SGLT-2抑制剂联合ACEI制剂治疗糖尿病肾病的疗效及对血清CysC、β_(2)-MG、hs-CRP的影响

Curative efficacy of sodium glucose cotransporter 2 inhibitor combined with ngiotensin converting inhibitor in the treatment of diabetic nephropathy and its effects on serum CysC,β_(2)-MG,hs-CRP levels

目的探讨钠-葡萄糖协同转运蛋白2(SGLT-2)抑制剂联合血管紧张素转换抑制剂(ACEI)治疗糖尿病肾病的疗效及对患者血清胱抑素C(CysC)、β_(2)微球蛋白(β_(2)-MG)、高敏C反应蛋白(hs-CRP)的影响。方法选取2019年3月至2020年6月珠海市中西医结合医院内分泌科收治的80例糖尿病肾病患者作为研究对象,按随机数表法分为观察组和对照组各40例。对照组患者采用培哚普利片治疗,观察组患者在对照组治疗的基础上联合达格列净片治疗,均持续治疗3个月。比较两组患者治疗3个月后的临床疗效,治疗前及治疗3个月后的空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、尿素氮(BUN)、血肌酐(SCr)、24 h尿蛋白定量(24 h UAER)、血清CysC、β_(2)-MG、hs-CRP水平和治疗期间的不良反应发生情况。结果治疗后,观察组患者的临床疗效总有效率为87.50%,明显高于对照组的65.00%,差异有统计学意义(P<0.05);治疗3个月后,观察组患者的FPG、2 hPG、HbA1c、BUN、SCr、24 h UAER分别为(6.16±1.30)mmol/L、(8.04±1.36)mmol/L、(6.90±0.63)%、(8.76±1.56)mmol/L、(105.57±8.31)μmol/L、(1.46±0.22)g,均明显低于对照组的(7.08±1.17)mmol/L、(9.22±1.41)mmol/L、(7.34±0.55)%、(10.08±1.74)mmol/L、(122.84±9.23)μmol/L、(1.95±0.30)g,差异均有统计学意义(P<0.05);治疗3个月后,观察组患者的血清CysC、β_(2)-MG、hs-CRP水平分别为(1.20±0.25)mg/L、(1.69±0.21)mg/L、(6.14±1.28)mg/L,明显低于对照组的(1.76±0.34)mg/L、(2.05±0.26)mg/L、(7.60±1.33)mg/L,差异均有统计学意义(P<0.05);观察组和对照组患者的不良反应总发生率分别为10.00%和7.50%,差异无统计学意义(P>0.05)。结论SGLT-2抑制剂达格列净联合ACEI培哚普利治疗糖尿病肾病患者的疗效显著,且可有效降低血清CysC、β_(2)-MG、hs-CRP水平,值得临床推广。

Objective To study the curative efficacy of sodium glucose cotransporter 2(SGLT-2)inhibitor combined with angiotensin converting inhibitor(ACEI)in the treatment of diabetic nephropathy and its effects on serum Cystatin C(CysC),β_(2)-microglobulin(β_(2)-MG),high sensitivity C-reactive protein(hs-CRP)levels in patients.Methods Eighty patients of diabetic nephropathy in Department of Endocrinology,Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from March 2019 to June 2020 were selected as the research subjects.They were randomly divided into an observation group and a control group,with 40 patients in each group.Patients in the control group were treated with perindopril tablets,and those in the observation group were treated with dapagliflozin tablets(SGLT-2 inhibitor)on the basis of the control group.Both groups were treated for 3 months.The clinical efficacy at 3 months after treatment,the changes in fasting blood glucose(FPG),2-hour postprandial blood glucose(2 hPG),glycosylated hemoglobin(HbA1c),urea nitrogen(BUN),serum creatinine(SCr),24-hour urinary protein quantification(24 h UAER),serum CysC,β_(2)-MG,hs-CRP levels before treatment and at 3 months after treatment were compared.The incidence of adverse reactions during treatment was also compared between the two groups.Results After treatment,the total effective rate in the observation group was 87.50%,which was significantly higher than 65.00%of the control group(P<0.05).After 3 months treatment,the FPG,2 hPG,HbA1c,BUN,SCr,and 24 h UAER in the observation group were(6.16±1.30)mmol/L,(8.04±1.36)mmol/L,(6.90±0.63)%,(8.76±1.56)mmol/L,(105.57±8.31)μmol/L,(1.46±0.22)g,which were significantly lower than(7.08±1.17)mmol/L,(9.22±1.41)mmol/L,(7.34±0.55)%,(10.08±1.74)mmol/L,(122.84±9.23)μmol/L,(1.95±0.30)g in the the control group(P<0.05).Three months after treatment,the serum CysC,β_(2)-MG,hs-CRP levels in the observation group were(1.20±0.25)mg/L,(1.69±0.21)mg/L,(6.14±1.28)mg/L,which were significantly lower than(1.76±0.34)mg/L,(2.05±0.26)mg/L,(7.60±1.33)mg/L in the control group(P<0.05).The total incidence of adverse reactions in the observation group and the control group were 10.00%and 7.50%,respectively,and the difference was not statistically significant(P>0.05).Conclusion SGLT-2 inhibitor dapagliflozin combined with ACEI perindopril in the treatment of diabetic nephropathy has significant efficacy,which can effectively reduce serum CysC,β_(2)-MG,hs-CRP levels,and thus is worthy of clinical promotion.