磷酸西格列汀联合二甲双胍治疗肥胖2型糖尿病合并心力衰竭的疗效及其对患者炎性因子的影响

目的 探讨磷酸西格列汀联合二甲双胍对肥胖2型糖尿病合并心力衰竭的疗效及其对患者炎性因子的影响.方法 于2014年1月至2015年12月在宝鸡市中心医院选择156例肥胖2型糖尿病合并心力衰竭患者,采用随机数字表法将其随机分为观察组(磷酸西格列汀+甘精胰岛素+二甲双胍)与对照组(甘精胰岛素+二甲双胍),每组78例,分别于治疗前及治疗1个月、3个月后测定并比较患者的空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖基化血红蛋白(HbA1c)、体质量指数(BMI)、α肿瘤坏死因子(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)及心功能.结果 观察组患者治疗1个月和3个月后的FPG[分别为(5.81±0.76)mmol/L、(5.46±0.43)mmol/L]、2 hPG[分别为(8.60±1.21)mmol/L、(8.06±0.67)mmol/L]、HbA1c[分别为(6.82±0.92)%、(6.31±0.55)%]均低于对照组相应值[FPG分别为(6.31±0.57)mmol/L、(6.13±0.31)mmol/L;2 hPG分别为(14.51±3.32)mmol/L、(15.70±2.11)mmol/L;HbA1c分别为(9.11±11.19)%、(9.03±0.88)%],差异均有统计学意义(P<0.05);治疗3个月后,观察组患者的BMI为(27.37±2.15),低于对照组的(30.45±3.17),差异有统计学意义(P<0.05);治疗1个月和3个月后,观察组患者的HR[分别为(94.48±14.38)次/min、(81.43±12.57)次/min]均低于对照组[分别为(107.53±12.45)次/min、(92.82±10.76)次/min],LVEF[分别为(69.47±7.45)%、(76.12±5.89)%]和Ea/Aa比值[分别为(1.33±0.23)、(1.48±0.16)]均高于对照组[LVEF分别为(58.95±6.34)%、(65.14±6.33)%;Ea/Aa比值分别为(1.26±0.17)、(1.33±0.21)],差异均有统计学意义(P<0.05);治疗1个月和3个月后,观察组患者的TNF-α[分别为(110.38±19.33)μg/mL、(84.56±16.63)μg/mL]、CRP[分别为(7.16±0.62)mg/L、(5.86±0.78)mg/L]和IL-6[分别为(307.62±38.45)μg/mL、(243.52±25.76)μg/mL]均低于对照组相应值[TNF-α分别为(124.62±18.69)μg/mL、(99.73±16.75)μg/mL;CRP分别为(7.67±0.76)mg/L、(7.24±1.13)mg/L;IL-6分别为(356.67±36.74)μg/mL、(319.35±29.38)μg/mL],差异均有统计学意义(P<0.05).结论 磷酸西格列汀联合二甲双胍能明显改善肥胖2型糖尿病合并心力衰竭患者的血糖及心功能,并抑制炎性因子,值得临床推广应用.

Efficacy of sitagliptin combined with metformin in the treatment of obese patients with type 2 diabetes complicated with heart failure and its influence on inflammatory factors

Objective To probe the efficacy of sitagliptin combined with metformin in the treatment of obese patients with type 2 diabetes complicated with heart failure and its influence on inflammatory factors. Methods A to-tal of 156 obese patients with type 2 diabetes mellitus complicated with heart failure, who admitted to our hospital from Jan 2014 to Dec 2015, were selected and randomly divided into the observation group (sitagliptin and glargine plus metformin) and the control group (glargine plus metformin), with 78 cases in each group. The levels of the glyco-sylated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2 hours postprandial blood glucose (2 hPG), body mass in-dex (BMI), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6) and heart function be-fore and after one month and three months of treatment were detected and compared. Results After one month and three months of treatment, the levels of FPG, 2 hPG and HbA1c in the observation group were (5.81 ± 0.76) mmol/L, (5.46±0.43) mmol/L, (8.60±1.21) mmol/L, (8.06±0.67) mmol/L, (6.82±0.92)%, (6.31±0.55)%, respectively, which were significantly lower than (6.31±0.57) mmol/L, (6.13±0.31) mmol/L, (14.51±3.32) mmol/L, (15.70±2.11) mmol/L, (9.11± 11.19)%, (9.03 ± 0.88)%in the control group (P<0.05). After treatment for 3 months, the BMI of the observation group was (27.37 ± 2.15), which was significantly lower than (30.45 ± 3.17) of the control group (P<0.05). After one month and three months of treatment, the HR of the observation group were (94.48 ± 14.38) per min, (81.43 ± 12.57) per min respec-tively, which were lower than (107.53±12.45) per min, (92.82±10.76) per min of the control group;the LVEF and Ea/Aa ratio of the observation group were (69.47 ± 7.45)%, (76.12 ± 5.89)%, (1.33 ± 0.23), (1.48 ± 0.16), respectively, which were higher than (58.95±6.34)%, (65.14±6.33)%, (1.26±0.17), (1.33±0.21) of the control group (P<0.05). After one month and three months of treatment, the TNF-α, CRP and IL-6 of the observation group were (110.38 ± 19.33) μg/mL, (84.56 ±16.63) μg/mL, (7.16 ± 0.62) mg/L, (5.86 ± 0.78) mg/L, (307.62 ± 38.45) μg/mL, (243.52 ± 25.76) μg/mL, respectively, which were lower than (124.62±18.69)μg/mL, (99.73±16.75)μg/mL, (7.67±0.76) mg/L, (7.24±1.13) mg/L, (356.67± 36.74)μg/mL, (319.35±29.38)μg/mL of the control group (P<0.05). Conclusion Sitagliptin combined with metformin can improve blood glucose and cardiac function in obese patients with type 2 diabetes complicated with heart failure, and inhibit inflammatory factors, which is worthy of clinical promotion.