GLP-1受体激动剂联合依帕司他与贝前列素治疗2型糖尿病伴有周围神经病变患者的临床效果

Effects of GLP-1 receptor agonist combined with epalrestat and beprost on type 2 diabetes mellitus patients with peripheral neuropathy

目的探讨胰高血糖素样肽-1(GLP-1)受体激动剂联合依帕司他、贝前列素治疗2型糖尿病伴有周围神经病变患者的临床效果。方法选取2019年7月至2021年7月在赤峰学院附属医院确诊的85例2型糖尿病伴有周围神经病变患者进行临床前瞻性随机试验,依据随机数字表方法将患者分为试验组43例和对照组42例。对照组患者采用降血糖药物+依帕司他+贝前列素的基础治疗,试验组在此治疗基础之上同时使用艾塞那肽进行治疗,两组疗程均为6个月。比较两组患者的血糖控制效果[空腹血糖、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)]、神经传导速度[神经传导速度(MNCV)和感觉神经传导速度(SNCV)]、血清鸢尾素、脂联素、一氧化氮、内皮素水平的变化及临床效果差异。结果治疗后,两组患者的空腹血糖、2 hPG、HbA1c较治疗前显著降低,差异均有统计学意义(P<0.05),但是两组患者之间的上述指标比较,差异均无统计学意义(P>0.05)。治疗后,两组患者的正中神经、腓总神经的MNCV、SNCV测定值较治疗前显著升高,且试验组正中神经MNCV、SNCV为(47.67±5.02)、(45.64±4.70)m/s,腓总神经MNCV、SNCV为(47.94±4.94)、(45.58±4.20)m/s,均高于对照组[正中神经:(43.88±4.64)、(42.81±5.12)m/s;腓总神经:(44.56±5.50)、(42.74±4.95)m/s],差异均有统计学意义(P<0.05)。治疗后,两组患者的血清鸢尾素、脂联素、一氧化氮较治疗前显著升高,内皮素较治疗显著降低,且试验组的血清鸢尾素、一氧化氮为(189.60±28.60)ng/mL、(69.50±12.44)μmol/L,均高于对照组[(174.40±26.30)ng/mL、(64.19±10.50)μmol/L],差异均有统计学意义(P<0.05)。治疗后,试验组患者的临床效果整体优于对照组,差异有统计学意义(P<0.05)。结论GLP-1受体激动剂联合依帕司他、贝前列素治疗2型糖尿病伴有周围神经病变临床效果较为显著,在改善神经传导速度,提高鸢尾素、脂联素、一氧化氮水平,降低内皮素方面的作用更为明显。

Objective To investigate the clinical effect of glucagon like peptide-1(GLP-1)receptor agonist combined with epalrestat and beprost in the treatment of type 2 diabetes mellitus patients with peripheral neuropathy.Methods In this study,85 type 2 diabetes mellitus patients with peripheral neuropathy diagnosed in Affiliated Hospital of Chifeng University from July 2019 to July 2021 were selected for clinical prospective randomized trial,and the patients were divided into test group(43 cases)and control group(42 cases)according to the random number grouping method.The patients in the control group were treated with hypoglycemic drugs+epalastatin+beprost,On the basis of this treatment,the test group also used exenatide for treatment,the treatment period of both groups were 6 months.The blood glucose control effect[fasting plasma glucose,2 h postprandial blood glucose(2 hPG),hemoglobin A1c(HbA1c)],nerve conduction velocity[motor nerve conduction velocity(MNCV),sensory nerve conduction velocity(SNCV)],changes in serum levels of Irisin,adiponectin,nitric oxide,endothelin and clinical effects of the two groups of patients were compared.Results After treatment,fasting plasma glucose,2 hPG,HbA1c of patients in the test group and control group were significantly lower than those before treatment(P<0.05),but the above indicators between the two groups were significantly different(P>0.05).After treatment,the MNCV and SNCV of median nerve and common peroneal nerve of patients in the test group and control group were higher than those before treatment,moreover,the MNCV and SNCV of the median nerve in the test group were(47.67±5.02),(45.64±4.70)m/s,and the MNCV and SNCV of the common peroneal nerve were(47.94±4.94),(45.58±4.20)m/s,which were significantly higher than those in the control group[median nerve:(43.88±4.64),(42.81±5.12)m/s,common peroneal nerve:(44.56±5.50),(42.74±4.95)m/s],the differences were statistically significant(P<0.05).After treatment,serum Irisin,adiponectin and nitric oxide of the patients in the test group and the control group were significantly higher than those before treatment,and endothelin was significantly lower than those before treatment,the levels of serum Irisin and nitric oxide in the test group were(189.60±28.60)ng/mL,(69.50±12.44)μmol/L,which were higher than those in the control group[(174.40±26.30)ng/mL,(64.19±10.50)μmol/L],and the differences were statistically significant(P<0.05).After treatment,the clinical effect of the patients in the test group was better than that of the patients in the control group,and the difference was statistically significant(P<0.05).Conclusion The clinical effect of GLP-1 receptor agonist combined with epalrestat and beprost in the treatment of type 2 diabetes mellitus with peripheral neuropathy is relatively significant,especially in improving nerve conduction velocity,increasing the level of Irisin,adiponectin and nitric oxide,and reducing endothelin.