CAJ | 학술논문

目的观察磷酸肌酸钠对糖尿病合并心力衰竭老年患者的临床治疗效果.方法选取2009年2月至6月在四川省人民医院住院治疗的糖尿病合并心力衰竭(纽约心脏病学会心功能分级Ⅲ～Ⅳ级)老年患者60例,采用抽签法随机分为对照组(n=30)和治疗组(n=30).在维持血糖、血压、血脂达标的情况下,对照组给予常规抗心力衰竭治疗,包括一般治疗与药物治疗(利尿剂、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体阻滞剂、β-受体阻滞剂、正性肌力药、醛固酮受体拮抗剂等),治疗组在此基础上静脉滴注磷酸肌酸钠2.0 g,每日1次,共14 d.治疗前后留取空腹血液标本,检测血糖、胰岛素、C肽、糖化血红蛋白、血浆脑钠肽、腺苷酸激活蛋白激酶,借助心脏超声检查评价患者心功能.应用t检验进行数据分析.结果治疗后,2组患者心功能指标6 min步行试验、左心室射血分数、左心室缩短分数、E峰与A峰比值均显著改善,治疗组6 min步行试验[分别为(106±21)、(94±17)m]和E峰与A峰比值(分别为0.29 ±0.14、0.19±0.10)较对照组改善更好,差异有统计学意义(t值分别为2.776、3.099,均P＜0.05).治疗后,2组患者血浆脑钠肽、腺苷酸激活蛋白激酶、胰岛素抵抗及胰岛素敏感指数均显著改善,治疗组较对照组腺苷酸激活蛋白激酶[分别为(12±4)、(10±5)ng/L]和胰岛素抵抗(分别为1.7±0.9、0.9±0.4)改善更好,差异有统计学意义(t值分别为2.586、4.258,均P＜0.05).结论磷酸肌酸钠可显著增强糖尿病合并心力衰竭老年患者心肌能量代谢,纠正胰岛素抵抗,调整心肌舒张功能,进而改善患者的临床症状及预后.
목적 관찰린산기산납대당뇨병합병심력쇠갈노년환자적림상치료효과.방법 선취2009년2월지6월재사천성인민의원주원치료적당뇨병합병심력쇠갈(뉴약심장병학회심공능분급Ⅲ～Ⅳ급)노년환자60례,채용추첨법수궤분위대조조(n=30)화치료조(n=30).재유지혈당、혈압、혈지체표적정황하,대조조급여상규항심력쇠갈치료,포괄일반치료여약물치료(이뇨제、혈관긴장소전환매억제제、혈관긴장소Ⅱ수체조체제、β-수체조체제、정성기력약、철고동수체길항제등),치료조재차기출상정맥적주린산기산납2.0 g,매일1차,공14 d.치료전후류취공복혈액표본,검측혈당、이도소、C태、당화혈홍단백、혈장뇌납태、선감산격활단백격매,차조심장초성검사평개환자심공능.응용t검험진행수거분석.결과 치료후,2조환자심공능지표6 min보행시험、좌심실사혈분수、좌심실축단분수、E봉여A봉비치균현저개선,치료조6 min보행시험[분별위(106±21)、(94±17)m]화E봉여A봉비치(분별위0.29 ±0.14、0.19±0.10)교대조조개선경호,차이유통계학의의(t치분별위2.776、3.099,균P＜0.05).치료후,2조환자혈장뇌납태、선감산격활단백격매、이도소저항급이도소민감지수균현저개선,치료조교대조조선감산격활단백격매[분별위(12±4)、(10±5)ng/L]화이도소저항(분별위1.7±0.9、0.9±0.4)개선경호,차이유통계학의의(t치분별위2.586、4.258,균P＜0.05).결론 린산기산납가현저증강당뇨병합병심력쇠갈노년환자심기능량대사,규정이도소저항,조정심기서장공능,진이개선환자적림상증상급예후.
Objective To observe the effectiveness of creatine phosphate (CP) in the elderly diabetic patients combined with heart failure (HF). Methods Sixty elderly diabetic patients combined with HF ( NYHA Ⅲ to Ⅳ grade) were enrolled in Sichuan Provincial People's Hospital from February to June in 2009, and adopting sortition was randomly assigned to the control group ( n = 30) and the treatment group (n = 30). In keeping glucose, blood pressure and lipid to reach purpose, subjects of the control group received routine treatment, including general treatment and medication such as diuretic, angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor blocker, beta-receptor blocker, positive inotropic, and aldosterone receptor antagonist. Those of the treatment group additionally had 2.0 g CP once per day.Glucose, insulin, C-peptide, glycosylated hemoglobin, plasma brain natriuretic peptide (BNP), AMP-activated protein kinase (AMPK) were tested before and after the intervention. t test was used for data analysis. Results After the intervention, 6-minute walking test (6MWT), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS) and E peak and A peak ratio (E/A ratio) were significantly improved in both groups ( t values were 2.776 and 3.099, both P ＜ 0.05 ). After the intervention, BNP, AMPK, insulin resistance (IR) and insulin sensitivity index were significantly improved in both groups. AMPK ((12±4) vs (10±5) ng/L) and IR (1.7±0.9 vs 0.9 ±0.4) were found to be significantly different between the treatment group and the control group ( t values were 2. 586 and 4.258,both P ＜ 0.05). Conclusion CP may be able to significantly improve myocardium energy metabolism,correct insulin resistance and regulate myocardial relaxation function, so as to improv clinical symptom and prognosis of elderly diabetic patients combined with HF.