Objective  To observe the clinical effect of dagglizin combined with metoprolol on patients with type 2 diabetes mellitus (T2DM) complicated with paroxysmal atrial fibrillation (PAF) and its effect on P wave dispersion and atrial electrophysiological parameters.

Methods  90 patients with T2DM and PAF were randomly divided into control group and observation group, with 45 cases in each group. Patients in the control group were given oral metoprolol after treatment of basic diseases, and patients in the observation group were given oral dagglizin on the basis of the control group. Both groups were treated for 6 months. The number of PAF episodes, duration, average heart rate, fasting blood glucose (FPG), postprandial 2h blood glucose (2hPG), glycosylated hemoglobin (HbA1c), as well as the longest P wave, shortest P wave, P wave dispersion, atrial electrophysiological parameters (atrial relative refractory period, atrial effective refractory period) and other indicators were observed before and after treatment in the two groups, and the clinical efficacy, total effective rate, and adverse drug reactions of PAF in the two groups were compared.

Results  There was no significant difference in the total effective rate between the two groups (P>0.05), but the clinical efficacy of the observation group was better than that of the control group (P<0.01). After treatment, the number of PAF ep-isodes in both groups decreased compared to the previous period (P<0.01), the duration of PAF, the longest P wave, the shortest P wave, and the dispersion of P wave were shortened compared to the previous period (P<0.05), the average heart rate and the levels of FPG, 2hPG, and HbA1c were de-creased compared to the previous period (P<0.01), and the relative and effective atrial refractory periods were prolonged compared to the previous period (P<0.01). Except for the shortest P wave, the above indicators in the observation group were significantly better than those in the control group (P<0.05). The adverse reactions in both groups were slight, with no statistically significant difference (P>0.05).

Conclusion  Dagglizin combined with metoprolol can improve the clinical symptoms of T2DM patients with PAF. The mechanism may be related to the improvement of P wave dispersion and atrial electrophysiological parameters.

1.Mantovani A, Rigolon R, Civettini A, et al. Hyperuricemia is associated with an increased prevalence of paroxysmal atrial fibrillation in patients with type 2 diabetes referred for clinically indicated 24-h holter monitoring[J]. J Endocrinol Invest, 2018, 41(2): 223-231. DOI: 10. 1007/ s40618-017-0727-4.

2.姜嫄, 杨文娟. 达格列净对老年2型糖尿病肾病患者肾功能及血管内皮因子的影响观察[J]. 中国药师, 2022, 25(6): 1032-1036. [Jiang Y, Yang WJ. Effects of dapagliflozin on renal function and vascular endothelial factor in elderly patients with type 2 diabetic nephropathy[J]. China Pharmacist, 2022, 25(6): 1032-1036.] DOI: 10.19962/j.cnki.issn1008-049X.2022.06.017.

3.De With RR, Erkuner O, Rienstra M, et al. Temporal patterns and short-term progression of paroxys-mal srtial fibrillation：date from RACEV[J]. Europace, 2020, 22(8): 1162-1172. DOI: 10. 1093/europace/ euaa123.

4.麻友键. P波离散度对孤立性阵发性房颤发生的预测价值[J]. 临床医学研究与实践, 2018, 3(6): 1-3. [Ma YJ. The value of P-wave dispersion for prediction of lone paroxysmal atrial fibrillation[J]. Clin Med Res and Pract, 2018, 3(6): 1-3.] DOI: 10.19347/j.cnki.2096-1413.201806001.

5.Chan YH, Chen SW, Chao TF, et al. The impact of weight loss related to risk of new-onset atrial fibril-lation in patients with type 2 diabetes mellitus treated with sodium-glucose cotransporter 2 inhibi-tor[J]. Cardiovasc Diabetol, 2021, 20(1): 93-106. DOI:  10.1186/s12933-021-01285-8.

6.林小凤. 美托洛尔联合厄贝沙坦治疗老年阵发性心房颤动的疗效[J]. 心血管康复医学杂志, 2016, 25(3): 305-308. [Lin XF. Therapeutic effect of metoprolol combined irbesartan on aged patients with paraxysmal atrial fibrillation[J]. Chinese Journal of Cardiovascular Rehabilitation Medicine, 2016, 25(3): 305-308. ] DOI: 10.3969/j.issn.1008-0074.2016.03.21.

