| Objective:Prospectively observe the use of sodium-glucose cotransporter 2 inhibitors combined with angiotensin receptor blockers in patients with type 2 diabetes and hypertension and SGLT-2 inhibitors combined with calcium channel blocker antihypertensive drugs in patients with changes in renal function,provide a theoretical basis for the clinical rational use of sodium-glucose cotransporter 2inhibitors.Method:A total of 92 patients with type 2 diabetes and hypertension in the endocrinology department of the First Affiliated Hospital of Nanchang University from July 2020 to March 2021 were selected.Randomly divided into SGLT2 inhibitors combined with ARB group of 46 cases,of which 13 cases were lost to follow-up,2 cases were withdrawn from the group due to ketosis,2 cases with urinary tract infection were withdrawn from the group,and 29 cases were finally completed;SGLT2 inhibitors combined with CCB antihypertensive drug group of 46 cases,10 cases were lost to follow-up,2 cases were withdrawn from the group due to ketosis,and 3 cases were withdrawn from urinary tract infection.Finally,31 cases were completed.Collect the general information of the two groups of research subjects including gender,age,height,diabetes course,BMI,weight,systolic blood pressure,diastolic blood pressure,fasting blood glucose,glycosylated hemoglobin,triglycerides,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,serum uric acid,urine albumin,blood creatinine,urea nitrogen,glomerular filtration rate.At the 4th,8th and 12th week after treatment,the blood pressure,weight,urine albumin,blood creatinine,blood uric acid,urea nitrogen,glomerular filtration rate of the two groups of patients were compared,The changes of renal function indexes and the occurrence of adverse reactions were also compared between the two groups.Results:1.The gender,age,height,diabetes course,BMI,weight,systolic blood pressure,diastolic blood pressure,fasting serum glucose,glycosylated hemoglobin,triglyceridesin,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprote cholesterol,urine albumin,serum uric acid,blood creatinine,urea nitrogen,and glomerular filtration rate of SGLT2 inhibitors combined with ARB drug group and of SGLT2 inhibitors combined with CCB drug group were no significant difference(P<0.05).2.The body weight of the SGLT2 inhibitors combined with ARB group after 3months of treatment was 64.68±6.84kg lower than 66.45±7.00kg before treatment(P<0.05),and after 3 months of treatment BMI was 23.59±2.32 kg/m~2 lower than24.23±2.35kg/m~2 before treatment(P<0.05)),systolic blood pressure,diastolic blood pressure and blood uric acid all decreased(P<0.05).The body weight of the SGLT2 inhibitors combined with CCB group after 3 months of treatment was65.85±6.40kg,which was lower than 67.71±6.69kg before treatment(P<0.05),and after 3 months of treatment,BMI was 23.24±2.47 kg/m~2 lower than 24.00±2.69 kg/m~2before treatment(P<0.05),Systolic blood pressure,diastolic blood pressure and blood uric acid all decreased(P<0.05).3.Compared with the baseline value of renal function before treatment,in the 4th week,8th week and 12th week after SGLT2 inhibitors combined with ARB treatment,Scr and BUN were not significantly increased(P>0.05),and eGFR was not Significantly decreased(P>0.05);4.Compared with the baseline value of renal function before treatment,in the 4th week,8th week and 12th week after SGLT2 inhibitors combined with CCB,Scr and BUN were not significantly increased(P>0.05),and eGFR was not Significantly decreased(P>0.05);5.There were no significant differences in Scr,BUN,and eGFR in the SGLT2inhibitors combined with ARB group and the SGLT2 inhibitors combined with CCB group at the 4th,8th,and 12th weeks after the treatment(P>0.05);6.Adverse reactions in the ARB group included 2 cases of ketosis and 2 cases of urinary tract infection.The adverse reactions in the CCB group included 2 cases of ketosis and 3 cases of urinary tract infection.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05);Conclusion:1.SGLT2 inhibitors can reduce weight,blood pressure,blood uric acid,blood lipids and urine albumin of patients with diabetes and hypertension;2.SGLT2 inhibitors combined with ARB drugs group and SGLT2 inhibitors combined with CCB drugs group did not see a decrease in eGFR in the early treatment period,and neither BUN nor Scr increased;3.There was no significant difference between the SGLT2 inhibitors combined with ARB drug group and the SGLT2 inhibitors combined with CCB drug group in the 4th,8th,and 12th weeks of treatment compared with eGFR,BUN,and Scr.SGLT2 inhibitors combined with ARB antihypertensive treatment does not increase the risk of early renal function decline. |
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