沙格列汀对T2DM患者炎症因子及下肢动脉IMT与斑块大小的影响

Effect of saxagliptin on inflammatory factors and intima-media thickness and plaque size in lower extremity artery of patients with type 2 diabetes mellitus

目的探讨沙格列汀对2型糖尿病(T2DM)患者下肢动脉内膜中膜厚度(IMT)与粥样硬化斑块大小及炎症因子水平的影响。方法选取徐州医科大学附属医院2018年1月至2019年1月收治的T2DM患者80例,根据随机数字表法将其分为A、B两组,每组40例,A组单用胰岛素治疗,B组胰岛素联合沙格列汀治疗。比较两组患者治疗前及治疗后6个月空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等指标水平,以及下肢动脉IMT和斑块大小。结果两组患者治疗前血糖、血脂、炎症指标、IMT及斑块大小比较,差异均无统计学意义(P>0.05)。与治疗前比较,两组患者治疗后FPG、2 hPG、HbA1c、hs-CRP、TNF-α、IL-6、下肢动脉IMT和斑块大小均明显降低(P<0.05);且B组患者治疗后FPG、2 hPG、HbA1c、hs-CRP、TNF-α、IL-6、下肢动脉IMT和斑块大小水平均明显低于A组(P<0.05);两组患者治疗后TC、TG、LDL-C、HDL-C水平较治疗前有所降低,但差异无统计学意义(P>0.05)。Spearman直线相关分析显示,下肢动脉IMT与hs-CRP、TNF-α及IL-6呈正相关(r=0.567、0.585、0.615,P<0.001、0.001、0.001),与FPG及HbA1c无明显相关性(r=0.129、0.118,P=0.263、0.306)。结论沙格列汀能够改善糖尿病患者下肢动脉粥样硬化,不仅与其降糖效应有关,而且与其能降低hs-CRP、TNF-α、IL-6水平有关。

Objective To observe the effects of saxagliptin on lower extremity arterial intima-media thickness(IMT),atherosclerotic plaque size and inflammatory factors levels in the patients with type 2 diabetes mellitus(T2DM).Methods A total of 80 patients with T2DM treated in the Affiliated Hospital of Xuzhou Medical University from January 2018 to January 2019 were selected and divided into group A and B according to the random number table method,40 cases in each group.Group A used the insulin treatment alone,while group B received of the treatment of insulin combined with saxagliptin.The levels of fasting blood glucose(FPG),2 h postprandial blood glucose(2 hPG),HbA1c,hs-CRP,TNF-α,IL-6.TC,TG,LDL-C and HDL-C,and lower extremity arterial IMT and plaque size were compared between the two groups.Results There was no statistically significant difference in blood glucose,blood lipid,inflammatory indexes,IMT and plaque size before treatment between the two groups(P>0.05).Compared with before treatment,the levels of FPG,2 hPG,HbA1c,hs-CRP,TNF-αand IL-6,lower extremity arterial IMT and plaque size after treatment in the two groups were significantly decreased(P<0.05);moreover the levels of FPG,2 hPG,HbA1c,hs-CRP,TNF-αand IL-6,lower extremity arterial IMT and plaque size after treatment in group B were significantly lower than those in group A(P<0.05).After treatment,the levels of TC,TG,LDL-C andHDL-C were significantly decreased compared with those before treatment,but the differences were not statistically significant(P>0.05).The Spearman linear correlation analysis showed that the lower extremity arterial IMT was positively correlated with the levels of hs-CRP,TNF-αand IL-6(r=0.567,0.585,0.615,P<0.001,0.001,0.001),and had no significant correlation with FPG and HbA1c(r=0.129,0.118,P=0.263,0.306).Conclusion Saxagliptin can improve the lower extremity arterial atherosclerosis in the patients with diabetes,which is not only related to its hypoglycemic effect,but also related to its reduction of hs-CRP,TNF-αand IL-6 levels.