=55) and experimental group (n=48). The control group was treated with metformin, and the experimental group was given dapagliflozinmore. The changes of blood electrolytes, urinary electrolytes, urine osmolality and other metabolic indexes were compared with the baseline and those in the control group after 24 weeks of treatment, and the safety of the medication was evaluated.Results After 24 weeks of treatment, the levels of urinary electrolyte and urine osmolality in the experimental group were higher than those in the baseline and the control group(P<0.05). The blood glucose parameters, TC, TG, 24 hour urinary protein, BMI and body weight in the experimental group were lower than those in the baseline and the control group(P<0.05). The levels of serum electrolyte, urinary pH, LDL C, HDL C and eGFR in the experimental group were the same as those in the baseline and control group(P>0.05).Conclusion In patients with poorly controlled T2DM treated with metformin alone, the combination of dapagliflozin can reduce blood glucose, improve blood lipids, reduce body weight and reduce urinary protein. Although it may cause an increase in urinary electrolytes and inurine osmolality, but there were no significant change in blood electrolyte levels. No serious adverse events occurred, and it was safe to use.