利拉鲁肽联合替米沙坦对早期糖尿病肾病患者血中TNF-α、IL-6及TGF-β1水平的影响

Liraglutide combined with low dosage telmisartan decreases the serum levels of TNF-α,IL-6 and TGF-β1 in patients with early diabetic nephropathy

目的探讨人胰高血糖素样肽-1(GLP-1)类似物利拉鲁肽联合小剂量血管紧张素Ⅱ(ANGⅡ)AT1受体拮抗剂替米沙坦,对早期糖尿病肾病患者生化指标及血中炎症介质TNF-α、IL-6及TGF-β1水平的影响。方法将200例符合诊断标准的早期糖尿病肾病患者随机平均分为2组,即利拉鲁肽+替米沙坦组和替米沙坦组(n=100)。分别对治疗前与治疗10周后患者生化指标包括糖化血红蛋白(HbA1c)、24小时尿白蛋白排泄率(UAER)、血肌酐(Cr)和血尿素(UA),以及血中TNF-α、IL-6和TGF-β1水平进行检测。结果经10周治疗后2组患者UAER、Cr和UA以及血中炎症介质TNF-α、IL-6和TGF-β1水平均较治疗前均有显著改善,差异均有计学意义(P均<0.05)。同时发现利拉鲁肽+替米沙坦组较替米沙坦组改善更加显著,差异均有统计学意义(P均<0.05)。治疗前与治疗后替米沙坦组患者HbA1c变化未见统计学差异(P>0.05)。而利拉鲁肽+替米沙坦组患者HbA1c在治疗10周后较治疗前有显著下降,差异有统计学意义(P<0.05)。结论人胰高血糖素样肽-1(GLP-1)拟似物利拉鲁肽联合小剂量血管紧张素Ⅱ(ANGⅡ)AT1受体拮抗剂替米沙坦和单用小剂量替米沙坦均可有效改善糖尿病肾病患者的生化指标以及与糖尿病肾病相关的炎症反应,且使用利拉鲁肽联合小剂量替米沙坦治疗的患者改善更加显著。该结果表明进一步加强血糖控制可以有效延缓糖尿病肾病的发展;同时也表明利拉鲁肽可能可以通过独立于降糖外的其他机制直接改善了糖尿病肾病相关的炎症反应,但仍需大样本的临床研究进一步的证实其价值。

Objective To explore the value of glucagon like peptide-1 （GLP-1） analog liraglutide combined with low dosage telmisartan on biochemical indicators and the serum levels of TNF-α, IL-6 and TGF-β1 in patients with early diabetic nephropatby. Methods 200 patients with early diabetic nephropathy with chosen standards were randomly di- vided into liraglutide combined with low dosage telmisartan treatment group （treatment group） and low dosage telmisar- tan treatment group （control group）. Before and after 10 weeks interventions, HbA1c, UAER, CR, UA and the serum levels of TNF-α, IL-6 and TGF-β1 were analyzed. Results After 10 weeks interventions, UAER, CR, UA and the ser- um levels of TNF-α, IL-6 and TGF-β1 were noticeably improved in two groups （P〈0.05 in all）. Moreover, the im- provements in treatment group were more significant than that in control group （P〈0.05 in all）. Then, our results also figured out that no difference on HbAlc was found in control group after 10 weeks treatments （P〈0.05）. Nevertheless, the level of HbAlc in treatment group was remarkably reduced after 10 weeks treatments （P〈0.05）. Conclusion Glu- cagon like peptide-1 （GLP-1） analog liraglutide combined with low dosage AT1R blocker telmisartan is a safe and effec- tive method for the treatment of patients with early diabetic nephropathy in clinic practice.