达格列净联合维格列汀治疗老年糖尿病肾病患者的效果

Efficacy of Dapagliflozin Combined with Vildagliptin in the Treatment of Elderly Patients with Diabetic Nephropathy

目的探讨达格列净联合维格列汀治疗老年糖尿病肾病(DN)患者的效果及对尿蛋白与肌酐比值(uPCR)、肾小球滤过率(eGFR)和血清内皮素-1(ET-1)水平的影响。方法选取98例老年DN患者,随机分为对照组和观察组,各49例,对照组接受维格列汀治疗,观察组接受达格列净联合维格列汀治疗,观察两组治疗前及治疗12周的血糖[空腹血糖(FBG)、餐后2 h血糖(2 h PG)及糖化血红蛋白(HbA1c)]、胰岛素抵抗指数(HOMA-IR)、肾功能(uPCR、eGFR)、血清血管内皮功能指标[血管内皮生长因子(VEGF)、血管生成素1(Ang1)、ET-1]及其他血清生化指标[转化生长因子β1(TGF-β1)、基质金属蛋白酶-9(MMP-9)、组织金属蛋白酶抑制剂-1(TIMP-1)]水平变化。结果治疗12周后,两组FBG、2 h PG、HbA1c、HOMA-IR、uPCR水平低于治疗前(P<0.05),eGFR水平高于治疗前(P<0.05),两组血清VEGF、Ang1、ET-l、TGF-β1及TIMP-1水平低于治疗前(P<0.05),血清MMP-9水平高于治疗前(P<0.05),以上指标观察组的变化幅度大于对照组(P<0.05)。结论达格列净联合维格列汀能有效控制老年DN患者的血糖水平,改善胰岛β细胞功能和肾功能,抑制血清ET-1等血管内皮功能指标和TGF-β1、TIMP-1水平,并可上调MMP-9水平。

Objective To explore the efficacy of dapagliflozin combined with vildagliptin in the treatment of elderly patients with diabetic nephropathy(DN)and the effects on urinary protein to creatinine ratio(uPCR),estimated glomerular filtration rate(eGFR)and serum endothelin-1(ET-1).Methods The data of 98 elderly patients with DN were selected and the patients were randomly divided into control group and observation group,with 49 cases in each group.The control group was given vildagliptin treatment,and the observation group was given dapagliflozin combined with vildagliptin treatment.Blood glucose[fasting blood glucose(FBG),2-hour postprandial blood glucose(2 h PG),glycosylated hemoglobin(HbA1c)],homeostasis model assessment of insulin resistance(HOMA-IR),renal function(uPCR,eGFR),serum vascular endothelial function indicators[vascular endothelial growth factor(VEGF),angiogenin 1(Ang1),ET-1]and other serum biochemical indicators[transforming growth factorβ1(TGF-β1),matrix metalloproteinase-9(MMP-9),tissue inhibitor of metalloproteinase-1(TIMP-1)]in the two groups were compared before and after 12 weeks of treatment.Results After 12 weeks of treatment,the FBG,2 h PG,HbA1c,HOMA-IR and uPCR in the two groups were decreased compared with before treatment(P<0.05),while the eGFR was higher than before treatment(P<0.05),and serum levels of VEGF,Ang1,ET-l,TGF-β1 and TIMP-1 in both groups were declined compared before treatment(P<0.05),while serum level of MMP-9 was higher compared with before treatment(P<0.05),and the changes of the above indicators in observation group were greater than those in control group(P<0.05).Conclusion Dapagliflozin combined with vildagliptin can effectively control the blood glucose of elderly patients with DN,improve the pancreaticβcell function and renal function,and inhibit the levels of serum ET-1 and other vascular endothelial function indicators,TGF-β1 and TIMP-1,and it plays an up-regulation role in MMP-9 level.