Canagliflozin治疗2型糖尿病的Meta分析

目的评价Canagliflozin治疗2型糖尿病的疗效和安全性。方法计算机检索PubMed、Embase、medline、Cochrane图书馆、CNKI、万方、维普、CBM 8个数据库,按Cochrane系统评价的方法评价纳入研究质量,并使用Rev Man 5.2软件进行Meta分析。结果共纳入8项随机对照试验,共计4 503例患者。Meta分析结果显示,Canagliflozin与安慰剂相比,降低糖化血红蛋白(HbA1c)[WMD=-0.74,95%CI(-0.84,-0.64),P<0.01]、空腹血糖(FPG)[WMD=-31.03,95%CI(-32.06,-25.50),P<0.01]和体质量[WMD=-2.43,95%CI(-2.77,-2.08),P<0.01]的疗效差异均有统计学意义,安全性方面,Canagliflozin与安慰剂相比总不良反应发生率[RR=1.16,95%CI(1.02,1.32),P=0.02]高于安慰剂组,发生低血糖事件的风险未高于安慰剂组[RR=1.35,95%CI(0.68,2.71),P=0.39]。结论与安慰剂比较,Canagliflozin可有效降低2型糖尿病患者HbA1c及空腹血糖,可明显降低体质量;Canagliflozin不良反应发生率略高,发生低血糖风险较低。

治疗2型糖尿病的新药Canagliflozin

2型糖尿病（T2DM）是一种常见的慢性疾病,是以糖代谢自身稳定控制功能受损而致高血糖为特征的综合征,约占所有糖尿病病例的90%[1].美国约有2 500万的成人糖尿病患者,其死亡风险是无糖尿病者的2倍.我国的成人糖尿病患病率约为9.7%,患者总数超过9 000万,约占全球糖尿病患者总数的1/3[2].

6-羟基脱氧Canagliflozin的合成及其生物活性

以Canagliflozin(1)为起始原料,经7步反应合成了其6-OH脱氧产物4-(6-脱氧-β-D-吡喃葡萄糖基)-2-[5-(4-氟苯基)噻吩-2-甲基]-1-甲基苯(8),8是与母体1相似的新型SGLT2抑制剂,总收率21%,其结构经1H NMR,13C NMR和MS表征。体外生物活性测试结果显示,1和8对hSGLT2的IC50分别为3.9 nM和4.8nM,对SGLT1的选择性(SGLT2/SGLT1)分别为178和194。在大鼠尿糖排泄实验(UGE)中8具有很强的尿糖排泄作用,与母体1并无显著性差异。

Canagliflozin-current status in the treatment of type 2 diabetes mellitus with focus on clinical trial data

Canagliflozin(CFZ) is a member of new class of glucose lowering agents, sodium-glucose co-transporter(SGLT) inhibitors, which got approval by food and drug administration. It has insulin independent action by blocking the transporter protein SGLT2 in the kidneys, resulting in urinary glucose excretion and reduction in blood glucose levels. In clinical trials, CFZ significantly decreased HbA1c level when administered either as monotherapy or as combined therapy with other anti-diabetic drugs. Intriguingly, it showed additional benefits like weight reduction and lowering of blood pressure. The commonly observed side effects were urinary and genital infections. It has exhibited favorable pharmacokinetic and pharmacodynamic profiles even in patients with renal and hepatic damage. Hence, this review purports to outline CFZ as a newer beneficial drug for type 2 diabetes mellitus.

