标题：达格列净治疗老年2型糖尿病患者的疗效及对患者胰岛β细胞功能、心功能的影响

      作者：蔡月娣 1，梁碧 2，黄彩英 3    1.广东省农垦中心医院内分泌科，广东 湛江 524000；2.湛江南粤医院内分泌科，广东 湛江 524000；3.广东省农垦中心医院重症医学科，广东 湛江 524000

      卷次： 2023年34卷2期

      【摘要】 目的 分析钠-葡萄糖协同转运蛋白2 (SGLT-2)抑制剂达格列净治疗老年2型糖尿病患者的疗效及对患者胰岛β细胞功能、心功能的影响。方法 选择2020年1月至2021年12月在广东省农垦中心医院接受治疗的60例老年2型糖尿病患者为研究对象，按照随机数表法分为对照组和观察组各30例。对照组患者采用常规降糖药物治疗，观察组患者在对照组治疗的基础上联合达格列净治疗，疗程为 12周。比较两组患者治疗前及治疗 12周后的空腹血糖 (FBG)、餐后 2 h 血糖 (2 hPBG)、糖化血红蛋白 A1c (HbA1c)、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)、左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)，比较两组患者在治疗期间的不良反应情况。结果 治疗前，两组患者的FBG、2 hPBG和HbA1c比较差异均无统计学意义(P>0.05)；治疗后，两组患者的上述血糖指标均降低，且观察组患者的FBG、2 hPBG和HbA1c分别为(6.79±1.03) mmol/L、(9.14±1.12) mmol/L和(6.47±0.95)%，明显低于对照组的(7.35±1.06) mmol/L、(9.67±1.52) mmol/L和(7.01±1.24)%，差异均有统计学意义(P<0.05)；治疗前，两组患者的空腹胰岛素水平、HOMA-IR、HOMA-β比较差异均无统计学意义(P>0.05)；治疗后，两组患者的空腹胰岛素水平、HOMA-β均升高，而HOMA-IR则降低，观察组患者的空腹胰岛素水平、HOMA-IR分别为(10.35±0.96) U/L、2.21±0.42，明显低于对照组的(10.68±0.91) U/L、2.65±0.55，而HOMA-β为70.86±9.64，明显高于对照组的64.08±9.12，差异均有统计学意义(P<0.05)；治疗前，两组患者的心功能指标差异均无统计学意义(P>0.05)；治疗后，两组患者的 LVEF均升高，而 LVEDD均降低，且观察组患者的 LVEF为(51.76±4.68)%，明显高于对照组的(48.83±8.22)%，而LVEDD为(50.39±14.33) mm，明显低于对照组的(55.95±15.31) mm，差异均有统计学意义(P<0.05)；观察组和对照组患者的总并发症发生率分别为6.67%和10.00%，差异无统计学意义(P>0.05)。结论 SGLT-2抑制剂达格列净治疗老年2型糖尿病可明显改善患者的胰岛β细胞功能和心功能，临床应用效果显著，具有临床应用价值。
      【关键词】 老年；2型糖尿病；钠-葡萄糖协同转运蛋白2抑制剂；达格列净；胰岛β细胞；心功能
      【中图分类号】 R587.1 【文献标识码】 A 【文章编号】 1003—6350（2023）02—0190—04

Efficacy of dapagliflozin in treatment of elderly patients with type 2 diabetes mellitus and its effect on pancreaticislet β cell function and cardiac function.
CAI Yue-Di 1, LIANG Bi 2, HUANG Cai-ying 3. 1.Department of Endocrinology,Guangdong Agricultural Reclamation Central Hospital, Zhanjiang 524000, Guangdong, CHINA; 2.Department ofEndocrinology, Zhanjiang Nanyue Hospital, Zhanjiang 524000, Guangdong, CHINA; 3.Department of Critical CareMedicine, Guangdong Agricultural Reclamation Central Hospital, Zhanjiang 524000, Guangdong, CHINA
【Abstract】 Objective To analyze the efficacy of sodium glucose cotransporter 2 (SGLT-2) inhibitor dapa-gliflozin in the treatment of elderly patients with type 2 diabetes mellitus and its effect on pancreatic islet β cell functionand cardiac function. Methods Sixty elderly patients with type 2 diabetes treated in Guangdong Agricultural Reclama-tion Central Hospital from January 2020 to December 2021 were selected as the study objects. According to the randomnumber table method, they were divided into a control group and an observation group, with 30 patients in each group.The patients in control group were treated with conventional hypoglycemic drugs, and the patients in observation groupwere treated with SGLT-2 inhibitor dapagliflozin on the basis of the control group, for 12 weeks. Before and after 12weeks of treatment, fasting blood glucose (FBG), 2 h postprandial blood glucose (2 hPBG), glycosylated hemoglobinA1c (HbA1c), fasting insulin, insulin resistance index (HOMA-IR), pancreatic islet β cell function index (HOMA-β),left ventricular ejection fraction (LVEF), and left ventricular end diastolic diameter (LVEDd) were analyzed between twogroups. The adverse reactions of the two groups during the treatment were compared. Results Before treatment, therewas no significant difference in FBG, 2 hPBG and HbA1c between the two groups (P>0.05). After treatment, the aboveblood glucose indexes decreased between the two groups, and the FBG, 2 hPBG, and HbA1c in the observation groupwere (6.79±1.03) mmol/L, (9.14±1.12) mmol/L, and (6.47±0.95)%, respectively, which were significantly lower than(7.35±1.06) mmol/L, (9.67±1.52) mmol/L, and (7.01±1.24)% in the control group (P<0.05). Before treatment, there wasno significant difference in fasting insulin level, HOMA-IR, and HOMA-β between the two groups (P>0.05). After treat-