目的: 观察达格列净联合胺碘酮治疗2型糖尿病（T2DM）合并阵发性心房颤动（PAF）患者的疗效及对左心房功能及左心耳容积的影响。方法: 选取2020年8月―2021年11月邢台市第三医院心内科收治的T2DM合并PAF患者94例为研究对象,随机分为对照组及观察组,各47例,对照组在患者基础疾病治疗后给予胺碘酮口服治疗,观察组在对照组治疗基础上给予达格列净口服治疗,两组均治疗6个月。观察两组患者治疗前、治疗3个月及治疗6个月后PAF发作次数、持续时间及平均心率变化情况;采用多普勒超声检查患者左心房前后径（LAD）、左心房舒张末期面积（LAEDA）、心房容量（AV）、左心房射血分数（LAEF）及左心耳舒张末期容积（LAAEDV）变化情况。结果: 经重复测量方差结果显示,观察组与对照组治疗前、治疗3个月、6个月,PAF发作次数、持续时间、平均心率、FPG、2hPG、HbA1c、LAD、LAEDA、AV、LAEF及LAAEDV组别与时间点的交互作用差异有统计学意义;与对照组比较,观察组患者治疗后PAF发作次数减少,PAF持续时间缩短,平均心率、FPG、2hPG、HbA1c水平降低,LAD缩短,LAEDA减少,AV及LAAEDV降低,LAEF升高;观察组临床疗效优于对照组,两组不良反应发生率无明显差异。结论: 达格列净联合胺碘酮治疗T2DM合并PAF具有良好的临床效果,其机制可能与进一步改善糖代谢,改善左心房结构与功能有关。
Abstract
Objective To observe the efficacy of Dapagliflozin combined with amiodarone in the treatment of patients with type 2 diabetes mellitus (T2DM) complicated with paroxysmal atrial fibrillation (PAF) and its effect on left atrial function and left atrial appendage volume. Methods 94 patients with T2DM complicated with PAF admitted to the Department of Cardiology of the third Xingtai hospital from August 2020 to November 2021 were selected as the research objects. They were randomly divided into control group and observation group, 47 cases in each group. The patients in the control group were treated with amiodarone orally after the treatment of basic diseases, and the patients in the observation group were treated with Dapagliflozin orally on the basis of the treatment of the control group. Both groups were treated for 6 months. The frequency of PAF, duration and average heart rate were observed before treatment, 3 months after treatment and 6 months after treatment; Doppler ultrasound was used to examine the changes of left atrial anteroposterior diameter (LAD), left atrial end diastolic area (LAEDA), atrial volume (AV), left atrial ejection fraction (LAEF) and left atrial appendage end diastolic volume (LAAEDV). Results The results of repeated measurement of variance showed that there were significant differences between the observation group and the control group in PAF attack frequency, duration, mean heart rate, FPG, 2hPG, HbA1c, LAD, LAEDA, AV, LAEF and LAAEDV at groups and time points before treatment, 3 months after treatment and 6 months after treatment; Compared with the control group, the number of PAF episodes, PAF duration, mean heart rate, FPG, 2hPG, HbA1c, LAD, LAEDA, AV and LAAEDV decreased, and LAEF increased in the observation group after treatment; The clinical efficacy of the observation group was better than that of the control group, and there was no significant difference in the incidence of adverse reactions between the two groups. Conclusion Dapagliflozin combined with amiodarone has a good clinical effect in the treatment of T2DM complicated with PAF. The mechanism may be related to the further improvement of glucose metabolism and the improvement of left atrial structure and function.
关键词
2型糖尿病 /
阵发性房颤 /
达格列净 /
胺碘酮 /
左房功能呢 /
左心耳容积
Key words
type 2 diabetes /
paroxysmal atrial fibrillation /
dapagliflozin /
amiodarone /
left atrial function /
left atrial appendage volume
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基金
邢台市重点研发计划自筹项目（NO.2021ZC109）
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