Berberine enhanced antidiabetic effects and attenuated untoward effects of canagliflozin in streptozotocininduced diabetic mice

OBJECTIVE To determine whether berberine can enhance the antidiabetic effects and alleviate the adverse effects of canagliflozin in diabetes mellitus.METHODS Streptozotocin-induced diabetic mice were introduced,and the combined effects of berberine and canagliflozin on glucose metabolism and kidney functions were investigated.RESULTS Berberine combined with canagliflozin(BC)increased reduction of fasting and postprandial blood glucose,diet,and water intake compared with berberine or canagliflozin alone.Interestingly,BC showed greater decrease in blood urea nitrogen and creatinine levels and lower total urine glucose excretion than canagliflozin alone.In addition,BC showed increased phosphorylated 5′AMP-activated protein kinase(pA MPK)expression and decreased tumor necrosis factor alpha(TNFα)levels in kidneys compared with berberine or canagliflozin alone.CONCLUSION These results indicated that BC is as tronger antidiabetic than berberine or canagliflozin alone with less negative side effectson the kidneys of diabetic mice.The antidiabetic effect is likely mediated by synergically promoting the expression of p AMPK and reducing the expression of TNFαin kidneys.This study first proved that canagliflozin combined withberberine is apromising treatment for diabetes mellitus.However,the exact mechanisms should be further investigated in future studies.

Canagliflozin attenuates hypertension induced myocardial hypertrophy and fibrosis via RAS and TGF-β1/Smad pathway

Objective:To investigate the effects of cagliazin,a sodium-glucose cotransporter 2 inhibitor(SGLT-2I),on ventricular remodeling in spontaneously hypertensive rats(SHR)through renin angiotensin system(RAS)and transforming growth factor-β1(TGF-β1).Methods:The experiment was divided into 4 groups:normal blood pressure control group,SHR group,cagliet net low-dose group(30mg/kg),cagliet net high-dose group(60mg/kg),once a day for 8 weeks.Normal blood pressure rats(WKY)were used as the control group to measure blood pressure with tail sleeve sphygmomanometer(BP)and blood glucose level was measured with glucose meter Cardiac function was evaluated by echocardiography,cell area of left ventricle was evaluated by histomorphology,real-time quantitative polymerase chain reaction and protein imprinting hybridization were used to detect TGF-β1 Smad4 renin from type I collagen(Col1a)type III collagen(Col3a)matrix metalloproteinase 2(MMP-2)Expression results of angiotensin II1 type receptor 1(AGTR1)and Angiotensin II2 type receptor 2(AGTR2).Results:After 8 weeks of administration,the cardiac weight/body weight ratio(HW/BW)of left ventricular weight/heart weight ratio(LVW/HW)of kaglinet low-dose group and high-dose group was statistically significant compared with that of spontaneous hypertensive rats(P&lt);Compared with SHRs,the expression of Col1a,Col3a,MMP2,TGF-β1,Smad4,Renin AGTR1 was significantly down-regulated and the expression of AGTR2 was up-regulated in cagliet net low-dose and high-dose groups Conclusions:Cagliazin can improve hypertension-induced cardiac remodeling by regulating RAS and TGF-β1/Smad signaling pathways.Conclusion:From the results,canaglifozin was found to ameliorate pressure overload-induced cardiac remodeling by regulating the RAS and TGF-β1/Smad signaling pathway.

Comparative efficacy of sodium glucose cotransporter-2 inhibitors in the management of type 2 diabetes mellitus:A real-world experience

