达格列净对糖尿病足患者临床疗效及外周血NLRP3炎性小体表达的影响

The Effect of Dapagliflozin on Clinical Efficacy of Diabetic Foot and NLRP3 Expression Inflammasome in Peripheral Blood

目的探讨达格列净对糖尿病足患者临床疗效及外周血核苷酸结合寡聚化结构域样受体蛋白3(NLRP3炎性小体表达的影响。方法以2017年1月至2019年10月入院糖尿病足患者180例为研究对象,根据随机数字表法将患者分为观察组(90例)和对照组(90例),对照组给予常规降糖治疗,观察组在对照组基础上加用达格列净,疗程为3个月。比较两组患者治疗前后血糖情况、临床疗效及外周血单核细胞(PBMCs)中NLRP3、半胱氨酸蛋白酶1(Caspase-1)m RNA和蛋白表达水平;相关炎性细胞因子(IL-1β、IL-6)水平;统计两组患者不良反应发生情况。结果与对照组治疗后比较,观察组治疗后空腹血糖、餐后血糖及糖化血红蛋白均显著降低(P<0.05);观察组治疗后外周血NLRP3、Caspase-1m RNA及蛋白表达水平较对照组治疗后明显降低(P<0.05);观察组治疗后外周血IL-1β和IL-6水平显著低于对照组治疗后(P<0.05);治疗后观察组临床总有效率为90%为显著高于对照组(77.8%)(P<0.05),而不良反应比较,两组差异无统计学意义(P>0.05)。结论达格列净可显著改善糖尿病足患者临床疗效,其可能与降低患者外周血NLRP3炎性小体表达及下游炎症反应有关。

Objective To explore the effect of dapagliflozin on clinical efficacy of diabetic foot patients and the expression of peripheral blood nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammasome.Methods From January 2017 to October 2019,180 patients with diabetic foot admitted to hospital were research objects.According to the random number table method,patients were divided into observation group(90 cases)and control group(90 cases).Control group was given conventional hypoglycemic therapy,and observation group was treated with dapagliflozin on the basis of control group.All course of treatment was 3 months.Blood glucose status,clinical efficacy,and NLRP3,caspase-1 mRNA and protein of peripheral blood mononuclear cells(PBMCs)were compared before and after treatment.Related inflammatory cytokines(IL-1β,IL-6)and adverse reactions were also compared.Results Compared with control group,fasting blood glucose,postprandial blood glucose and glycosylated hemoglobin of observation group were significantly reduced after treatment(P<0.05).The expression of NLRP3,Caspase-1 mRNA and protein in peripheral blood of observation group were significantly lower than those of control group after treatment(P<0.05).The IL-1βand IL-6 in peripheral blood after treatment in observation group were significantly lower than those in control group(P<0.05).After treatment,the total clinical effective rate of observation group was 90%,which was significantly higher than that of control group(77.8%)(P<0.05).However,there was no significant difference in adverse reactions(P>0.05).Conclusion Dapagliflozin could significantly improve clinical efficacy of diabetic foot patients,which may be related to the reduction of the expression of NLRP3 inflammasomes in peripheral blood and downstream inflammation.