利拉鲁肽联合二甲双胍治疗糖尿病合并冠心病患者对血糖、血脂、CRP、心功能的影响

摘要

目的 观察利拉鲁肽联合二甲双胍治疗糖尿病伴冠心病患者的疗效及对血糖、血脂及C反应蛋白(CRP)、心功能的影响.方法 选择2016年2月-2017年1月河北省廊坊市中医医院糖尿病肾病科收治的糖尿病合并冠心病患者96例作为研究对象,按照随机数字表法分为2组,每组48例.对照组给予盐酸二甲双胍片,初始剂量500 mg,2次/d,最大剂量≤2 000 mg/d;观察组在对照组治疗基础上加用利拉鲁肽,初始剂量0.6 mg/次皮下注射,1次/d;以后逐步增至1.8 mg剂量维持治疗.2组患者均连续治疗3个月.比较2组患者治疗前后血糖、血脂、CRP、心功能变化情况,并对2组患者安全性进行评价.结果 治疗后,观察组血糖指标空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)低于对照组,空腹C肽(CPO)高于对照组(t=5.373、9.007、4.368、1.985,P=0.000、0.000、0.000、0.033);观察组患者总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、CRP明显低于对照组,高密度脂蛋白胆固醇(HDL-C)显著高于对照组(t=5.233、4.495、5.536、6.683、2.052,P=0.000、0.000、0.000、0.000、0.021);观察组心功能指标左室射血分数(LVEF)、舒张期早期峰值速度/舒张晚期峰值速度(E/A)明显高于对照组,左室舒张末期内径(LVEDD)、左室后壁厚度(LVPWT)显著低于对照组(t=5.145、4.699、4.034、5.758,P=0.000、0.000、0.000、0.000);2组患者治疗过程中一过性厌食、恶心/呕吐、腹泻、一过性低血糖等不良反应发生率比较,差异无统计学意义(χ2=0.947、0.634、1.355、0.806,P=0.331、0.426、0.244、0.369).结论 利拉鲁肽联合二甲双胍治疗糖尿病合并冠心病患者能有效改善心功能,纠正血脂异常,减轻炎性反应,安全可靠,值得推广应用.%Objective To investigate the effects of combination therapy of liraglutide and metformin on cardiac function,blood lipid and CRP in patients with coronary artery disease and diabetes.Methods Ninety-six cases of patients with coronary artery disease and diabetes were selected,who were treated in hospital from February 2016 to January 2017,and they were divided into the observation group (48 cases) and control group (48 cases).The patients of control group were treated with metformin hydrochloride tablets (initial dose of 500 mg / time,2 times / d,the maximum dose ≤ 2 000 mg / d).On the basis of control group,the patients of observation group were treated with liraglutide (subcutaneous injection,initial dose of 0.6 mg / time,1 time / d;then the dose gradually increased to 1.8mg to maintain).The patients of two groups were all treated for 3 months.Compare the safety of treatment and changes of the blood glucose,blood lipids,and heart function levels of two groups.Results After the treatment,the FPG,2hPG,HbA1c levels of the observation group were significantly lower than those of the control group,the CPO levels of the observation group were significantly higher than those of the control group (t=5.373,t=9.007,t=4.368,t=1.985,P=0.000,P=0.000,P=0.000,P=0.033);The TC,TG,LDL-C,CRP levels of the observation group were significantly lower than those of the control group,the HDL-C levels of the observation group were significantly higher than those of the control group (t=5.233,t=4.495,t=5.536,t=6.683,t=2.052;P=0.000,P=0.000,P=0.000,P=0.000,P=0.021);The LVEF,E/A levels of the observation group were significantly higher than those of the control group,the LVEDD,LVPWT levels of the observation group were significantly lower than those of the control group (t=5.145,t=4.699,t=4.034,t=5.758;P=0.000,P=0.000,P=0.000,P=0.000);There were anorexia,nausea / vomiting,diarrhea,a transient hypoglycemia and other adverse reactions occurred in both two groups,but there were no statistically significant between the two groups (χ2=0.947,χ2=0.634,χ2=1.355,χ2=0.806;P=0.331,P=0.426,P=0.244,P=0.369).Conclusion With treating patients with coronary heart disease and diabetes,liraglutide combined with metformin can effectively improve the heart function and dyslipidemia,reduce the inflammatory response,it is also safe and reliable,which makes it worthy of application.