BACKGROUND Sodium glucose cotransporter-2 inhibitors(SGLT-2i)are a class of drugs with modest antidiabetic efficacy,weight loss effect,and cardiovascular benefits as proven by multiple randomised controlled trials(RCTs).However,real-world data on the comparative efficacy and safety of individual SGLT-2i medications is sparse.AIM To study the comparative efficacy and safety of SGLT-2i using real-world clinical data.METHODS We evaluated the comparative efficacy data of 3 SGLT-2i drugs(dapagliflozin,canagliflozin,and empagliflozin)used for treating patients with type 2 diabetes mellitus.Data on the reduction of glycated hemoglobin(HbA1c),body weight,blood pressure(BP),urine albumin creatinine ratio(ACR),and adverse effects were recorded retrospectively.RESULTS Data from 467 patients with a median age of 64(14.8)years,294(62.96%)males and 375(80.5%)Caucasians were analysed.Median diabetes duration was 16.0(9.0)years,and the duration of SGLT-2i use was 3.6(2.1)years.SGLT-2i molecules used were dapagliflozin 10 mg(n=227;48.6%),canagliflozin 300 mg(n=160;34.3%),and empagliflozin 25 mg(n=80;17.1).Baseline median(interquartile range)HbA1c in mmol/mol were:dapagliflozin-78.0(25.3),canagliflozin-80.0(25.5),and empagliflozin-75.0(23.5)respectively.The respective median HbA1c reduction at 12 months and the latest review(just prior to the study)were:66.5(22.8)&69.0(24.0),67.0(16.3)&66.0(28.0),and 67.0(22.5)&66.5(25.8)respectively(P<0.001 for all comparisons from baseline).Significant improvements in body weight(in kilograms)from baseline to study end were noticed with dapagliflozin-101(29.5)to 92.2(25.6),and canagliflozin 100(28.3)to 95.3(27.5)only.Significant reductions in median systolic and diastolic BP,from 144(21)mmHg to 139(23)mmHg;(P=0.015),and from 82(16)mmHg to 78(19)mmHg;(P<0.001)respectively were also observed.A significant reduction of microalbuminuria was observed with canagliflozin only[ACR 14.6(42.6)at baseline to 8.9(23.7)at the study end;P=0.043].Adverse effects of SGLT-2i were as follows:genital thrush and urinary infection-20(8.8%)&17(7.5%)with dapagliflozin;9(5.6%)&5(3.13%)with canagliflozin;and 4(5%)&4(5%)with empagliflozin.Diabetic ketoacidosis was observed in 4(1.8%)with dapagliflozin and 1(0.63%)with canagliflozin.CONCLUSION Treatment of patients with SGLT-2i is associated with statistically significant reductions in HbA1c,body weight,and better than those reported in RCTs,with low side effect profiles.A review of large-scale real-world data is needed to inform better clinical practice decision making.

度拉糖肽联合卡格列净对早期血糖控制不佳超重型T2DM患者的疗效

目的评价度拉糖肽联合卡格列净对早期血糖控制不佳超重型2型糖尿病(T2DM)患者的临床治疗效果。方法研究对象为2021年7月至2022年12月在郑州人民医院内分泌代谢科收治的口服联合降糖方案血糖控制不好的超重型T2DM患者120例,随机分为试验组和对照组,每组60例。试验组以周制剂度拉糖肽联合卡格列净治疗,对照组给予14 d胰岛素泵治疗至血糖稳定后,改用门冬胰岛素30注射液。经3个月治疗后,比较两种不同治疗策略的临床效果。包括临床疗效、血糖情况、胰岛功能、体格检查指标、血脂情况、血清因子[中性粒细胞与淋巴细胞比值(NLR)、C反应蛋白(CRP)、谷胱甘肽过氧化物酶(GSH-Px)及超氧化物歧化酶(SOD)]水平比较,分析GSH-Px、SOD分别与NLR及CRP间的相关性;并对比其诊疗过程中发生的不良反应。结果共剔除患者16例,最终纳入统计学分析病例包括试验组52例,对照组52例。两组空腹血糖(FPG)、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)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、NLR及CRP水平与治疗前相比均降低,空腹胰岛素(FINS)、稳态模型胰岛β细胞功能指数(HOMA-β)、空腹C肽(FCP)、高密度脂蛋白(HDL-C)、GSH-Px及SOD水平与治疗前相比均增加,且试验组优于对照组,差异有统计学意义(P<0.05)。Pearson分析可知,GSH-Px与NLR、CRP及NLR与SOD均呈负相关。治疗过程中,试验组不良反应发生率为19.23%(10/52),对照组为36.54%(19/52),试验组低于对照组,差异有统计学意义(χ^(2)=3.873,P<0.05)。结论度拉糖肽联合卡格列净对于早期血糖控制不佳超重型T2DM患者较胰岛素表现出更好的临床治疗效果,值得临床推广应用。

