利拉鲁肽与西格列汀对早期2型糖尿病肾病患者肾脏血流动力学及NLR、Cys-C、MCP-1的影响

Effects of liraglutide and selegiline on renal hemodynamics and NLR, Cys-C, and MCP-1 in patients with early stage type 2 diabetic nephropathy

目的探究利拉鲁肽与西格列汀对早期2型糖尿病肾病(T2DN)患者肾脏血流动力学及中性粒细胞/淋巴细胞比值(NLR)、血清胱抑素C(CysC)、单核细胞趋化因子-1(MCP-1)的影响。方法选取2020年12月—2022年12月邯郸市第一医院内分泌一科收治的早期T2DN患者110例为研究对象。按随机数排秩法将患者分为对照组(n=55)与观察组(n=55)。对照组予以西格列汀治疗,观察组予以利拉鲁肽联合西格列汀治疗,2组患者均治疗12周。比较2组疗效、血糖指标、双肾主动脉(MRA)和叶间动脉(IRA)的肾脏血流动力学指标、NLR、Cys-C、MCP-1以及不良反应发生情况,分析尿蛋白排泄率(UAER)与血清NLR、CysC、MCP-1的关系。结果观察组总有效率为90.91%,高于对照组的67.27%(χ^(2)/P=9.290/0.002)。治疗12周后,2组HbA_(1c)、FPG、2 h PG水平较治疗前降低,且观察组低于对照组(t/P=4.222/<0.001、6.064/<0.001、6.648/<0.001);2组IRA、MRA的Vdmin、Vsmax较治疗前升高,且观察组较对照组升高更明显(t/P=3.733/<0.001、6.800/<0.001,2.598/0.011、2.043/0.043);2组IRA、MRA的PI、RI较治疗前降低,且观察组较对照组降低更明显(t/P=4.194/<0.001、3.933/<0.001,3.265/0.001、6.171/<0.001);2组UAER、NLR、Cys-C、MCP-1水平较治疗前明显降低,且观察组较对照组降低更明显(t/P=14.534/<0.001、2.609/0.010、9.795/<0.001、6.618/<0.001);Pearson分析,NLR、Cys-C、MCP-1与UAER均呈正相关(r=0.513、0.764、0.685,P均<0.001)。2组不良反应发生率比较差异无统计学意义(χ^(2)/P=0.910/0.340)。结论利拉鲁肽联合西格列汀治疗早期T2DN具有良好疗效,可有效改善肾脏血流动力学,调节NLR、Cys-C、MCP-1水平,保护肾功能。

Objective To investigate the effects of liraglutide and selegiline on renal hemodynamics and neutrophil/lymphocyte ratio(NLR),serum cystatin C(CysC),and monocyte chemoattractant-1(MCP-1)in patients with early-onset type 2 diabetic nephropathy(T2DN).The effects of NLR,serum cystatin C(CysC),and monocyte chemokine-1(MCP-1).Methods One hundred and ten patients with early T2DN admitted to the Department of Endocrinology I of the First Hospital of Handan City from December 2020 to December 2022 were selected as study subjects.The patients were divided into observation group(n=55)and control group(n=55)according to random number ranking method.The control group was treated with selegiline and the observation group was treated with liraglutide combined with selegiline for 12 weeks.We compared the efficacy,glycemic indexes,renal hemodynamic indexes in both renal aorta(MRA)and interlobar artery(IRA),NLR,Cys-C,MCP-1,and the occurrence of adverse reactions between the two groups,and analyzed the relationship between urinary protein excretion rate(UAER)and serum NLR,CysC,and MCP-1.Results The total effective rate of the observation group was 90.91%,higher than that of the control group,which was 67.27%(χ^(2)/P=9.290/0.002).After 12 weeks of treatment,the levels of HbA_(1c),FPG,and 2 h PG in the 2 groups were lower than those before treatment,and the observation group was lower than the control group(t/P=4.222/<0.001,6.064/<0.001,6.648/<0.001);Vdmin and Vsmax of IRA and MRA in the 2 groups were elevated compared with those before treatment,and the elevation was more obvious in the observation group than the control group(t/P=3.733/<0.001,6.800/0.001,2.598/0.011,2.043/0.043);the PI and RI of IRA and MRAof group 2 were reduced compared with those before treatment,and the reduction was more obvious in the observation group than in the control group(t/P=4.194/<0.001,3.933/<0.001,3.265/0.001,6.171/<0.001);2 group’s UAER,NLR,Cys-C,and MCP-1levels were reduced compared with those before treatment,and the reduction was more obvious in the observation group than the control group(t/P=14.534/<0.001,2.609/0.010,9.795/<0.001,6.618/<0.001);Pearson's analysis,NLR,Cys-C,and MCP-1 were positively correlated with UAER(r=0.513,20.764,0.685,all P<0.001).The difference in the incidence of adverse reactions between the 2 groups was not statistically significant when compared(χ^(2)/P=0.910/0.340).Conclusions Liraglutide combined with selegiline has good efficacy in the treatment of early T2DN,which can effectively improve renal hemodynamics,regulate the levels of NLR,Cys-C and MCP-1,and protect renal function.