| 冯亮,张丛良,王贵芝,等.达格列净对 2型糖尿病合并心肌梗死病人心肌微灌注的影响及与新发心房颤动相关性分析[J].安徽医药,2025,29(11):2325-2329. |
| 达格列净对 2型糖尿病合并心肌梗死病人心肌微灌注的影响及与新发心房颤动相关性分析 |
| Effect of dapagliflozin on myocardial microperfusion in patients with type 2 diabetes mellitus and myocardial infarction and its association with new-onset atrial fibrillation |
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| DOI：10.3969/j.issn.1009-6469.2025.11.045 |
| 中文关键词: 糖尿病， 2型 达格列净 糖尿病并发症 心肌梗死 心肌微灌注 新发心房颤动 |
| 英文关键词: Diabetes mellitus, type 2 Dapagliflozin Diabetes complications Myocardial infarction Myocardial microperfu-sion New onset atrial fibrillation |
| 基金项目: |
| 作者 | 单位 | | 冯亮 | 保定市第一中心医院心内四科,河北保定,071000 | | 张丛良 | 曲阳县第一医院心内科,河北保定 073100 | | 王贵芝 | 保定市妇幼保健院高危产科,河北保定 071000 | | 姚海珍 | 保定市第一中心医院心内四科,河北保定,071000 | | 张潮 | 定兴县医院心内科,河北保定 072650 | | 刘欣 | 保定市第一中心医院心内四科,河北保定,071000 | | 刘芳 | 保定市第一中心医院心内四科,河北保定,071000 |
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| 中文摘要: |
| 目的探究达格列净对 2型糖尿病合并心肌梗死病人心肌微灌注的影响及与新发心房颤动相关性分析。方法回顾性收集 2021年 3月至 2023年 1月保定市第一中心医院诊治的 196例 2型糖尿病合并心肌梗死病人临床资料，根据是否服用达格列净将病人分为服用组( n=106)和未服用组( n=90)。比较两组治疗前后心肌微灌注情况［校正心肌梗死溶栓试验血流帧数(CTFC)和心肌梗死溶栓试验心肌灌注分级( TMPG)］根据是否存在新发心房颤动将研究对象分为发生组( n=52)和未发生组(n=144)，采用独立样本 t检验比较两组年龄、身体质量指，数( BMI)、糖化血红蛋白( HbA1c)、高密度脂蛋白胆固醇( HDL-C)、总胆固醇(TC)、甘油三酯( TG)、低密度脂蛋白胆固醇( LDL-C)水平，采用 χ2检验比较两组吸烟、饮酒、合并高血压、使用胰岛素、服用达格列净和发生新发心房颤动占比差异，采用二元 logistic回归分析探索影响新发心房颤动的因素。结果治疗后，两组 CTFC、TMPG等心肌微灌注值均较治疗前降低，且治疗后服用组 CTFC［( 33.34±1.26)帧比( 44.40±1.52)帧］、 TMPG［( 97.90±1.90)帧比(103.43±2.15)帧］低于未服用组( P<0.05)。单因素分析结果显示，发生组与未发生组病人的 BMI及血清中 TC、TG、 LDL-C水平差异无统计学意义( P>0.05)，然而两组之间年龄及 HbA1c、HDL-C水平差异有统计学意义( P<0.05)。另外，发生组与未发生组在性别、是否合并高血压方面差异无统计学意义(P>0.05)，但两组在吸烟、饮酒、使用胰岛素、服用达格列净方面差异有统计学意义( P<0.05)。 logistic回归分析显示年龄大(OR=1.14)、低 HDL-C(OR=0.02)、饮酒( OR=0.04)、未使用胰岛素( OR= 23.39)及未服用达格列净( OR=6.53)是影响 2型糖尿病合并心肌梗死病人新发心房颤动的独立危险因素( P<0.05)。结论达格列净有助于改善 2型糖尿病合并心肌梗死病人的心肌微灌注，年龄大、低 HDL-C水平、饮酒、未使用胰岛素、未服用达格列净是影响该病人群体新发心房颤动的独立危险因素。 |
| 英文摘要: |
| Objective To investigate the effect of dapagliflozin on myocardial microperfusion in patients with type 2 diabetes mellitusand myocardial infarction and its association with new-onset atrial fibrillation.Methods Clinical data of 196 patients with type 2 dia-betes mellitus and myocardial infarction treated at Baoding First Central Hospital from March 2021 to January 2023 were retrospective-ly collected. Patients were divided into the dapagliflozin group (n=106) and the control group (n=90) based on dapagliflozin use. Myo-cardial microperfusion parameters before and after treatment [corrected Thrombolysis in Myocardial Infarction (TIMI) frame count (CT-FC) and TIMI myocardial perfusion grade (TMPG)] were compared between the two groups. Patients were categorized into atrial fibrilla-tion group (n=52) and a non-atrial fibrillation group (n=144) based on the development of new-onset atrial fibrillation. Independent sam-ple t-test was used to compare age, body mass index (BMI), hemoglobin A1c (HbA1c), high-density lipoprotein cholesterol (HDL-C), to-tal cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) between groups. Chi-square test was used to compare differences in smoking, alcohol consumption, hypertension comorbidity, insulin use, dapagliflozin use and incidence of new-onset atrial fibrillation. Binary logistic regression analysis was used to identify factors associated with new-onset atrial fibrillation.Re. sults After treatment, both groups showed significant improvements in myocardial microperfusion parameters (CTFC and TMPG) com-pared to pre-treatment levels. The dapagliflozin group demonstrated significantly lower post-treatment CTFC [(33.34±1.26) frames vs. (44.40±1.52) frames] and TMPG [(97.90±1.90) frames vs. (103.43±2.15) frames] compared to the control group (P<0.05). Univariate analysis revealed no significant differences in BMI, TC, TG or LDL-C levels between the atrial fibrillation and non-atrial fibrillation groups (P>0.05), but significant differences in age, HbA1c and HDL-C levels (P<0.05). No significant differences were found in gender or hypertension comorbidity between groups (P>0.05), but significant differences existed in smoking, alcohol consumption, insulin use, and taking dapagliflozin (P<0.05). Logistic regression analysis identified advanced age (OR=1.14), low HDL-C(OR=0.02), alcohol con-sumption (OR=0.04), non-use of insulin (OR=23.39), and non-use of dapagliflozin (OR=6.53) as independent risk factors for new-onset atrial fibrillation in patients with type 2 diabetes mellitus and myocardial infarction (P<0.05).Conclusions Dapagliflozin helps im-prove myocardial microperfusion and myocardial infarction in patients with type 2 diabetes mellitus and myocardial infarction. Ad-vanced age, low HDL-C level, alcohol consumption, non-use of insulin, and non-use of dapagliflozin are independent risk factors for new-onset atrial fibrillation in this patient population. |
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