马椿乔

[摘要]目的探討恩格列净联合二甲双胍治疗老年2型糖尿病的临床效果及对糖脂代谢的影响。方法选取 2018年1月至2020年1月在厦门市第五医院诊治的92例老年2型糖尿病患者为研究对象，按照随机抽签的方式分为研究组和对照组，每组各46例。两组患者入院后均给予健康宣教，同时严格进行饮食控制和运动指导。对照组患者口服盐酸二甲双胍缓释片，研究组在口服二甲双胍缓释片的同时于清晨空腹加用恩格列净片。连续用药6个月后，比较两组患者治疗前后的糖代谢指标[空腹血糖（FBG）、餐后2 h 血糖（2 hPG）和糖化血红蛋白（HbAlc）]、脂代谢指标[三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）]水平、胰岛功能指标[空腹胰岛素（FINS）、胰岛素分泌指数（HOMA-β）]水平、体重指数（BMI）、不良反应发生情况及年用药经济分析。结果治疗后，研究组患者的FBG、2 hPG和HbAlc均低于对照组，差异有统计学意义（ P <0.05）;研究组患者的 TC、TG、LDL-C 水平均低于对照组，HDL-C 水平高于对照组，差异有统计学意义（P <0.05）;研究组患者 FINS、HOMA-β水平均高于对照组，差异有统计学意义（P <0.05）;研究组患者 BMI 低于对照组，差异有统计学意义（ P <0.05）;两组不良反应发生率比较差异无统计学意义（χ2=0.123，P=0.726）;研究组的日均费用、年均费用以及无并发症时的年状态总成本高于对照组，差异有统计学意义（ P <0.05），但在有并发症的情况下两组年状态总成本差异无统计学意义（ P >0.05）。结论恩格列净联合二甲双胍能有效改善老年2型糖尿病患者糖脂代谢，改善胰岛功能，且安全性较高，联合用药有明显的效果-成本优势。

[关键词]恩格列净;老年;2型糖尿病;糖代谢;脂代谢

[中图分类号] R587.2  [文献标识码] A   [文章编号]2095-0616（2021）24-0200-05

Clinical effect of empagliflozin combined with metformin in the treatment of elderly type 2 diabetes and its influence on metabolic status

MA  Chunqiao

Department of Pharmacy， Xiamen Fifth Hospital，Fujian， Xiamen 361101， China

[Abstract] Objective To investigate the clinical effect of enpagliflozin combined with metformin in the treatment of elderly type 2 diabetes and its influence on glucose and lipid metabolism. Methods A total of 92 elderly patients with type 2 diabetes who were diagnosed and treated in Xiamen Fifth Hospital from January 2018 to January 2020 were selected as the research objects.They were divided into the study group and the control group according to a random lottery method， with 46 cases in each group. After admission， both groups of patients were given health education and strict diet control and exercise guidance. The patients in the control group took metformin hydrochloride sustained- release tablets orally，and the study group received enpagliflozin tablets on an empty stomach early in the morning while taking metformin hydrochloride sustained-release tablets. After 6 months of continuous medication， the glucose metabolism indexes （fasting blood glucose [FBG]， postprandial 2 h blood glucose [2 hPG]and glycosylated hemoglobin [HbAlc]），lipid metabolism indexes （triacylglycerol [TG]， Total cholesterol [TC]，low-density lipoprotein cholesterol [LDL-C] and high-density lipoprotein cholesterol [HDL-C]） levels，islet function indicators （fasting insulin [FINS]， insulin secretion index [HOMA-β]） levels，Body mass index （BMI）， adverse reactions and economic analysis of annual medication. Results After treatment， the FBG， 2 hPG， and HbAlc of the study group were lower than those of the control group， and the difference was statistically significant （ P <0.05）. The TC， TG， and LDL-C levels of the study group were lower than those of the control group. The level of HDL-C was higher than that of the control group， and the difference was statistically significant （ P <0.05）. The levels of FINS and HOMA-β in the study group werehigher than those of the control group， and the difference was statistically significant （ P <0.05）. The BMI of the study group was lower than that of the control group， and the difference was statistically significant （ P <0.05）. The difference in the incidence of adverse reactions between the two groups was not statistically significant （χ2=0.123， P=0.726）. The study group The average daily cost， average annual cost， and total cost without complications were higher than those in the control group， and the difference was statistically significant （ P <0.05）， but there was no difference in the total annual cost of the two groups with complications statistically significant （ P >0.05）. Conclusion Enpagliflozin combined with metformin can effectively improve glucose and lipid metabolism in elderly patients with type 2 diabetes，improve islet function，and has high safety. The combination of drugs has obvious effects- cost advantages.

[Key words] Empagliflozin; Elderly; Type 2 diabetes mellitus; Glucose metabolism; Lipid metabolism

糖尿病是临床上常见的一种血糖代谢紊乱性疾病，其中以2型糖尿病最为多见，占成年人糖尿病的90%以上[1]。据统计，我国糖尿病患者截至2017年已超过1.1亿，预计到2030年，我国糖尿病患者将高达5.5亿[2-3]。在成人2型糖尿病患者中，老年人群患病率占比高达20%，隨着人口老龄化的不断加剧，这一数据将呈现持续增高趋势[4]。……