SGLT2抑制剂联合ARB治疗糖尿病肾脏病的临床疗效

目的探讨钠-葡萄糖协同转运蛋白2(SGLT-2)抑制剂联合血管紧张素Ⅱ受体拮抗剂(ARB)对治疗2型糖尿病肾脏病(DKD)的疗效。方法2型糖尿病性肾病患者90例,随机分为3组,每组各30例,分别接受厄贝沙坦(厄贝沙坦组)、恩格列净(恩格列净组)、厄贝沙坦联合恩格列净(联合治疗组)治疗,控制血糖水平一致,持续治疗12周,比较尿蛋白排泄率(UAE)、肾小球滤过率(eGFR)及体重等。结果治疗后三组UAE、尿蛋白定量较治疗前均有下降(P<0.05),联合治疗组UAE和尿蛋白定量较其他两组明显降低(P<0.05);治疗后三组eGFR均有下降,联合治疗组eGFR下降率高于其它两组(P<0.05);且治疗后恩格列净组和联合治疗组体重明显降低(P<0.05)。结论厄贝沙坦和恩格列净均能减少DKD患者的蛋白尿,联合治疗效果优于单用;联合治疗后eGFR下降更明显;恩格列净减重作用优于厄贝沙坦;降压效果厄贝沙坦优于恩格列净。

Objective To evaluate the effect of Sodium-glucose cotransporter-2(SGLT-2)inhibitors combined angiotensinⅡreceptor blocker(ARB)on patient with type 2 diabetes and diabetic kidney disease(DKD).Methods 90 cases of type 2 diabetic nephropathy patients were randomly divided into three groups,30 cases each group.The patients were treated with irbesartan(irbesartan group),engelgin group(engelgeling group),irbesartan combined with engliglin(combined treatment group).The blood glucose levels were controlled in the same way.The urine protein excretion rate(UAE),glomerular filtration rate(EGFR)and body weight were compared.To compare the differences of urinary protein excretion and glomerular filtration rate(eGFR)and weight in these three groups after sustaining treatment of 12 weeks.Results Both the urinary albumin excretion rate(UAE)and urine protein quantification were decreased after treatment in the three groups(P<0.05),and the decrease of UAE and urine protein quantification in the combined group was higher than those other two monotherapy groups(P<0.05).The eGFR was decreased in all three groups after treatment.The decrease rate of eGFR in combined group was obvious than that in the other two groups(P<0.05).After treatment,the weight of empagliflozin group and combined group were significantly decreased(P<0.05).Conclusions Both empagliflozin group and irbesartan group can reduce proteinuria,but the combined group is more obvious in reducing proteinuria than the monotherapy group in patients with DKD.The eGFR decreases significantly after combined treatment.The weight reduction effect of empagliflozin is better than irbesartan.The antihypertensive effect of irbesartan is greater than empagliflozin.