利拉鲁肽对糖尿病视网膜病变患者的临床疗效及作用机制研究

Study on the effect and mechanism of liraglutide in diabetic retinopathy

目的 探讨利拉鲁肽对糖尿病视网膜病变(DR)的临床疗效及机制。方法 前瞻性选取120例非增生型糖尿病视网膜病变(NPDR)患者,随机分为对照组和研究组。对照组采用常规治疗,研究组在对照组治疗的基础上使用利拉鲁肽0.6 mg/d皮下注射。分析两组NPDR患者临床疗效、氧化应激指标及对胰高血糖素样肽-1(GLP-1)mRNA及内皮型一氧化氮(e-NOS)mRNA表达。采用非条件Logistic回归分析NPDR危险因素,采用Pearson相关性分析临床及氧化应激指标的相关性。结果 治疗后研究组总有效率高于对照组( P <0.05),而视野灰度值(VGV)低于对照组( P <0.05)。治疗后研究组体质量指数(BMI)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、3-硝基酪氨酸(3-NT)低于对照组,空腹C肽(C-P)、一氧化氮(NO)、超氧化物歧化酶(SOD)、谷胱甘肽(GSH)高于对照组( P <0.05)。HbA1c、3-NT为NPDR的危险因素( P <0.05),NO、SOD、GSH、eNOS mRNA、GLP mRNA为NPDR的保护因素( P <0.05)。NO、SOD及GSH与TG、3-NT呈负相关,与GLP-1 mRNA及e-NOS mRNA呈正相关。结论 利拉鲁肽有明显治疗NPDR的效果,可能与利拉鲁肽抗氧化应激以及刺激GLP-eNOS/NO通路有关。

Objective To investigate the effect and mechanism of liraglutide on clinical efficacy and oxidative stress in patients with diabetic retinopathy. Methods One hundred and twenty patients with non-proliferative diabetic retinopathy were randomly divided into control group and study group. The control group received conventional treatment, and the study group received subcutaneous injection of liraglutide 0.6 mg/d on the basis of the control group. And then the clinical characteristics of different groups, the clinical efficacy, oxidative stress and expression of glucagon-like peptide-1 (GLP-1) mRNA and endothelial nitric oxide (e-NOS) mRNA in patients with non-proliferative diabetic retinopathy influences were analyzed. Unconditional logistic regression was used to analyze the risk factors of NPDR, and Pearson correlation was used to analyze the correlation between clinical and oxidative stress indicators. Results The total effective rate of study group was higher than that of control group after treatment ( P <0.05), while VGV was lower than that of control group ( P <0.05). After treatment, After treatment, BMI, HbA1c, TG, 3-NT were lower than the control group, CP, NO, SOD and GSH were higher than the control group ( P <0.05). Logistic regression analysis showed that HbA1c and 3-NT were risk factors for NPDR ( P <0.05), and NO, SOD, GSH, eNOS mRNA and GLP mRNA were protective factors for NPDR ( P <0.05). Pearson correlation analysis showed that NO, SOD and GSH were negatively correlated with TG and 3-NT, and positively correlated with GLP-1 mRNA and e-NOS mRNA. Conclusion Liraglutide has obvious effects on the treatment of NPDR, and this effect may be related to the anti-oxidative stress of liraglutide and the stimulation of GLP-eNOS/NO pathway.