摘要
目的探讨西格列汀联合达比加群酯对冠状动脉旁路移植术后2型糖尿病患者疗效及预后的影响。方法选取就诊的冠状动脉旁路移植术后2型糖尿病患者60例,采用随机、平行对照法分为西格列汀组(A组)、西格列汀+阿司匹林联合用药组(B组)、西格列汀+达比加群酯联合用药组(C组),每组20例。监测3组患者治疗前后空腹血糖水平(FPG)、餐后2 h血糖水平(2hFPG)、糖化血红蛋白(HbA1c)、D二聚体(D-D)之间的水平,ELISA酶联免疫吸附试验法测定内皮素转换酶(ECE)的活性,观察3组患者药物安全性及出院后2周生活质量指标的差异。结果 3组患者治疗后FPG、2hFPG及HbA1c水平较治疗前均明显下降(P<0.05),但组间差异无统计学意义(P>0.05);B组血清D-D、ECE水平与A组比较差异有统计学意义(P<0.05);C组血清D-D、ECE水平与A组比较差异有统计学意义(P<0.01);且B、C组患者患者预后生活质量高于A组。B、C组血清D-D、ECE水平相比较差异有统计学意义(P<0.01);C组患者住院患者预后生活质量评分较B组高,差异有统计学意义(P<0.05);3组患者治疗期间无药物不良反应发生。结论西格列汀联合达比加群酯对冠状动脉旁路移植术后2型糖尿病患者不仅具有较好降糖作用且能改善血管凝血状态,预防体循环栓塞的形成,保护血管内皮细胞,药物安全性高,患者预后生活质量良好,对冠状动脉粥样硬化性心脏病的二级预防起了重要作用,为临床治疗冠状动脉旁路移植术后2型糖尿病患者提供循证医学依据。
Objective To investigae the clinical efficacy and prognosis of sitagliptin combined with dabigatran ester in treatment of 2 diabetes mellitus after coronary artery bypass grafting. Methods Sixty patients with type 2 diabetes mellitus who underwent coronary artery bypass grafting in our hospital were randomly divided into three groups： sitagliptin group（ group A）,sitagliptin ＋ aspirin group（ group B）,sitagliptin ＋ dabigatran ester（ group C）,with 20 patients in each group. after treatment the levels of fasting blood glucose（ FPG）,postprandial 2 h blood glucose（ 2hFPG）,glycosylated protein glucose（ HbA1c）,D-dimer（ D-D）,the activity of endothelin-converting enzyme（ ECE） were detected by enzyme-linked immunosorbent assay（ ELISA）,moreover,the drug safety and life quality of patients at 2 weeks after discharging from hospital were observed and compared among the three groups. Results After treatment,the levels of FPG,2hFPG and glycosylated hemoglobin were decreased,but there were no significant differences among the three groups（ P〉0. 05）. There were significant differences in the serum levels of D-D and ECE between group A and group B,between group A and group C and between group B and group C（ P〈0. 05）. Moreover the life quality of patients in group B and group C was higher than that in group A,moreover,which in group C was higher than that in group B,however there was no significant difference between the two groups（ P〈0. 05）. In addition no adverse drug reactions were found during treatment in the three groups. Conclusion The combination application of sitagliptin with dabigatran ester has not only hypoglycemic effects,but also can improve clotting status of blood vessel in patients with type 2 diabetes mellitus after coronary artery bypass grafting,which can also prevent systemic circulation embolization,protect vascular endothelial cells,with high drug safety,good prognosis and life quality of patients,therefor,which plays an important role in the secondary prevention of coronary heart disease and provides evidencebased medicine basis for clinical treatment of type 2 diabetes mellitus after coronary artery bypass grafting.
作者
方晓琳
FANG Xiaolin(Department of Endocrinology, The General Hospital of CNPC in Jilin,Jilin,Jilin 132021, Chin)
出处
《河北医药》
CAS
2018年第16期2492-2494,2498,共4页
Hebei Medical Journal
