利拉鲁肽治疗超重、肥胖2型糖尿病并肾脏疾病的临床观察

Clinical observation of liraglutide in the treatment of overweight and obese type 2 diabetes mellitus with nephropathy

目的观察利拉鲁肽治疗超重、肥胖2型糖尿病(type 2 dabetes mellitus,T2DM)并肾脏疾病的临床效果。方法筛选超重、肥胖T2DM患者70例,糖化血红蛋白(glycated hemoglobin,HbA_(1)c)符合(7%≤HbA_(1)c≤11%),随机分成2组,胰岛素联合二甲双胍和(或)阿卡波糖组(胰岛素组)、利拉鲁肽联合二甲双胍和(或)阿卡波糖(利拉鲁肽组):治疗24周,观察治疗前后体重(body weight,WT)、腰围(waist circumference,WC)、HbA_(1)c、胰岛素抵抗指数(insulin resistance index,HOMA-IR)、尿白蛋白肌酐比值(urinary albumin creatinine ratio,UACR)、估计肾小球滤过率(estimate glomerular filtration rate,eGFR)、血、尿α1-微球蛋白(α1 microglobulin,α1-MG)、血、尿β2-微球蛋白(β2 microglobulin,β2-MG)等指标的变化。结果研究结束时胰岛素组完成30例,利拉鲁肽组完成31例,胰岛素组治疗后与治疗前比较HbA_(1)c、HOMA-IR、UACR、eGFR、血α1-MG、尿α1-MG、血β2-MG、尿β2-MG明显降低,差异有统计学意义(P<0.01)。利拉鲁肽组治疗后与治疗前比较WT、WC、体重指数、HbA_(1)c、HOMA-IR、UACR、eGFR、血α1-MG、尿α1-MG、血β2-MG、尿β2-MG明显降低,差异有统计学意义(P<0.01)。利拉鲁肽组治疗后与胰岛素组治疗后比较,UACR、eGFR、血α1-MG、尿α1-MG、尿β2-MG降低更加明显,差异有统计学意义(P<0.05)。结论利拉鲁肽治疗超重、肥胖T2DM合并肾脏疾病患者不仅可以降低血糖、减轻体重,还可以改善肾功能,延缓肾脏疾病的进展,并且这种作用是独立于降糖之外的作用。

Objective To observe the clinical efficacy of liraglutide in the treatment of overweight,and obese type 2 dabetes mellitus(T2DM)complicated with nephropathy.Methods Seventy overweight and obese T2DM patients with glycated hemoglobin(HbA_(1)c)(7%≤HbA_(1)c≤11%)were selected and randomly divided into two groups:insulin combined with metformin and/or acarbose group(insulin group)and liraglutide combined with metformin and/or acarbose group(liraglutide group).Before and at 24 weeks after treatment,body weight(WT),waist circumference(WC),HbA_(1)c,insulin resistance index(HOMA-IR),urinary albumin creatinine ratio(UACR),estimation glomerular filtration rate(eGFR),serum and urinaryα1 microglobulin(α1-MG),serum and urinaryβ2 microglobulin(β2-MG),and other indicators were analyzed.Results At the end of the study,30 patients in the insulin group completed the study and 31 patients in the liraglutide group completed the study.Compared with those before treatment,HbA_(1)c,HOMA-IR,UACR,eGFR,serumα1-MG,urinaryα1-MG,bloodβ2-MG and urinaryβ2-MG in the insulin group were lower significantly after treatment,which showed significant difference(P<0.01).After treatment,WT,WC,body mass index,HbA_(1)c,HOMA-IR,UACR,EGFR,serumα1-MG,urinaryα1-MG,bloodβ2-MG,urinaryβ2-MG decreased significantly in liraglutide group compared with those before treatment,with statistical significance(P<0.01).After treatment,UACR,eGFR,serumα1-MG,urinaryα1-MG and urinaryβ2-MG decreased more significantly in the liraglutide group than in the insulin group,with statistical significance(P<0.05).Conclusion In the treatment of overweight and obese T2DM patients with nephropathy,liraglutide can not only reduce blood glucose and weight,but also improve renal function and delay the progression of nephropathy,and this effect is independent of the effect of lowering blood glucose.