胰高血糖素样肽-1受体激动剂治疗糖尿病肾病的有效性及安全性分析

Analysis of the effectiveness and safety of vitamin glucagon-like peptide-1 receptor agonists in the treatment of diabetic nephropathy

目的探讨胰高血糖素样肽-1受体(GLP-1)激动剂治疗糖尿病肾病的效果。方法采用前瞻性研究方法,选取2017年1月至2020年1月四川绵阳四0四医院内分泌科收治的86例糖尿病肾病作为研究对象,采用随机数字表分为试验组和对照组各43例。2组患者均采用基础降糖药物方案+生活方式控制方式治疗,试验组在上述基础方案上加用利拉鲁肽治疗,对照组在上述基础方案上采用胰岛素强化治疗方案治疗。对比2组治疗前、治疗6个月后的空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(Hb A1c)、Gutt-胰岛素敏感性指数(Gutt-ISI)、估计肾小球滤过率(e GFR)、尿微量白蛋白(UMA)、肌酐(Cr)、尿白蛋白/肌酐比值(ACR)、胱抑素C(Cys C)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、体重指数(BMI)、血栓素B2(TX-B2)、一氧化氮(NO)、内皮素-1(ET-1)、血管性血友病因子(v WF),不良反应发生率。结果治疗前,2组患者的FPG、2h PG、Hb A1c、Gutt-ISI、e GFR、UMA、Cr、ACR、Cys C、TG、TC、LDL-C、BMI、TX-B2、NO、ET-1、v WF测定值比较,差异均无统计学意义(P>0.05)。治疗6个月后,试验组患者Gutt-ISI、eGFR测定值高于对照组,UMA、ACR、CysC测定值低于对照组,差异均有统计学意义(P<0.05)。治疗6个月后,试验组的TX-B2、ET-1、vWF测定值低于对照组,NO测定值高于对照组,差异均有统计学意义(P<0.05)。治疗6个月后,试验组的TG测定值低于对照组,差异有统计学意义(P<0.05),Cr、TC、LDL-C、BMI与对照组比较,差异均无统计学意义(P>0.05)。试验组的不良反应发生率6.98%与对照组的13.95%比较,差异无统计学意义(P>0.05)。结论对于口服降糖药效果不佳,早期肾损伤的患者,采用GLP-1激动剂治疗糖尿病肾病有利于血糖控制、降低血脂水平,对肾功能损伤具有一定的保护作用。

Objective To explore the effect of glucagon-like peptide-1 receptor(GLP-1) agonists in the treatment of diabetic nephropathy. Methods From January 2017 to January 2020,86 patients with diabetic nephropathy admitted to the Department of Endocrinology,Mianyang 404 Hospital were prospectively selected as the research objects,and divided into the experimental group and the control group with 43 cases each using a random number table. The two groups of patients were treated with basic hypoglycemic drugs + lifestyle control methods. The experimental group was treated with Liraglutide based on the above-mentioned basis regimen,and the control group was treated with insulin intensive treatment based on the above-mentioned basic regimen. The fasting blood glucose(FPG),2 h postprandial blood glucose(2h PG),glycosylated hemoglobin(HbA1c),and Gutt-Insulin sensitivity index(Gutt-ISI),estimated glomerular filtration rate(eGFR),urine microalbumin(UMA),creatinine(Cr),urine albumin/creatinine ratio(ACR),cystatin C(CysC),triacylglycerol(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),body mass index(BMI),thromboxane B2(TX-B2),nitric oxide(NO),endothelin-1(ET-1),von Willebrand factor(vWF) of the two groups before treatment and after 6 months of treatment,incidence of adverse reactions were compared. Results Before treatment,compared the measured values of FPG,2 h PG,Hb A1 c,Gutt-ISI,e GFR,UMA,Cr,ACR,CysC,TG,TC,LDL-C,BMI,TX-B2,NO,ET-1,vWF of the 2 groups,the difference was not statistically significant(P>0.05). After6 months of treatment,the measured values of Gutt-ISI and e GFR in the experimental group were higher than those in the control group,the measurement values of UMA,ACR,and CysC in the experimental group were lower than those in the control group,and the differences were significant(P<0.05). After 6 months of treatment,the measured values of TX-B2,ET-1,and v WF in the experimental group were lower than those in the control group,and the measured value of NO was higher than that in the control group,the differences were statistically significant(P<0.05). After 6 months of treatment,the measured value of TG in the test group was lower than that in the control group,and the difference was statistically significant(P< 0. 05). Compared with the control group,there was no statistically significant difference in Cr,TC,LDL-C,and BMI(P>0.05). The incidence of adverse reactions in the experimental group was 6. 98%,compared with 13. 95% in the control group,and the difference was not statistically significant(P>0.05). Conclusion For patients with poor effect of oral hypoglycemic agents and early kidney injury,the use of GLP-1 agonists to treat diabetic nephropathy has a certain protective effect on blood sugar control,lower blood lipid levels,and kidney function damage.