达格列净治疗急性心肌梗死合并应激性高血糖的效果

李鹏飞 冷飞

[摘要]目的 探討达格列净治疗急性心肌梗死合并应激性高血糖的效果。方法 选取2017年1月～2019年12月我院心内科收治的66例急性心肌梗死合并应激性高血糖患者作为研究对象，按照随机数字表法将其分为D组（30例）和I组（36例）。D组给予达格列净，I组给予胰岛素降糖。比较两组患者的血糖、心功能等指标。结果 两组患者治疗1、6周后的空腹血糖（FBG）及餐后2小时血糖（2 h PBG）均低于治疗前，差异有统计学意义（P<0.05）。治疗1周后，D组患者的FBG、2 h PBG水平低于I组，差异有统计学意义（P<0.05）。治疗6周后，D组患者的左室射血分数（LVEF）高于I组，体重指数（BMI）低于I组，差异有统计学意义（P<0.05）。两组患者的低血糖发生率比较，差异无统计学意义（P>0.05）。结论 达格列净治疗急性心肌梗死患者合并应激性高血糖的效果确切，并能够有效提升心功能，安全性良好。

[关键词]急性心肌梗死;应激性高血糖;达格列净

[中图分类号] R542.2          [文献标识码] A          [文章编号] 1674-4721（2020）7（b）-0065-04

Effect of Dapagliflozin in the treatment of acute myocardial infarction with stress hyperglycemia

LI Peng-fei1   LENG Fei2

1. Department of Internal Medicine Cardiovascular， Central Hospital of Huludao City， Liaoning Province， Huludao   125001， China; 2. Department of Endocrinology， Central Hospital of Huludao City， Liaoning Province， Huludao   125001， China

[Abstract] Objective To investigate the effect of Dapagliflozin in the treatment of acute myocardial infarction with stress hyperglycemia. Methods From January 2017 to December 2019， 66 patients with acute myocardial infarction and stress hyperglycemia who were hospitalized in the department of internal medicine cardiovascular of our hospital were selected as the research objects. They were divided into group D （30 cases） and group I （36 cases） according to the random number table method. Patients in group D were given Dapagliflozin， and group I was given Insulin. The blood glucose， cardiac function and other indicators were compared between the two groups. Results Fasting blood glucose （FBG） and blood glucose （2 h PBG） at 1 and 6 weeks after treatment were both lower in the two groups than those before treatment， with statistically significant differences （P<0.05）. After 1 week of treatment， the levels of FBG and 2 h PBG in group D were lower than those in group I， with statistically significant differences （P<0.05）. After 6 weeks of treatment， the left ventricular ejection fraction （LVEF） of group D was higher than that of group I， and the body mass index （BMI） was lower than that of group I， with statistically significant differences （P<0.05）. The incidence of hypoglycemia between the two groups was not statistically significant （P>0.05）. Conclusion Dapagliflozin is effective in treating patients with acute myocardial infarction combined with stress hyperglycemia， and can effectively improve cardiac function with good safety.

达格列净一方面能够通过促进尿钠排泄、渗透性利尿、改善心脏前负荷[16]，增强心肌收缩能力，进而提高心功能，改善急性心肌梗死预后;另一方面可通过减少心肌膜活性中心Na+/H+交换泵提升线粒体内钙离子水平[17]，发挥正性肌力作用;除此之外，SGLT-2i的减重受益亦能够一定程度上减轻心肌耗氧，有利于心功能的恢复。本研究结果显示，治疗6周后，D组患者的LVEF高于I组，BMI低于I组，差异有统计学意义（P<0.05）。D组治疗6周后LVEF的提升，也明确了达格列净具有降糖功能以外，还具有改善急性心肌梗死患者心脏预后的疗效。不良反应方面，达格列净的副作用较小，本研究结果显示，两组患者的低血糖发生率比较，差异无统计学意义（P>0.05）。D组仅出现低血糖1例，且与主食量不足有关，印证了达格列净的安全性。

综上所述，达格列净治疗急性心肌梗死合并应激性高血糖见效快而且控糖平稳，长期应用能够有效提升患者的心功能，改善急性心肌梗死患者的预后，安全性较好。

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（收稿日期：2019-07-12）