左卡尼汀联合恩格列净治疗对早期糖尿病肾病患者的疗效

Effect of levocarnitine combined with engegligin on early diabetes nephropathy

目的探究左卡尼汀联合恩格列净治疗对早期糖尿病肾病(DN)患者尿蛋白、肾小球滤过率(eGFR)及血清可溶性细胞黏附分子-1(sICAM⁃1)、补体C1q肿瘤坏死因子相关蛋白9(CTRP9)水平的影响。方法选择2021年4月-2022年8月河南科技大学第一附属医院收治的90例DN Mogensen分期Ⅱ~Ⅲ期患者进行前瞻性研究,利用随机数字表法进一步将其分为对照组(n=45)和研究组(n=45)。对照组在常规治疗的基础上给予恩格列净,1片/次,1次/d,治疗3个月;研究组在对照组的基础上给予左卡尼汀,1片/次,3次/d,治疗3个月。收集患者的临床资料,比较两组患者临床疗效、肾功能指标、炎症指标、血清sICAM⁃1、CTRP9水平的变化及不良反应发生率。结果与对照组(77.78%)比较,研究组(95.56%)的总有效率显著增加,差异有统计学意义(χ^(2)=4.712,P=0.030)。治疗后,对照组和研究组24 h尿蛋白[(92.84±20.28)mg vs.(80.32±18.44)mg]、尿素氮[(9.06±2.01)mmol/L vs.(7.92±1.78)mmol/L]、血肌酐[(82.33±20.37)μmol/L vs.(65.83±18.05)μmol/L]、血清sICAM⁃1[(6.62±1.36)pg/mL vs.(5.38±1.01)pg/mL]、白细胞介素6(IL⁃6)[(7.63±1.74)pg/mL vs.(6.45±1.36)pg/mL]及IL⁃1β[(3.17±0.62)pg/mL vs.(2.22±0.36)pg/mL]均明显降低(t=3.064、2.848、4.067、4.910、3.584、8.889,P均<0.01),eGFR[(88.68±19.35)mL/(min·1.73 m^(2))vs.(105.38±21.36)mL/(min·1.73 m^(2))]、血清CTRP9[(3.39±0.72)pg/mL vs.(4.17±0.86)pg/mL]明显升高(t=3.887、4.665,P均<0.001),且上述指标研究组改善的效果更为明显(P<0.05),差异均有统计学意义。结论左卡尼汀联合恩格列净治疗可降低早期DN患者血清sICAM⁃1及炎症因子表达水平,升高血清CTRP9的表达水平,并可能有助于改善患者的肾功能。

Objective To investigate the impacts of levocarnitine combined with empagliflozin on urinary protein,estimated glomerular filtration rate(eGFR),serum soluble intercellular cell adhesion molecule⁃1(sICAM⁃1)and C1q tumor necrosis factor related protein 9(CTRP9)levels in patients with early diabetes nephropathy(DN).Methods Ninety patients with DN(Mogensen Staging PhaseⅡ-Ⅲ)admitted to the First Affiliated Hospital of Henan University of Science and Technology from April 2021 to August 2022 were randomly grouped into control group(45 cases)and study group(45 cases).The control group was given empagliflozin,1 tablet/time,1 time/d,for 3 months;the study group was given levocarnitine,1 tablet/time,3 times/d,in addition of empagliflozin as in the control group for 3 months.The clinical data of patients were collected,and the clinical efficacy,renal function indicators,inflammatory indicators,changes in serum sICAM⁃1,CTRP9 levels and the incidence of adverse reactions were compared between the two groups.Results Compared with the control group(77.78%),the total effective rate of the study group(95.56%)was obviously increased,the difference was statistically significant(χ^(2)=4.712,P=0.030).After treatment,the 24⁃hour urinary total protein[(92.84±20.28)mg vs.(80.32±18.44)mg],urea nitrogen[(9.06±2.01)mmol/L vs.(7.92±1.78)mmol/L],serum creatinine[(82.33±20.37)μmol/L vs.(65.83±18.05)μmol/L],serum sICAM⁃1[(6.62±1.36)pg/mL vs.(5.38±1.01)pg/mL],interleukin⁃6(IL⁃6)[(7.63±1.74)pg/mL vs.(6.45±1.36)pg/mL]and IL⁃1β[(3.17±0.62)pg/mL vs.(2.22±0.36)pg/mL]of DN patients in the two groups were obviously decreased(t=3.064,2.848,4.067,4.910,3.584,8.889;all P<0.01),while eGFR[(88.68±19.35)mL/(min·1.73 m^(2))vs.(105.38±21.36)mL/(min·1.73 m^(2))]and serum CTRP9[(3.39±0.72)pg/mL vs.(4.17±0.86)pg/mL]were obviously increased(t=3.887,4.665;all P<0.001),and the improvement effects of the above indicators in the study group were more obvious(P<0.05).Conclusions Levocarnitine combined with empagliflozin was effective in the treatment of early DN patients.It could reduce the expression levels of serum sICAM⁃1 and inflammatory factors,increase the expression level of CTRP9,and improve the renal function of patients.