[1]崔向勇.达格列净联合二甲双胍治疗2型糖尿病肾病疗效观察[J].新乡医学院学报,2022,39(4):362-366.[doi:10.7683/xxyxyxb.2022.04.013]
　CUI Xiangyong.Effect of dapagliflozin combined with metformin in the treatment of patients with type 2 diabetic nephropathy[J].Journal of Xinxiang Medical University,2022,39(4):362-366.[doi:10.7683/xxyxyxb.2022.04.013]
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达格列净联合二甲双胍治疗2型糖尿病肾病疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年4
页码:
362-366
栏目:
临床研究
出版日期:
2022-04-05

文章信息/Info

Title:
Effect of dapagliflozin combined with metformin in the treatment of patients with type 2 diabetic nephropathy
作者:
崔向勇
（新乡市第一人民医院内分泌科，河南　新乡　453002）
Author(s):
CUI Xiangyong
(Department of Endocrinology,Xinxiang First People′s Hospital,Xinxiang 453002,Henan Province,China)
关键词:
2型糖尿病肾病; 钠-葡萄糖协同转运蛋白2抑制剂; 达格列净; 二甲双胍; 胰岛β细胞功能; 血管内皮功能
Keywords:
type 2 diabetic nephropathy; sodium glucose cotransporter 2 inhibitor; dapagliflozin; metformin; islets β-cell function; vascular endothelial function
分类号:
R587.1
DOI:
10.7683/xxyxyxb.2022.04.013
文献标志码:
A
摘要:
目的　探讨达格列净联合二甲双胍治疗2型糖尿病肾病（T2DN）的临床疗效。方法　选择2020年1月至2021年2月新乡市第一人民医院收治的90例T2DN患者为研究对象。根据治疗方法将患者分为对照组和观察组，每组45例。2组患者均接受常规处理，包括T2DN健康宣传教育、控制饮食、运动；2组患者均常规给予厄贝沙坦片150 mg，早晨口服，每日1次。对照组患者在常规处理基础上，给予二甲双胍片0.5 g，口服，每日3次；观察组患者在对照组治疗基础上给予达格列净片 10 mg，早晨口服，每日1次；2组患者均接受3个月的连续治疗。治疗3个月后，评估2组患者的临床治疗效果，并计算总有效率。治疗前、治疗3个月后，使用血糖仪检测2组患者空腹血糖（FBG）水平，使用全自动生物化学分析仪测定患者空腹胰岛素（FINS）水平，并计算稳态模型胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β）。治疗前、治疗3个月后，使用全自动生物化学分析仪测定患者血肌酐（Scr）及血尿素氮（BUN）水平，并使用生物化学分析仪测定患者24 h尿蛋白定量。治疗前、治疗3个月后，使用声波图像诊断装置测定患者血管内皮依赖性舒张功能（FMD），采用酶联免疫吸附法测定患者血清内皮素-1（ET-1）水平，采用还原比色法测定患者血清一氧化氮（NO）水平。记录2组患者治疗期间低血糖、消化道反应、头晕头痛等不良反应发生情况，并计算不良反应发生率。结果　治疗3个月后，对照组和观察组患者的治疗总有效率分别为73.33%（33/45）、91.11%（41/45），观察组患者的总有效率显著高于对照组（χ2=4.865，P<0.05）。治疗前2组患者的FBG水平及HOMA-IR、HOMA-β比较差异无统计学意义（P>0.05）；2组患者治疗3个月后的FBG水平及HOMA-IR均显著低于治疗前，HOMA-β显著高于治疗前（P<0.05）；治疗3个月后，观察组患者的FBG水平及HOMA-IR均显著低于对照组，HOMA-β显著高于对照组（P<0.05）。治疗前2组患者的Scr、BUN水平及24 h尿蛋白定量比较差异无统计学意义（P>0.05）；2组患者治疗3个月后的Scr、BUN水平及24 h尿蛋白定量均显著低于治疗前（P<0.05）；治疗3个月后观察组患者的Scr、BUN水平及24 h尿蛋白定量均显著低于对照组（P<0.05）。治疗前2组患者的FMD及ET-1、NO水平比较差异无统计学意义（P>0.05）；治疗3个月后，2组患者的FMD及NO水平均显著高于治疗前，ET-1水平显著低于治疗前（P<0.05）；治疗3个月后，观察组患者的FMD及NO水平均显著高于对照组，ET-1水平显著低于对照组（P<0.05）。治疗期间，对照组和观察组患者不良反应发生率分别为13.33%（6/45）、8.89%（4/45），2组患者的不良反应发生率比较差异无统计学意义（χ2=0.450，P>0.05）。结论　达格列净联合二甲双胍治疗T2DN患者的疗效显著，有助于改善患者胰岛β细胞功能和血管内皮功能。
Abstract:
Objective　To investigate the clinical efficacy of dapagliflozin combined with metformin in the treatment of patients with type 2 diabetic nephropathy (T2DN).Methods　A total of 90 patients with T2DN admitted to the First People′s Hospital of Xinxiang City from January 2020 to February 2021 were selected as the research subjects.According to different treatment methods,the patients were divided into the control group and the observation group,with 45 cases in each group.The patients in the two groups received routine treatment,including health promotion and education of T2DN,diet control,exercise；the patients in the two groups were routinely given irbesartan tablets 150 mg,orally in the morning,once a day.On the basis of routine treatment,the patients in the control group were given oral metformin tablets 0.5 g by oral,three times a day;on the basis of the treatment of the control group,the patients in the observation group were given dapagliflozin tablets 10 mg,orally in the morning,once a day;the patients in the two groups received continuous treatment for three months.After three months of treatment,the clinical treatment effect of the patients in the two groups was evaluated,and the total effective rate was calculated.Before treatment and after three months of treatment,fasting blood