早期糖尿病肾病使用利拉鲁肽降糖对肾功能的保护作用

Protective effect of hypoglycemic therapy by liraglutide on renal function in early diabetic nephropathy

目的：研究利拉鲁肽联合常规降糖方案治疗对早期糖尿病肾病患者肾功能的影响。方法：选择肾脏病分期1～2期的134例糖尿病肾病患者作为研究对象,分为两组,观察组接受利拉鲁肽联合常规降糖方案治疗,对照组接受常规降糖方案治疗,治疗后8周时,测定并比较两组血糖代谢指标、血清和尿液中肾功能指标以及脂肪细胞因子的含量。结果：治疗后8周时,观察组空腹血糖（FBG）、餐后2h血糖（2hPBG）、空腹血胰岛素（FINS）含量以及胰岛素抵抗指数（HOMA-IR）均显著低于对照组（P〈0.05）,胰岛素β细胞功能指数（HOMA-β）显著高于对照组（P〈0.05）;观察组血清分泌型卷曲相关蛋白5（SFRP5）、Nesfatin-1、Omentin-1含量显著高于对照组（P〈0.05）,血清胰岛素样生长因子1（IGF-1）、视黄醇结合蛋白（RBP）、同型半胱氨酸（Hcy）、脑钠肽（BNP）、Chemerin、Leptin、内脂素（visfatin）含量均显著低于对照组（P〈0.05）;观察组尿液尿蛋白排泄量（UAER）、白蛋白/肌酐比值（ACR）、尿肝型脂肪酸结合蛋白（L-FABP）均显著低于对照组（P〈0.05）。结论：利拉鲁肽治疗早期糖尿病肾病能够有效控制血糖、增加胰岛素敏感性、改善肾功能并调节脂肪细胞因子的分泌,具有积极的临床应用前景。

Objective： To study the effect of liraglutide combined with routine hypoglycemic therapy on renal function in patients with early diabetic nephropathy. Methods： A total of 134 diabetic nephropathy patients with 1-2-stage of kidney disease staging were selected as the research subjects and divided into two groups, observation group accepted liraglutide combined with routine hypoglycemic treatment and control group received routine hypoglycemic treatment. 8 weeks after treatment, the levels of glucose metabolism indexes as well as renal function indexes and adipocytokines in serum and urine of two groups were determined. Results： Eight weeks after treatment, FBG, PBG and FINS levels as well as HOMA-IR index of observation group were significantly lower than those of control group while HOMA-13 index was significantly higher than that of control group; serum SFRP5, Nesfatin-1 and Omentin-1 levels of observation group were significantly higher than those of control group while serum IGF-1, RBP, Hcy, BNP, Chemerin, Leptin and Visfatin levels were significantly lower than those of control group; u- rine UAER, ACR and L-FABP of observation group were significantly lower than those of control group. Conclusions： Liraglu- tide treatment of early diabetic nephropathy can effectively control blood glucose, increase insulin sensitivity, improve renal function and regulate the secretion of adipocytokines, and it has a positive ProsPect of clinical application.