李鵬飛 冷飛

[摘要]目的 探討達格列凈治療急性心肌梗死合并應激性高血糖的效果。方法 選取2017年1月～2019年12月我院心內科收治的66例急性心肌梗死合并應激性高血糖患者作為研究對象，按照隨機數(shù)字表法將其分為D組（30例）和I組（36例）。D組給予達格列凈，I組給予胰島素降糖。比較兩組患者的血糖、心功能等指標。結果 兩組患者治療1、6周后的空腹血糖（FBG）及餐后2小時血糖（2 h PBG）均低于治療前，差異有統(tǒng)計學意義（P<0.05）。治療1周后，D組患者的FBG、2 h PBG水平低于I組，差異有統(tǒng)計學意義（P<0.05）。治療6周后，D組患者的左室射血分數(shù)（LVEF）高于I組，體重指數(shù)（BMI）低于I組，差異有統(tǒng)計學意義（P<0.05）。兩組患者的低血糖發(fā)生率比較，差異無統(tǒng)計學意義（P>0.05）。結論 達格列凈治療急性心肌梗死患者合并應激性高血糖的效果確切，并能夠有效提升心功能，安全性良好。

[關鍵詞]急性心肌梗死;應激性高血糖;達格列凈

[中圖分類號] R542.2? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 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.

達格列凈一方面能夠通過促進尿鈉排泄、滲透性利尿、改善心臟前負荷[16]，增強心肌收縮能力，進而提高心功能，改善急性心肌梗死預后;另一方面可通過減少心肌膜活性中心Na+/H+交換泵提升線粒體內鈣離子水平[17]，發(fā)揮正性肌力作用;除此之外，SGLT-2i的減重受益亦能夠一定程度上減輕心肌耗氧，有利于心功能的恢復。本研究結果顯示，治療6周后，D組患者的LVEF高于I組，BMI低于I組，差異有統(tǒng)計學意義（P<0.05）。D組治療6周后LVEF的提升，也明確了達格列凈具有降糖功能以外，還具有改善急性心肌梗死患者心臟預后的療效。不良反應方面，達格列凈的副作用較小，本研究結果顯示，兩組患者的低血糖發(fā)生率比較，差異無統(tǒng)計學意義（P>0.05）。D組僅出現(xiàn)低血糖1例，且與主食量不足有關，印證了達格列凈的安全性。

綜上所述，達格列凈治療急性心肌梗死合并應激性高血糖見效快而且控糖平穩(wěn)，長期應用能夠有效提升患者的心功能，改善急性心肌梗死患者的預后，安全性較好。

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（收稿日期：2019-07-12）