钠-葡萄糖协同转运蛋白2抑制剂达格列净对2型糖尿病肾病肾移植患者血糖及肾功能的影响

Effects of sodium glucose cotransporter 2 inhibitor dagagligin on blood glucose and renal function in patients with type 2 diabetic nephropathy and renal transplantation

目的探讨钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂达格列净对2型糖尿病肾病(T2DN)肾移植患者血糖及肾功能的影响。方法选择2011年1月~2017年12月在我院接受肾移植且临床资料完整的48例T2DN患者,将其随机分为试验组(达格列净+基础降糖方案,25例)及对照组(基础降糖方案,23例)。收集并比较两组患者一般临床资料[性别、年龄、BMI、糖尿病病程、术前透析时间、透析类型(腹膜透析、血液透析)、肾移植时间、血压、降糖药使用情况]、治疗前及治疗1、6、12、18及24个月的实验室检查结果[空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血肌酐(SCr)、估算的肾小球滤过率(eGFR)、尿微量白蛋白/尿肌酐比值(ACR)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)]、不良事件发生情况。结果试验组患者治疗1、6、12、18及24个月的FPG水平、治疗6、12、18及24个月的HbA1c水平、治疗24个月的ACR、治疗12、18及24个月的TC水平、治疗18及24个月的TG水平均低于同组治疗前(P<0.05)。试验组患者治疗6、12、18及24个月的FPG及HbA1c水平、治疗24个月的ACR、治疗后12、18及24个月的TC水平、治疗后18及24个月的TG水平均低于同期对照组,eGFR高于同期对照组(P<0.05)。与对照组比较,试验组患者泌尿系统感染发生率高(P=0.045)。结论SGLT2抑制剂联合其他降糖药物降低了T2DN肾移植患者的FPG、ACR、TC、TG水平,维持了eGFR水平,但可能会增加泌尿系感染的机会。

Objective To explore the effects of sodium dependent glucose transporters 2(SGLT2)inhibitor dapagliflozin on blood glucose and renal function in patients with type 2 diabetes nephropathy(T2 DN)and renal transplantation.Methods A total of 48 T2 DN patients who received kidney transplantation in our hospital from January 2011 to December 2017 with complete clinical data were selected,and they were randomly divided into experimental group(dagliazin+basic hypoglycemic regimen,25 cases)and control group(basic hypoglycemic regimen,23 cases).The general clinical data[gender,age,BMI,diabetes course,preoperative dialysis time,dialysis type(peritoneal dialysis,hemodialysis),kidney transplant time,blood pressure,use of antidiabetic drugs],laboratory examination results before and after 1,6,12,18 and 24 months of treatment[fasting plasma glucose(FPG),hemoglobin A1 c(HbA1 c),serum creatinine(SCr),estimated glomerular filtration rate(eGFR),urinary microalbumin/urinary creatinine ratio,total cholesterol(ACR),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)],the incidence of adverse events in two groups were collected and compared.Results FPG levels at 1,6,12,18 and 24 months after treatment,HbA1 c levels at 6,12,18 and 24 months after treatment,ACR at 24 months after treatment,TC levels at 12,18 and 24 months after treatment,TG levels at 18 and 24 months after treatment of experimental group were all lower than those before treatment in the same group(P<0.05).FPG and HbA1 c levels at 6,12,18 and 24 months after treatment,ACR at 24 months after treatment,TC levels at 12,18 and 24 months after treatment,TG levels at 18 and 24 months after treatment were all lower than control group in the same period,eGFR was higher than control group in the same period(P<0.05).Compared with the control group,the incidence of urinary tract infection was higher in the experimental group(P=0.045).Conclusion SGLT2 inhibitors combined with other hypoglycemic agents reduced FPG,ACR,TC and TG levels in T2 DN and renal transplantation patients,maintained eGFR levels,but may increase the chance of urinary tract infection.