7.中华医学会糖尿病学分会, 国家基层糖尿病防治管理办公室. 国家基层糖尿病防治管理指南(2018)[J]. 中华内科杂志, 2018, 57(12): 885-893. DOI: 10.3760/cma.j.issn.0578-1426.2018.12.003.

8.黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗建议-2015[J]. 中国心脏起搏与电生理杂志, 2015, 29(5): 377-434. [Huang CX, Zhang S, Huang DJ, et al. Atrial fibrillation: current understanding and treatment recommendations - 2015[J]. Chinese Journal of Cardiac Pacing and Electrophysiology, 2015, 29(5): 377-434.] DOI: 10.13333/j.cnki.cjcpe.2015.05.001.

9.石铭宇, 滕世超, 姜丽, 等. 阿托伐他汀对犬心房及肺静脉电活动的影响[J]. 心脏杂志, 2016, 28(2): 157-159. [Shi MY, Teng SC, Jiang L, et al. Effects of atorvastatin on atrial and pulmonary vein electrical activity[J]. Chinese Heart Journal, 2016, 28(2): 157-159.] DOI: 10.13191/j.chj.2016.0042.

10.Wijesurendra RS, Casadei B. Mechanisms of atrial fibrillation[J]. Heart, 2019, 105(24): 1860-1867. DOI: 10.1136/ heartjnl-2018-314267.

11.Sagris M, Vardas EP, Theofilis P, et al. Atrial fibrillation: pathogenesis, predisposing factors, and ge-netics[J]. Int J Mol Sci, 2021, 23(1): 6-22. DOI: 10. 3390/ ijms23010006.

12.唐平, 孙致连, 程筱玲, 等. 达格列净或阿卡波糖联合二甲双胍对初诊2型糖尿病患者血糖波动的影响比较[J]. 药物流行病学杂志, 2022, 31(7): 435-438. [Tang P, Sun ZL, Cheng XL, et al. Comparison of effects of dapagli-flozin or acarbose combined with metformin on glycemic variability in newly diagnosed type 2 diabe-tes mellitus patients[J]. Chinese Journal of Pharmacoepidemiology, 2022, 31(7): 435-438.] DOI: 10.19960/j.cnki.issn1005-0698.2022.07.001.

13.王擎, 王建礼, 王海英, 等. 糖尿病对心房颤动的作用[J]. 国际心血管病杂志, 2020, 47(1): 40-43. [Wang Q, Wang JL, Wang HY, et al. Effect of diabetes on atrial fibrillation[J]. International Journal of Cardiovascular Diseases, 2020, 47(1): 40-43.] DOI: 10.3969/j.issn.1673-6583.2020.01.010.

14.陈宇宁, 严萍, 刘如松. 达格列净治疗糖尿病合并高血压的临床效果[J]. 临床合理用药杂志, 2021, 14(11): 50-53. [Chen YN, Yan P, Liu RS. Clinical effect of daggligin on diabetes complicated with hypertension[J]. Journal of Clinical Rational Drug Use, 2021, 14(11): 50-53.] DOI: 10.15887/j.cnki.13-1389/r.2021.31.016.

15.李茂, 罗定兰. 达格列净对单用二甲双胍血糖控制不佳2型糖尿病患者的疗效及氧化应激的影响[J]. 临床内科杂志, 2021, 38(10): 678-681. [Li M, Luo DL. Effect of dapagliflozin on therapeutic effect and oxidative stress in type 2 diabetic patients with poor glycemic control of metformin alone [J]. Journal of Clinical Inter-nal Medicine, 2021, 38(10): 678-681.] DOI: 10.3969/j.issn.1001-9057.2021.10.009.

16.Zelniker TA, Bonaca MP, Furtado RHM, et al. Effect of dapagliflozin on atrial fibrillation in patients with type 2 diabetes mellitus: insights from the DECLARE-TIMI 58 Trial[J]. Circulation, 2020, 141(15): 1227-1234. DOI: 10.1161/CIRCULATIONAHA.119.044183.

