艾塞那肽治疗早期糖尿病肾病的疗效及其对晚期糖基化终产物的影响

Clinical efficacy of exenatide in the treatment of early diabetic nephropathy and its effect on advanced glycation end products

目的观察艾塞那肽治疗早期糖尿病肾病的疗效,并探讨其对患者晚期糖基化终产物的影响。方法选取2019年1~11月口服2种降糖药物血糖控制效果欠佳来上海市宝山区仁和医院接受治疗的早期糖尿病肾病患者72例,按照随机数表法均分为观察组和对照组,每组36例。对照组在口服降糖药物治疗基础上联合胰岛素治疗,观察组在口服降糖药物基础上联合艾塞那肽治疗。治疗20周后,比较两组患者的空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、收缩压(SBP)、舒张压(DBP)、血肌酐(Scr)、尿素氮(BUN)、尿白蛋白/尿肌酐值(UACR)、晚期糖基化终末产物(AGEs)、环磷酸腺苷(cAMP)水平及不良反应发生情况。结果治疗前,两组患者的FPG、2 hPG、HbA1c、SBP、DBP比较差异均无统计学意义(P>0.05);治疗后,两组患者的FPG、2 hPG、HbA1c均降低,且观察组明显低于对照组,差异均具有统计学意义(P<0.05);治疗后,观察组患者的SBP、DBP均降低,且明显低于对照组,差异均具有统计学意义(P<0.05);治疗前,两组患者的Scr、UACR、AGEs、cAMP水平比较差异均无统计学意义(P>0.05);治疗后,两组患者的Scr、UACR、AGEs、cAMP水平明显降低,且观察组明显低于对照组,差异均具有统计学意义(P<0.05);两组患者的BUN水平治疗前后比较差异无统计学意义(P>0.05);两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论艾塞那肽应用于早期糖尿病肾病治疗,可起到降低2 hPG水平、控制血压、减少蛋白从尿液流失进而促进肾功能改善的作用,具有很好的安全性。

Objective To observe the efficacy of exenatide in the treatment of early diabetic nephropathy,and to explore its effect on patients with advanced glycation end products.Methods From January 2019 to November 2019,72 patients with early diabetic nephropathy who were treated with two kinds of hypoglycemic drugs orally in Baoshan District Renhe Hospital of Shanghai were selected from January 2019 to November 2019,and were divided into the observation group and control group according to random number table method,with 36 patients in each group.The control group was treated with insulin therapy based on oral hypoglycemic drugs,and the observation group was treated with exenatide therapy based on oral hypoglycemic drugs.After 20 weeks of treatment,fasting blood glucose(FPG),2-hour postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c),systolic blood pressure(SBP),diastolic blood pressure(DBP),creatinine(Scr),and urea nitrogen(BUN),urine albumin/urinary creatinine value(UACR),advanced glycation end products(AGEs),cyclic adenosine monophosphate(cAMP)level,and occurrence of adverse reactions of the two groups of patients were compared.Results Before treatment,there was no significant difference in FPG,2 hPG,HbA1c,SBP,DBP between the two groups(all P>0.05);after treatment,FPG,2 hPG and HbA1c in both groups were reduced,and the levels in the observation group was significantly lower than those in the control group(P<0.05);after treatment,the SBP and DBP of the observation group decreased,which were significantly lower than those in the control group(P<0.05).Before treatment,there was no significant difference in the levels of Scr,UACR,AGEs,and cAMP between the two groups of patients(all P>0.05);after treatment,the levels of Scr,UACR,AGEs,and cAMP of the two groups of patients were significantly reduced,and those in the observation group were significantly lower those in the control group(all P<0.05);there was no statistically significant difference in BUN levels between the two groups before and after treatment(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Exenatide used in the treatment of early diabetic nephropathy can play a role in reducing 2 hPG levels,controlling blood pressure,reducing urinary protein excretion,and improving renal function,which has good safety.