二肽基肽酶4抑制剂对尿微量白蛋白影响的研究进展

Effects of Dipeptidyl Peptidase-4 inhibitor on albuminuria in patients with type 2 diabetes mellitus

作为一类新型口服降糖药,二肽基肽酶4(DPP-4)抑制剂已广泛用于T2DM的治疗。近年来研究提示,DPP-4抑制剂可能具有独立于降糖效果以外的肾脏保护作用,部分临床研究显示,DPP-4抑制剂具有降低T2DM患者尿微量白蛋白(UMalb)、延缓肾病进展的效应,基础研究表明其肾脏保护的机制可能涉及抗炎、抗氧化、改善内皮细胞功能等作用。而目前DPP-4抑制剂降低UMalb方面的数据主要来源于动物实验和少量小样本临床观察,因而仍有必要开展更多更严谨的大型随机对照(RCT)研究,验证其肾脏保护作用。本文对DPP-4抑制剂在肾脏保护,尤其是改善UMalb方面的研究进展做一综述。

Dipeptidyl Peptidase-4 inhibitor （DPP-4 inhibitor）, a new kind of oral anti-diabetic medicine,has been widely used for the treatment of type 2 diabetes （T2DM） during the last decades. Recent evidence showed that DPP-4 inhibitor may have renal protective effects beyond glycemic control. Some clinical studies revealed that the reduction of HbA1c by DPP-4 inhibitor was paralleled by an improvement of albuminuria and renal function. Experimental studies indicated that the renal protection mechanism of DPP-4 inhibitor may be involved in its multiple effects including anti-inflammatory, antioxidation and improvement of endothelial function. However, the evidence of decreasing albuminuria for DPP-4 inhibitor mainly comes from animal models and some clinical trials with small sample size. More large randomized controlled trials （RCT） will be needed to certify the renal protection effect of DPP-4 inhibitor. In this review, the role of DPP-4 inhibitor on albuminuria will be considered and discussed from both experimental and clinical perspectives.