17.黄洁, 江海英. 酒石酸美托洛尔联合胺碘酮治疗冠心病伴快速性心律失常患者的临床疗效及其安全性[J]. 临床合理用药杂志, 2022, 15(9): 39-41, 45. [Huang J, Jiang HY. Clinical efficacy and safety of metoprolol tartrate combined with amiodarone in the treatment of coronary heatt disease with tachyarrhythmia[J]. Journal of Clinical Ra-tional Drug Use, 2022, 15(9): 39-41, 45.] DOI: 10.15887/j.cnki.13-1389/r.2022.09.010.

18.卢春霞. 胺碘酮联合美托洛尔治疗阵发性心房纤颤的临床分析[J]. 河南医学研究, 2014, 23(8): 70-71. [Lu CX. Clinical analysis of amiodarone combined with metoprolol in the treatment of paroxysmal atrial fibril-lation[J]. Henan Medical Research, 2014, 23(8): 70-71.] DOI: 10.3969/j.issn.1004-437X2014.08.038.

19.任烈娟. 美托洛尔联合稳心颗粒治疗高血压合并阵发性房颤的效果[J]. 临床医学研究与实践, 2018, 3(22): 112-113. [Ren LJ. Effect of metoprolol combined with Wenxin granule on hypertension complicated with parox-ysmal atrial fibrillation[J]. Clin Med Res and Pract, 2018, 3(22): 112-113.] DOI: 10.19347/j.cnki.2096-1413. 201822051.

20.吴巧云, 梁海棠, 朱志玲, 等. P波离散度及心率变异指数与阵发性房颤射频消融术后复发的关系[J]. 中国老年学杂志, 2017, 37(20): 5046-5048. [Wu QY, Liang HT, Zhu ZL, et al. Relationship between P-wave dispersion and heart rate variability index and recurrence of paroxysmal atrial fibrillation after radiofrequency abla-tion[J]. Chinese Journal of Gerontology, 2017, 37(20): 5046-5048.] DOI: 10.3969/j.issn.1005-9202. 2017.20.041.

21.彭麟越, 韩薇. 心房颤动中心房纤维化机制的研究进展[J]. 中国循证心血管医学杂志, 2022, 14(2): 244-246. [Peng LY, Han W. Research progress in the mechanism of central atrial fibrosis in atrial fibrillation[J]. Chinese Journal of Evidence-Based Cardiovascular Medicne, 2022, 14(2): 244-246.] DOI: 10.3969/j.issn.1674-4055. 2022.02.31.

22.Bohne LJ, Johnson D, Rose RA, et al. The association between diabetes mellitus and atrial fibrillation: clinical and mechanistic insights[J]. Front Physiol, 2019, 26(10): 135-146. DOI:  10.3389/fphys.2019.00135 .

23.马英东, 王梁, 刘琳琳, 等. 达格列净对急性心肌梗死后大鼠的心肌电活动影响的研究[J]. 中国心血管病研究, 2021, 19(2): 147-151. [Ma YD, Wang L, Liu LL, et al. Effect of Dapagliflozin on myocardial electrical activity in rats after acute myocardial infarction[J]. Chinese Journal of Cardiovascular Research, 2021, 19(2): 147-151.] DOI: 10.3969/j.issn.1672-5301.2021.02.011.

24.高婧晗, 刘飞, 杨晓蕾, 等. 钙离子稳态的调控在糖尿病相关心房颤动中的作用[J]. 心血管病学进展, 2021, 42(10): 888-891. [Gao JH, Liu F, Yang XL, et al. Regulation of calcium homeostasis in diabetes-related atrial fi-brillation[J]. Advances in Cardiovascular Diseases, 2021, 42(10): 888-891.] DOI: 10.16806/j.cnki.issn.1004-3934.2021.10.006.

25.Ye Y, Jia X, Bajaj M, et al. Dapagliflozin attenuates Na+ /H+ exchanger-1 in cardiofibroblasts via AMPK activation[J]. Cardiovasc Drugs Ther, 2018, 32(6): 553-558. DOI: 10.1007/s10557-018-6837-3.