达格列净片对老年2型DKD合并高血压患者尿蛋白的影响

Effect of Dapagliflozin tablet on urine protein in elderly patients with Type 2 diabetic nephropathy complicated with hypertension

目的探讨达格列净对老年2型糖尿病肾病(DKD)合并高血压病患者尿蛋白的影响。方法选取2018年12月~2019年12月于郑州大学第一附属医院住院的老年2型糖尿病肾病患者186例为研究对象,所有入选者均患有高血压病。根据是否给予达格列净治疗分为达格列净组(93例,使用达格列净10mg)和对照组[93例,使用非钠-葡萄糖同向转运蛋白2抑制剂(SGLT2i)的常规药物治疗]。首次入院时均完善糖化血红蛋白(HbA_(1c))、血压、基线体重或BMI、24 h尿蛋白、尿白蛋白肌酐比(UACR)和肾小球滤过率(eGFR),观察1年后两组患者的上述指标结果。结果达格列净组的UACR、收缩压(SBP)及体重指数(BMI)在治疗1年后均较对照组有明显降低,差异有统计学意义(P<0.05)。1年内发生的首要终点事件结果分析,达格列净组较对照组具有明显的保护作用(HR=0.157,95%CI 0.046~0.538,P<0.05)。1年内发生的累积泌尿系统及下肢截肢事件结果分析,两组比较差异无统计学意义(HR=0.901,95%CI 0.383~2.121,P>0.05)。结论在老年2型糖尿病肾病合并高血压病的患者中应用达格列净药物降糖的同时可以有效减少尿蛋白排泄,保护肾功能。

Objective To investigate the effect of dapagliflozin on urinary protein in elderly patients with type 2 diabetic nephropathy complicated with hypertension.Methods 186 elderly patients with type 2 diabetic nephropathy(DKD)admitted to The First Affiliated Hospital of Zhengzhou University from December 2018 to December 2019 were observed.All the enrolled patients had hypertension.According to whether dapagliflozin was given,the patients were divided into two groups:dapagliflozin group(93 patients were treated with dapagliflozin 10mg)and control group(93 patients were treated with conventional drugs other than SGLT2i).Hemoglobin A1c(HbA_(1c)),blood pressure,baseline body weight or BMI,24-hour urinary protein,urinary albumin creatinine ratio(UACR)and glomerular filtration rate(eGFR)were completed at first admission.Results of these indicators were observed 1 year later in both groups.Results The UACR,SBP and BMI of the dapagliflozin group were significantly lower than those of the control group after 1 year of treatment,and the differences were statistically significant(P<0.05).In the analysis of primary endpoint events that occurred within 1 year,the dapagliflozin group had a significant protective effect compared with the control group(HR=0.157,95%CI 0.046-0.538,P<0.05).There was no significant difference in cumulative urinary and lower limb amputation events at 1 year between the two groups(HR=0.901,95%CI 0.383-2.121,P>0.05).Conclusion Dapagliflozin can effectively reduce urinary protein excretion and protect renal function in elderly patients with type 2 diabetic nephropathy complicated with hypertension.