glucose (FBG) levels of patients in the two groups were detected by blood glucose meter,fasting insulin (FINS) levels were determined by automatic biochemical analyzer,and the homeostasis model insulin resistance index (HOMA-IR) and islet β cell function index (HOMA-β) were calculated.Before treatment and after three months of treatment,the serum creatinine (Scr) and blood urea nitrogen (BUN) levels were measured by the automatic biochemical analyzer,and the 24-hour urine protein was determined by the biochemical analyzer.Before treatment and after three months of treatment,the endothelium-dependent diastolic function (FMD) of patients was measured by the acoustic imaging diagnostic device.The serum endothelin-1 (ET-1) level was determined by enzyme-linked immunosorbent assay,and the serum nitric oxide (NO) level was determined by reduction colorimetry.The occurrence of adverse reactions such as hypoglycemia,gastrointestinal reactions,dizziness and headache during the treatment period of patients in the two groups were recorded,and the incidence of adverse reactions was calculated.Results　After three months of treatment,the total effective rates of patients in the control group and the observation group were 73.33% (33/45) and 91.11% (41/45),respectively;the total effective rate of patients in the observation group was significantly higher than that in the control group (χ2 = 4.865,P<0.05).Before treatment,there was no significant difference in the levels of FBG,HOMA-IR and HOMA-β of patients between the two groups (P>0.05);the level of FBG and HOMA-IR of patients in the two groups after three months of treatment were significantly lower than those before treatment,HOMA-β was significantly higher than that before treatment (P<0.05);after three months of treatment,the FBG level and HOMA-IR of patients in the observation group were significantly lower than those in the control group,and HOMA-β was significantly higher than that in the control group (P<0.05).Before treatment,there was no significant difference in the levels of Scr,BUN and 24 h-urine protein of patients between the two groups (P>0.05);the levels of Scr,BUN and 24 h-urine protein of patients in the two groups after three months of treatment were significantly lower than those before treatment(P<0.05);after three months of treatment,the levels of Scr,BUN and 24-h urine protein of patients in the observation group were significantly lower than those in the control group (P<0.05).Before treatment,there was no significant difference in FMD and the levels of ET-1 and NO of patients between the two groups (P>0.05);the FMD and the level of NO of patients in the two groups after three months of treatment were significantly higher than those before treatment,the level of EF-1 of patients was significantly lower than that before treatment (P<0.05);after three months of treatment,the FMD and the levels of NO of patients in the observation group were significantly higher than those in the control group,and the level of ET-1 was significantly lower than that in the control group (P<0.05).During the treatment period,the incidence of adverse reaction of patients in the control group and observation group were 13.33% (6/45) and 8.89% (4/45),respectively;there was no significant difference in the incidence of adverse reaction of patients between the two groups (χ2=0.450,P>0.05).Conclusion　Dapagliflozin combined with metformin has a significant curative effect in the treatment of T2DN patients,which can improve the effect of pancreatic β-cell function and vascular endothelial function.

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更新日期/Last Update: 2022-04-05