利拉鲁肽对老年2型糖尿病患者经皮冠状动脉介入治疗后造影剂肾病及预后的影响

Impact of liraglutide on contrast-induced nephropathy and prognosis in elderly patients with type 2diabetes after PCI

目的 探讨利拉鲁肽对老年2型糖尿病(T2DM)患者经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)及预后的影响。方法 回顾性分析2021年1月至2022年6月于天津市胸科医院心内科行PCI的老年T2DM患者364例,根据既往是否使用利拉鲁肽分为利拉鲁肽组145例和对照组219例。收集2组患者一般临床资料并使用倾向性评分匹配法校正混杂因素,倾向性评分匹配后,共纳入患者220例,每组110例。比较匹配后2组PCI术前及术后48 h血清肌酐(Scr)、尿素(BUN)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、高敏C反应蛋白(hs-CRP)、丙二醛(MDA)、超氧化物歧化酶(SOD)、B淋巴细胞瘤-2相关X蛋白/B淋巴细胞瘤2基因比值、半胱氨酸天冬氨酸蛋白酶9及CIN发病率的差异,并在出院后随访18个月。采用多因素logistic回归分析利拉鲁肽对CIN发生的影响,采用Kaplan-Meier生存曲线分析和log rank检验比较2组主要不良心血管事件(MACE)发生的差异。结果 利拉鲁肽组术后48 h Scr、BUN、NGAL、hs-CRP、MDA水平显著低于对照组,SOD水平显著高于对照组(P<0.05,P<0.01)。利拉鲁肽组术后48 h CIN发病率显著低于对照组(7.27%vs 16.36%,P<0.05)。多因素logistic回归分析显示,利拉鲁肽是老年T2DM患者发生CIN的独立保护因素(OR=0.341,95%CI:0.128~0.906,P=0.031)。中位随访时间14.75(12.60,16.33)个月,利拉鲁肽组MACE发生率显著低于对照组(log rank χ^(2)=5.656,P=0.017)。结论 利拉鲁肽可以减少老年T2DM患者PCI术后CIN及MACE的发生,可能与其抗炎、抗氧化应激作用有关。

Objective To investigate the impact of liraglutide on contrast-induced nephropathy(CIN)and prognosis in elderly patients with type 2diabetes(T2DM)after PCI.Methods A retrospective trial was conducted on 364elderly T2DM patients undergoing PCI in Department of Cardiology of Tianjin Chest Hospital from January 2021to June 2022.According to whether liraglutide was used in the past,they were divided into liraglutide group(n=145)and control group(n=219).Their general clinical data were collected in the two groups.Propensity score matching was used to adjust confounding factors and to assign the patients.After propensity score matching,there were 220patients finally included,with 110in each group.The levels of serum creatinine(Scr),blood urea nitrogen(BUN),neutrophil gelatinase-associated lipocalin(NGAL),hypersensitive C-reactive protein(hs-CRP),malondialdehyde(MDA),superoxide dismutase(SOD),Bax/BCL-2and Caspase 9,and incidence of CIN were compared before and in 48hafter PCI between the matched patients from the two groups.These patients were followed up for 18months after discharge.Multivariate logistic regression analysis was employed to determine the effect of liraglutide on the occurrence of CIN.Kaplan-Meier curve analysis and Log rank test were appliedto compare the differences in the incidence of major adverse cardiovascular events(MACE)between 2groups.Results The levels of Scr,BUN,NGAL,hs-CRP,and MDA were significantlylower,and SOD level was obviously higher in the liraglutide group than the control group in 48hafter PCI(P<0.05,P<0.01).The liraglutide group had notably lower incidence of CIN than thecontrol group within 48hafter PCI(7.27%vs 16.36%,P<0.05).Multivariate logistic regression analysis indicated liraglutide as an independent protective factor against CIN (OR=0.341,95%CI:0.128-0.906,P=0.031).During the median follow-up period of 14.75(12.60,16.33)months,a lower MACE occurrence rate was seen in the liraglutide group than the control group(log rankχ^(2)=5.656,P=0.017).Conclusion Liraglutide can reduce the incidences of CIN and MACE in elderly T2DM patients after PCI,which may be associated with its anti-inflammatoryand antioxidant effects.