利拉鲁肽对早期糖尿病肾病代谢、炎症及肾损害指标的影响

Effects of liraglutide on metabolism,inflammation and renal damage indicators in the treatment of early diabetes nephropathy

目的探讨早期糖尿病肾病(DKD)患者应用利拉鲁肽治疗后代谢指标、炎症指标及肾损害功能指标获益情况。方法纳入160例早期DKD患者,对照组和治疗组分别为80例,对照组给予二甲双胍联合其它口服药物或胰岛素治疗,治疗组保留二甲双胍基础上改用利拉鲁肽治疗,均治疗3个月,治疗前后留取晨尿标本测定尿微量白蛋白(UAlb)和尿肌酐(uUCr)计算比值(UACR),应用彩色多普勒超声测定肾血流参数,测定肾脏功能和炎症指标。结果治疗3个月后,治疗组体质量指数(BMI)、腰围(WC)、低密度脂蛋白胆固醇(LDL)、甘油三脂(TG)相比治疗前和对照组治疗后明显下降,差异有统计学意义(P<0.01);治疗组患者血胱抑素、UACR水平低于治疗前和对照组(P<0.05);治疗组肾动脉和肾段动脉舒张期末血流速度(EDV)均明显高于治疗前和对照组(P<0.01);治疗组治疗后患者CRP、TNF-α、IL-6水平低于治疗前(P<0.05)和对照组(P<0.05);治疗组血胱抑素相比治疗前和对照组治疗后明显下降,有统计学意义(P<0.05);治疗组肾动脉和肾段动脉EDV均明显高于治疗前和对照组(P<0.01),治疗组肾大叶间动脉收缩期峰值血流速度(PSV)及EDV均明显高于治疗前和对照组(P<0.01)。而阻力指数(RI)则显著低于治疗前和对照组(P<0.01)。结论利拉鲁肽可改善早期DKD患者的血脂、体重及炎症指标,提升肾动脉血流,改善肾脏功能指标。

Objective To explore the improvement of metabolic indicators,inflammatory indicators and renal damage function indicators in patients with early diabetes kidney disease(DKD)after treatment with liraglutide.Methods A total of 160 patients with early DKD were enrolled,which were divided into the control group and the treatment group,with 80 cases in each group.The control group was treated with metformin combined with other oral drugs or insulin,while the treatment group was treated with liraglutide on the basis of metformin.All patients were treated for three months.Morning urine samples were taken before and after treatment to measure urinary microalbumin(UAlb)and urinary creatinine(UCr)in order to calculate the UACR.The renal blood flow parameters before and after treatment were measured by using color Doppler ultrasound.The renal function,and inflammatory indicators were measured.Results After three months of treatment,body mass index(BMI),waist circumference(WC),low density lipoprotein cholesterol(LDL)and Triglyceride(TG)in the treatment group decreased significantly compared with those in the control group(P<0.05);After three months of treatment,the levels of serum cystatin and UACR in the treatment group were lower than those before treatment(P<0.05);The end diastolic blood flow velocity(EDV)of renal artery and segmental artery in the treatment group was significantly higher than that in the control group(P<0.01);The levels of CRP,TNF-αand IL-6 of patients in the treatment group after treatment were lower than those before treatment;After three months of treatment,the serum cystatin in the treatment group decreased significantly compared with that before treatment and that after treatment in the control group,with statistical significance(P<0.05).After three months of treatment,the EDV of renal artery and renal segmental artery in the treatment group was significantly higher than that before treatment and that in the control group(P<0.01),and the peak systolic blood flow velocity(PSV)and EDV of renal interlobular artery in the treatment group were significantly higher than that before treatment and that in the control group(P<0.01).The resistance index(RI)in the treatment group was significantly lower than that before treatment and in the control group(P<0.01).Conclusion In addition to hypoglycemic effect,liraglutide can improve blood lipid and inflammatory indicators of the weight gauge in early DKD patients,enhance renal artery blood flow,and improve renal function indicators.