SGLT2抑制剂与GLP-1受体激动剂对2型糖尿病合并感染患者肾功能的保护作用

Protective effects of SGLT 2 inhibitors versus GLP-1 receptor agonists on renal function in type 2 diabetic patients with infection

目的探究钠-葡萄糖协同转运蛋白2(sodium-glucose cotransporter 2 Inhibitors,SGLT2)抑制剂和胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)受体激动剂对2型糖尿病合并感染患者肾功能的影响。方法选取2020年1月至2023年1月在济南市第二人民医院接受治疗的120例2型糖尿病合并感染患者作为研究对象,利用抽签的方式将其随机平均分为两组。对照组男23例,女37例,年龄(55.23±5.46)岁;观察组男26例,女34例,年龄(54.87±4.98)岁。两组均维持原降糖治疗及抗感染治疗,在此基础上对照组给予利拉鲁肽治疗,观察组给予达格列净治疗,均连续应用14 d。比较两组患者治疗前后空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(hemoglobin a1c,HbA1c)、餐后2 h血糖(2-hour postprandial blood glucose,2hPBG)、胰岛素抵抗指数(homeostatic model assessment of insulin resistance,HOMA-IR)的水平,总胆固醇(total cholesterol,TC)、三酰甘油(triglycerides,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-Density lipoprotein cholesterol,HDL-C)的水平,及患者体内阳性细菌清除率、肾功能相关指标变化情况。结果两组患者治疗前血糖水平、HOMA-IR指标比较,差异均无统计学意义(均P>0.05);治疗后,两组血糖水平及HOMA-IR指标均降低;治疗后对照组FPG、HbA1c、2hPBG、HOMA-IR分别为(7.73±0.52)mmol/L、(7.80±0.67)%、(13.57±1.86)mmol/L、(3.15±0.29)mmol/L,观察组分别为(6.51±0.96)mmol/L、(5.95±0.72)%、(7.90±0.74)mmol/L、(2.56±0.33)mmol/L,观察组指标降低更明显(t=8.656、14.570、22.146、10.403,均P<0.05)。两组患者治疗前血脂水平比较,差异均无统计学意义(均P>0.05);治疗后,两组TC、TG、LDL-C水平均下降,HDL-C水平上升。治疗后对照组TC、TG、LDL-C水平分别为(5.36±1.02)mg/dl、(1.88±0.34)mg/dl、(2.77±0.77)mg/dl,观察组分别为(4.98±0.95)mg/dl、(1.66±0.31)mg/dl、(1.89±0.45)mg/dl,对照组HDL-C为(1.02±0.14)mg/dl,观察组为(1.13±0.22)mg/dl,观察组血脂水平改变较对照组显著(t=2.112、3.704、7.643、-3.267,均P<0.05)。两组患者治疗前肾功能指标比较差异无统计学意义(均P>0.05),治疗后两组肾功能指标均高于治疗前;治疗后,对照组β2微球蛋白为(1.62±0.21)mg/L、胱抑素为(1.49±0.24)mg/L、血肌酐为(97.54±8.96)mg/L、尿素氮为(5.54±2.41)mg/L,观察组分别为(1.55±0.13)mg/L、(1.32±0.34)mg/L、(94.42±9.62)mg/L、(5.36±2.34)mg/L,观察组较对照组上升幅度更小。两组不良反应比较,差异无统计学意义(P>0.05)。结论SGLT2抑制剂与GLP-1受体激动剂均具有降糖、降脂作用,对治疗2型糖尿病合并感染患者的效果良好,能保护患者肾功能,且SGLT2抑制剂治疗效果更好。

Objective To explore the effects of sodium-glucose cotransporter 2(SGLT 2)inhibitors and glucagon-like peptide-1(GLP-1)receptor agonists on renal function in type 2 diabetic patients with infection.Methods One hundred and twenty type 2 diabetic patients with infection treated in Jinan Second People's Hospital from January 2020 to January 2023 were selected and randomly divided into a control group and an observation group by lottery,with 60 cases in each group.There were 23 males and 37 females in the control group;they were(55.23±5.46)years old.There were 26 males and 34 females in the observation group;they were(54.87±4.98)years old.Both groups maintained primary hypoglycemic therapy and received anti-infection treatment.Before and after the treatment,fasting plasma glucose(FPG),glycated hemoglobin A1c(HbA1c),2-hour postprandial blood glucose(2hPBG),the insulin resistance index(homeostatic model assessment of insulin resistance,HOMA-IR),levels of total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C),the clearance rates of positive bacteria,and the changes in renal function-related indicators were compared between the two groups.Before the treatment,there were no statistical differences in the blood glucose levels and HOMA-IR between the two groups(all P>0.05).After the treatment,the FPG,HbA1c,2hPBG,and HOMA-IR decreased in both groups,and those in the observation group were lower than those in the control group[(6.51±0.96)mmol/L vs.(7.73±0.52)mmol/L,(5.95±0.72)%vs.(7.80±0.67)%,(7.90±0.74)mmol/L vs.(13.57±1.86)mmol/L,(2.56±0.33)mmol/L vs.(3.15±0.29)mmol/L;t=8.656,14.570,22.146,and 10.403;all P<0.05].Before the treatment,there were no statistical differences in the serum lipid levels between the two groups(all P>0.05).After the treatment,the levels of TC,TG,and LDL-C decreased and the HDL-C level increased in both groups,and the levels in the observation group were better than those in the control group[(4.98±0.95)mg/dl vs.(5.36±1.02)mg/dl,(1.66±0.31)mg/dl vs.(1.88±0.34)mg/dl,(1.89±0.45)mg/dl vs.(2.77±0.77)mg/dl,and(1.13±0.22)mg/dl vs.(1.02±0.14);t=2.112,3.704,7.643,-3.267;all P<0.05].Before the treatment,there were no statistical differences in the levels of renal function indicators between the two groups(all P>0.05).After the treatment,the levels ofβ2 microglobins,cystatin C,blood creatinine,and blood urea nitrogen were higher than those before the treatment in both groups,and the levels in the observation group were lower than those in the control group[(1.55±0.13)mg/L vs.(1.62±0.21)mg/L,(1.32±0.34)mg/L vs.(1.49±0.24)mg/L,(94.42±9.62)mg/L vs.(97.54±8.96)mg/L,(5.36±2.34)mg/L vs.(5.54±2.41)mg/L.There was no statistical difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Both SGLT 2 inhibitors and GLP-1 receptor agonists for type 2 diabetic patients are effective,have glucose-and lipid-lowering effects,and can protect renal function,but SGLT 2 inhibitors is better.