观察达格列净对2型糖尿病患者的作用和血尿酸的影响

Observation the Effects of Dapagliflozin on Patients with Type 2 Diabetes Mellitus and the Influence of Blood Uric Acid

目的 观察达格列净对2型糖尿病患者的作用和血尿酸(serum uric acid,SUA)的影响。方法 选取2020年4月—2021年10月重庆市红十字会医院(江北区人民医院)内分泌门诊收治的102例2型糖尿病患者作为研究对象,按照SUA<300μmol/L,300~<400μmol/L,400~500μmol/L,>500μmol/L对患者进行分组,分为ABCD4组。达格列净治疗12周,对比治疗前后体质量、腰围、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、糖化血红蛋白(glycated hemoglobin A1c,HbA1c)、空腹血糖(fasting plasma glucose,FPG),餐后2 h血糖(2-hour postprandial blood glucose,2 hPG)、尿微量白蛋白/肌酐(urine albumin creatine ratio,UACR)、肾小球滤过率(estimated glomerular filtration rate,eGFR)、三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、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)、SUA、24 h尿尿酸、血肌酐(serum creatinine,SCr)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)的变化。结果 治疗后12周,患者体质量、腰围、SBP、DBP、UACR、eGFR、TG、TC、LDL-C均低于治疗前,差异无统计学意义(P>0.05);FPG,2 hPG、HbA1c、SUA均低于治疗前,差异有统计学意义(P<0.05);24 h尿尿酸、SCr、HDL-C高于治疗前,差异无统计学意义(P>0.05)。4组间年龄、FPG、2 hPG、SBP、DBP、UACR比较,差异无统计学意义(P>0.05);随基线SUA水平升高,体质量、腰围、SCr呈上升趋势,24 h尿尿酸呈下降趋势。4组SUA和24 h尿尿酸比较,差异有统计学意义(P<0.05);4组达格列净治疗前后SUA差值逐渐升高,B组高于A组,差异无统计学意义(P>0.05),C组、D组高于A组、B组,差异有统计学意义(P<0.05),D组高于C组,差异无统计学意义(P>0.05)。结论 达格列净可以降低2型糖尿病患者的FPG、2 hPG、HbA1c、SUA,且基线SUA水平越高,降低SUA幅度越大。

Objective To observe the effect of dapagliflozin on patients with type 2 diabetes and its effect on serum uric acid(SUA).Methods From April 2020 to October 2021,102 patients with type 2 diabetes mellitus admitted to the endocrine clinic of Chongqing Red Cross Hospital(Jiangbei District People's Hospital)were selected as the research objects,and they were divided into four groups ABCD according to blood uric acid<300μmol/L,300~<400μmol/L,400~500μmol/L,>500μmol/L.Dapagliflozin was treated for 12 weeks.Body weight,waist circumference,systolic blood pressure(SBP),diastolic blood pressure(DBP),glycated hemoglobin A1c(HbA1c),fasting plasma glucose(FPG),2-hour postprandial blood glucose(2 hPG),urine albumin creatine ratio(UACR),estimated glomerular filtration rate(eGFR),triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),SUA,24-hour urine uric acid,serum creatinine(SCr),estimated glomerular filtration rate(eGFR)were compared before and after treatment.Results At 12 weeks after treatment,the body weight,waist circumference,SBP,DBP,UACR,eGFR,TG,TC and LDL-C of the patients were lower than those before treatment,and the differences were not statistically significant(P>0.05);FPG,2 hPG,HbA1c and SUA were lower than those before treatment,and the differences were statistically significant(P<0.05);24 h urine uric acid,SCr and HDL-C were higher than those before treatment,and the difference was not statistically significant(P>0.05).There was no statistically significant difference in age,FPG,2 hPG,SBP,DBP and UACR among the four groups(P>0.05).With the increase of baseline SUA level,body weight,waist circumference and SCr showed an upward trend,and 24-hour urine uric acid showed a downward trend.There were statistically significant differences in SUA and 24-hour urine uric acid among the four groups(P<0.05).The difference of SUA in the four groups before and after dapagliflozin treatment gradually increased,and that in group B was higher than that in group A,but the difference was not statistically significant(P>0.05),the difference of SUA in group C and group D was higher than that in group A and group B,and the difference was statistically significant(P<0.05),group D was higher than group C,and the difference was not statistically significant(P>0.05).Conclusion Dapagliflozin can reduce fasting blood glucose,2-hour postprandial blood glucose,glycosylated hemoglobin and uric acid in patients with type 2 diabetes,and the higher the baseline blood uric acid level,the greater the reduction in blood uric acid.