卡格列净通过PDGF/SIRT1减轻糖尿病肾病小鼠肾纤维化

目的探讨卡格列净通过PDGF/SIRT1减轻糖尿病肾病小鼠肾纤维化的潜在机制。方法使用链脲菌素(streptozotocin,STZ)建立糖尿病肾病小鼠模型,并设置以下组别:①对照小鼠;②STZ灌胃小鼠;③卡格列净处理的STZ小鼠;④BSA处理的STZ小鼠;⑤PDGF蛋白处理的STZ小鼠;⑥卡格列净与BSA共处理的STZ小鼠;⑦卡格列净与PDGF蛋白共处理的STZ小鼠。采集各组小鼠肾脏组织和血清,分析肌成纤维细胞标志物(Ⅰ型胶原、纤维连接蛋白、α-SMA)的mRNA水平和蛋白水平、线粒体生物发生的指标(线粒体DNA拷贝数、关键调节因子SIRT1和电子传递链蛋白的不同亚基的表达水平)、血清中PDGF的表达水平。结果STZ显著增强了Ⅰ型胶原、纤维连接蛋白和α-SMA的mRNA和蛋白表达;而卡格列净治疗后,这些肌成纤维细胞标志物的表达水平恢复到了正常水平。STZ降低了线粒体DNA拷贝数,而卡格列净可以阻止这种下降。同时,卡格列净纠正了STZ导致的SIRT1、抑制素1(PHB1)、热休克蛋白60(HSP60)、电压依赖性阴离子通道(VDHC)、琥珀酸脱氢酶复合物黄素蛋白亚基A(SDHA)和细胞色素C氧化酶Ⅳ(CoxⅣ)的降低。此外,STZ诱导的PDGF的上升因卡格列净的存在而恢复。相比于STZ处理小鼠,STZ与PDGF蛋白共处理的小鼠肾脏中SIRT1的表达水平更低、肌成纤维细胞标志物的mRNA水平更高;相比于STZ与卡格列净共处理小鼠,STZ、PDGF蛋白与卡格列净共处理的小鼠肾脏中SIRT1的表达水平、肌成纤维细胞标志物的mRNA水平无显著区别。结论卡格列净治疗可以减轻糖尿病肾病的肾纤维化病变,并且依赖于PDGF/SIRT1介导的线粒体生物发生轴。

卡格列净通过TGF-β/STAT3减轻STZ诱导的糖尿病肾病小鼠肾损伤

目的探讨卡格列净通过TGF-β/STAT3减轻链脲佐菌素(streptozotocin,STZ)诱导的糖尿病肾病小鼠肾损伤潜在机制。方法使用STZ建立糖尿病肾病小鼠模型,分为正常对照组、STZ诱导的糖尿病肾病小鼠组、卡格列净治疗组、TGF-β抑制剂治疗组和STAT3抑制剂治疗组。测量肾重/体重比、尿白蛋白、肾功能参数和血清TGF-β水平,以及肾脏中STAT3的磷酸化水平。结果糖尿病肾病小鼠表现出肾损伤迹象,包括肾重/体重比和尿白蛋白显著增加(P<0.05),而卡格列净治疗后这些指标恢复到正常水平。血清中TGF-β水平在糖尿病肾病小鼠中升高(P<0.05),而卡格列净治疗后恢复至对照水平。糖尿病肾病小鼠肾脏中STAT3的磷酸化水平显著增加(P<0.05),而卡格列净治疗可阻止这种增加,但未影响STAT3总水平。此外,TGF-β表达与STAT3磷酸化呈正相关(P<0.05)。结论卡格列净通过调节TGF-β和STAT3途径减轻糖尿病肾病的肾损伤。

