西格列汀联合胰岛素治疗对稳定晚期糖尿病肾病患者空腹血糖的效果

Clinical Efficacy of sitagliptin Combined with Insulin Glargine in Stabilizing Blood Glucose of Patients with Late Diabetic Nephropathy

目的:观察西格列汀对稳定晚期糖尿病肾病(DN)空腹血糖的疗效及安全性。方法:68例晚期DN患者随机分为对照组和联合治疗组,两组DN患者维持慢性肾衰中原有治疗方案,对照组使用甘精胰岛素,联合治疗组在甘精胰岛素基础上加用西格列汀(100 mg/d)控制空腹血糖,于治疗前和治疗3月时采集两组患者空腹静脉血并分离血清,采用酶法检测空腹血糖(FPG)及血肌酐(Cr)、散射比浊法测定CRP水平、离子交换液相层析法检测糖基化血红蛋白(Hb A1c),计算肾小球滤过率(e GFR);记录两组DN患者甘精胰岛素用量及低血糖发生率。结果:与治疗前比较,治疗后两组患者FPG、Hb A1c均有所降低,但仅联合治疗组差异有统计学意义(P<0.05);与治疗前比较,e GFR、Cr及CRP水平差异无统计学意义(P>0.05);治疗后,联合治疗组e GFR和Cr水平虽表现出一定程度改善的趋势,但差异无统计学意义(P>0.05);对照组CRP水平变化不明显(P>0.05),联合治疗组降低,差异有统计学意义(P<0.05);联合治疗组甘精胰岛素的用量低于对照组(P<0.05);对照组低血糖发生率(17.65%)高于联合治疗组(5.88%,P<0.05)。结论:西格列汀联合甘精胰岛素控制晚期DN患者空腹血糖效果优于单一甘精胰岛素,其机制可能与患者炎症状态有关。

Objective：To observe the clinical efficacy and safety of sitagliptin in stabilizing blood glucose of patients with late diabetes nephropathy（ DN）. Methods：68 cases of patients with late DN were randomly divided into control group（34 cases）and treatment group（34 cases）. On the basis of original chronic renal failure treatment,the control group were given insulin glargine and the treatment group were given sitagliptin（100 mg,once a day）combined with insulin glargine. Before and three months after treatment,fasting blood glucose and serum creatinine（ Cr）were detected by enzyme method,C-reactive protein（ CRP）level was determined by scattering turbidimetric method,glycosy-lated hemoglobin（HbA1c）level was detected by lion-exchange liquid chromatography,glomerular fil-tration rate（ eGFR）was calculated,insulin glargine dosage and the incidence of hypoglycemia were recorded. Results：After treatment,both the two groups showed lower levels of FPG and HbA1c,but only the change of treatment group had statistical significance（ P〈0 . 05 ）. After treatment ,the treat-ment group showed the improvements of eGFR and Cr ,but the change had no statistical significance （ P〉0 . 05 ）. The change of CRP in control group had no statistical significance（ P〉0 . 05 ）,while the treatment group had lower level of CRP and the change had statistical significance（ P〈0 . 05 ）. Com-pared with control group,the treatment group had lower the dosage of insulin glargine and hypoglyce-mia incidence（ P 〈0 . 05 ）. Conclusion：The clinical efficacy of sitagliptin combined with insulin glargine in the treatment of late diabetic nephropathy is more effective than single insulin,the possible mechanism is related to decrease of inflammatory reaction level.