达格列净治疗糖尿病肾病84例临床疗效观察

Dapagliflozin in treating diabetic kidney disease:clinical efficacy observation on 84 cases

目的评价在真实世界中达格列净对于糖尿病肾病(DKD)治疗的有效性和安全性。方法选取2018年1月至2020年5月于我院接受达格列净治疗且随访超过12个月的DKD患者84例,回顾性分析达格列净对DKD患者血糖、血压、体重、血脂、尿蛋白量、肾功能的影响,比较治疗前后临床治疗效果的差异,并记录治疗过程中的不良反应。结果84例DKD患者的平均年龄为(52.47±8.87)岁,男性56例(66.7%),糖尿病病程8(3,17)年,合并肥胖及超重者35例(41.7%),合并糖尿病性视网膜病变患者47例(56.0%),高血压69例(82.1%),24 h尿蛋白定量为3100(700,9100)mg,估算的肾小球滤过率为87.1(49.7,108.2)mL/(min·1.73 m^(2))。在随访过程中,共有12例(14.3%)患者停用达格列净(男4例、女8例)。女性更容易发生泌尿系感染[17.9%(5/28)vs 1.8%(1/56);OR=11.96,95%CI 1.32~108.07,P=0.007]。随访12个月后DKD患者的体重(P=0.02)、BMI(P=0.02)、收缩压(P=0.04)、每日胰岛素总量(P<0.01)、空腹血糖(P<0.01)、糖化血红蛋白(P<0.01)、24 h尿蛋白定量(P=0.05)均下降。结论真实世界的观察性数据支持达格列净对DKD的治疗效果较好且相对安全。

Objective To evaluate the efficacy and safety of dapagliflozin in the treatment of diabetic kidney disease(DKD)in the real world.Methods A total of 84 DKD patients who received dapagliflozin in our hospital from Jan.2018 to May 2020 and who were followed up for more than 12 months were selected.The effects of dapagliflozin on blood glucose,blood pressure,body weight,blood lipid,proteinuria and renal function of DKD patients were analyzed retrospectively,the differences of clinical outcomes before and after treatment were compared,and the adverse reactions during treatment were recorded.Results Of the 84 patients,the average age was(52.47±8.87)years and 56 cases(66.7%)were males.The diabetes history was 8(3,17)years,35 cases(41.7%)had obesity and overweight,47 cases(56.0%)had diabetic retinopathy,69 cases(82.1%)had hypertension,the 24-h urinary protein level was 3100(700,9100)mg,and the estimated glomerular filtration rate(eGFR)was 87.1(49.7,108.2)mL/(min·1.73 m^(2)).During the follow-up period,12 cases(14.3%)stopped dapagliflozin(4 males and 8 females).Females were more prone to urinary tract infections(17.9%[5/28]vs 1.8%[1/56];odds ratio[OR]=11.96,95%confidence interval[CI]1.32-108.07,P=0.007).After 12 months of follow-up,body weight(P=0.02),body mass index(BMI)(P=0.02),systolic blood pressure(P=0.04),total daily insulin dosage(P<0.01),fasting blood glucose(P<0.01),the glycated hemoglobin(P<0.01),and 24-h urinary protein level(P=0.05)were significantly decreased.Conclusion Based on the real-world observational data,dapagliflozin is a relatively safe and effective drug for DKD.