二甲双胍对2型糖尿病肾脏病患者血清人软骨糖蛋白-39的影响

The Effect of Metformin on the Serum Level of YKL-40 in Patients with Type 2 Diabetic Nephropathy

目的探讨二甲双胍对早期2型糖尿病肾病(DKD)患者血清人软骨糖蛋白-39(YKL-40)的影响。方法选取2015年6月至2017年8月于菏泽市立医院内分泌科住院的120例DKD患者作为研究对象,随机分为观察组和对照组,每组60例。观察组患者采用二甲双胍联合胰岛素治疗,对照组患者采用单纯胰岛素治疗,疗程均为12周,观察两组患者治疗前后血糖、糖化血红蛋白(HbA1c)、空腹胰岛素水平(FIns)、胰岛素抵抗指数(HOMA-IR)、血肌酐(Scr)、尿白蛋白与肌酐比值(ACR)、肾小球滤过率(eGFR)、YKL-40的变化。结果两组患者治疗后空腹血糖、餐后2小时血糖、HbA1c均显著下降,与治疗前相比差异均有统计学意义(均P<0.05),两组间差异无统计学意义(P>0.05);观察组患者治疗后FIns及HOMA-IR均较治疗前显著下降,差异均有统计学意义(均P<0.05),对照组治疗前后差异无统计学意义(P>0.05)。两组患者治疗后Scr、ACR均有下降,与治疗前相比差异均有统计学意义(均P<0.05);与对照组相比,观察组的下降程度更显著,差异有统计学意义(P<0.05)。两组患者治疗后eGFR均有上升,与治疗前相比差异有统计学意义(P<0.05);与对照组相比,观察组的上升程度更明显,差异有统计学意义(P<0.05)。治疗后,与对照组相比,观察组患者血清YKL-40水平显著下降,差异有统计学意义(P<0.05)。结论二甲双胍可以降低早期2型DKD患者的血清YKL-40水平,可能延缓DKD的发展。

Objective To investigate the effect of metformin on the serum level of YKL-40 in patients with early type 2 diabetic nephropathy. Methods A total of 120 patients with DKD were selected in Heze Municiple Hospital from June 2015 to August2017, were randomly divided into metformin combined with insulin group(the experimental group) and simple insulin group(the control group), and the course of treatment was 12 weeks. The changes in parameters including plasma glucos, HbA1 c, FIns,HOMA-IR, Scr, ACR, eGFR, YKL-40, were observed before and after treatment. Results After treatment, fasting blood glucose,2-hour postprandial blood glucose and HbA1 c were significantly decreased in both groups compared with before treatment(P<0.05), and there was no statistical difference between the two groups(P>0.05). FIns and HOMA-IR in the observation group were significantly decreased after treatment compared with before treatment(P<0.05), and there was no statistical difference between before and after treatment in the control group(P>0.05). Scr and ACR were decreased in both groups after treatment, there were statistical significance compared with before treatment(P<0.05);compared with the control group, the decline in the observation group were more statistical significance(P<0.05). After treatment, eGFR increased in both groups, with significant difference compared with before treatment(P<0.05);compared with the control group, the degree of increase in the observation group was more obvious, with significant difference(P<0.05). Compared with the control group, the serum level of YKL-40 in the experimental group decreased significantly after treatment(P<0.05). Conclusion Metformin has the effect that can reduce the serum level of YKL-40 in patients with early type 2 diabetic nephropathy. It may delay the development of diabetic kidney disease.