作者：杨璨，白龙，杨晓红

单位：

河北医科大学第二医院心内科

Units：

DepartmentofCardiology,theSecondHospitalofHebeiMedicalUniversity,Shijiazhuang050000,China

关键词：

冠心病; 糖尿病,2型; 造影剂肾病; 达格列净;

Keywords：

Coronarydisease;Diabetesmellitus,type2;Contrast-inducednephropathy;Dapagliflozin

CLC：

R541.4R587.1

DOI：

10.12114/j.issn.1008-5971.2022.00.315

Funds：

河北医科大学第二医院科学研究( 2020-R403)

摘要：

目的 探讨达格列净对冠心病合并2型糖尿病患者PCI后肾功能及造影剂肾病（CIN）的影响。方法选取2021年于河北医科大学第二医院心内科行择期PCI的冠心病合并2型糖尿病患者59例，按照随机数字表法将患者分为研究组（n=36）和对照组（n=23）。研究组采用标准冠心病治疗方案联合达格列净治疗，对照组采用标准冠心病治疗方案联合阿卡波糖治疗。比较两组术后48 h CIN发生率、基线资料、术前和术后48 h肾功能指标[血肌酐（Scr）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、胱抑素C(Cys-C)、估算肾小球滤过率（eGFR）]。采用多因素Logistic回归分析探讨达格列净对冠心病合并2型糖尿病患者PCI后发生CIN的影响。观察患者住院期间严重不良事件、达格列净或阿卡波糖相关不良反应、急性肾损伤发生情况。结果 研究组CIN发生率为5.6%(2/36)，对照组CIN发生率为13.0%(3/23)。两组CIN发生率比较，差异无统计学意义（P>0.05）。两组术后48 h Scr、NGAL、Cys-C分别高于本组术前，eGFR分别低于本组术前，且研究组术前与术后48 h Scr、NGAL、Cys-C、eGFR的差值小于对照组（P<0.05）。多因素Logistic回归分析结果显示，使用达格列净不是冠心病合并2型糖尿病患者PCI后发生CIN的影响因素（P>0.05）。所有患者住院期间无严重不良事件发生。所有患者未出现达格列净或阿卡波糖相关不良反应及急性肾损伤。结论 达格列净对冠心病合并2型糖尿病患者肾功能的改善作用优于阿卡波糖，但其不是患者PCI后发生CIN的影响因素。

Abstract：

ObjectiveToinvestigatetheeffectofdapagliflozinonrenalfunctionandcontrast-inducednephropathy(CIN)inpatientswithcoronaryheartdiseasecomplicatedwithtype2diabetesmellitusafterPCI.MethodsAtotalof59patientswithcoronaryheartdiseasecomplicatedwithtype2diabetesmellitusundergoingelectivePCIintheDepartmentofCardiologyoftheSecondHospitalofHebeiMedicalUniversityin2021wereselectedanddividedintostudygroup(n=36)andcontrolgroup(n=23)accordingtotherandomnumbertablemethod.Thestudygroupreceivedstandardcoronaryheartdiseaseregimencombinedwithdapagliflozin,whilethecontrolgroupreceivedstandardcoronaryheartdiseaseregimencombinedwithacarbose.TheincidenceofCINat48hafteroperation,baselinedata,renalfunctionindicators[serumcreatinine(Scr),neutrophilgelatinase-associatedlipocalin(NGAL),cystatinC(Cys-C),estimatedglomerularfiltrationrate(eGFR)]beforeoperationand48hafteroperationwerecomparedbetweenthetwogroups.MultivariateLogisticregressionanalysiswasusedtoinvestigatetheeffectofdapagliflozinonCINinpatientswithcoronaryheartdiseasecomplicatedwithtype2diabetesmellitusafterPCI.Seriousadverseevents,adversereactionsrelatedtodagliazineoracarbose,andacutekidneyinjurywereobservedduringhospitalization.ResultsTheincidenceofCINwas5.6%(2/36)inthestudygroupand13.0%(3/23)inthecontrolgroup.TherewasnosignificantdifferenceintheincidenceofCINbetweenthetwogroups(P>0.05).TheScr,NGALandCys-Cofthetwogroupsat48hafteroperationwerehigherthanthosebeforeoperation,andtheeGFRofthetwogroupswaslowerthanthatbeforeoperation,respectively(P<0.05).ThedifferenceofScr,NGAL,Cys-CandeGFRbeforeoperationand48hafteroperationofthestudygroupwaslowerthanthatofthecontrolgroup(P<0.05).MultivariateLogisticregressionanalysisshowedthatdapagliflozinwasnottheinfluencingfactorofCINinpatientswithcoronaryheartdiseasecomplicatedwithtype2diabetesmellitusafterPCI(P>0.05).Noseriousadverseeventsoccurredinallpatientsduringhospitalization.Nodagliazineoracarboserelatedadversereactionsoracutekidneyinjuryoccurredinallpatients.ConclusionTheimprovementeffectofdagliazineonrenalfunctioninpatientswithcoronaryheartdiseasecomplicatedwithtype2diabetesmellitusisbetterthanacarbose,butitisnottheinfluencingfactorofCINinpatientsafterPCI.

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