新型Na^+依赖性葡萄糖共转运体2(SGLT2)抑制剂6-脱氧canagliflozin的简便合成方法及其晶型研究

目的开发一条合成新型Na+依赖性葡萄糖共转运体2(SGLT2)抑制剂6-脱氧canagliflozin的简便实用的路线,并研究其可供药用的晶型。方法利用6-脱氧葡萄糖片段和含噻吩的苷元片段作为起始原料,经过3步反应合成了目标分子6-脱氧canagliflozin。使用从溶剂中结晶的方法来制备不同晶型,使用粉末X-射线衍射和差热分析来测定晶型。结果得到了一条简便实用的合成6-脱氧canagliflozin的路线,并获得了其2个晶型和1个与L-脯氨酸的共结晶。结论新合成路线具有步骤短、产率高的优点。6-脱氧canagliflozin的晶型B比较稳定,可以作为其最佳药用形式。

卡格列净联合洛塞那肽对2型糖尿病胰岛素抵抗患者胰岛功能、YKL-40、PPARγ的影响

目的研究卡格列净联合洛塞那肽对2型糖尿病胰岛素抵抗患者疗效,及对胰岛功能、血清YKL-40、过氧化物酶体增殖物激活受体γ(PPARγ)的影响。方法选择2型糖尿病患者98例,随机均分为对照组(洛塞那肽治疗)和联合组(卡格列净联合洛塞那肽治疗),比较两组临床疗效、胰岛功能、血清YKL-40、PPARγ水平、血糖指标及不良反应发生率。结果联合组治疗总有效率高于对照组(P<0.05)。两组不良反应总发生率比较差异无显著性(P>0.05)。与治疗前比较,两组治疗后胰岛素曲线下面积、胰岛β细胞功能指数、PPARγ升高,胰岛素抵抗指数、YKL-40、空腹血糖、2 h餐后血糖、糖化血红蛋白、体质指数降低;且联合组变化更为显著(P<0.05)。结论卡格列净联合洛塞那肽治疗可有效提高2型糖尿病胰岛素抵抗患者胰岛功能,并显著改善YKL-40、PPARγ水平。

Canagliflozin：治疗2型糖尿病的新型钠-葡萄糖共转运体2抑制剂

钠-葡萄糖共转运体2(SGLT2)是近年来新发现的2型糖尿病治疗靶点。抑制SGLT2可减少肾脏葡萄糖的重吸收,增加尿糖排出,从而降低血糖。Canagliflozin是SGLT2抑制剂,可结合饮食控制和运动来改善成人2型糖尿病的血糖。Canagliflozin的推荐剂量为100 mg,口服,每日1次。临床试验表明canagliflozin治疗2型糖尿病安全有效,耐受性好。

卡格列净减轻心肌梗死后细胞凋亡及炎症反应改善预后

目的探究在心肌梗死(MI)后使用卡格列净(CANA)对心脏炎症反应及细胞凋亡的作用。方法选用15只8~10周龄C57/BL6小鼠(SPF级),用抽签法随机抽取5只小鼠为Sham组(假手术+生理盐水灌胃),剩余10只小鼠通过结扎左冠状动脉前降支的方法制作MI模型,制作成功后的10只MI小鼠随机分为2组:MI组(生理盐水灌胃)、CANA+MI组(CANA灌胃),每组5只。CANA+MI组小鼠以20 mg/(kg·d^(-1))卡格列净灌胃4周,Sham组及MI组则使用同等体积生理盐水灌胃4周。4周后,使用小鼠超声机测量左室收缩末期内径及左室射血分数。苏木精染色、Tunel染色用于明确心脏结构及MI后细胞凋亡状况。IF免疫荧光染色用于检测MI后心脏炎症反应程度。Western blotting用于检测炎症及凋亡相关蛋白表达水平。结果与MI组相比,CANA+MI组左室射血分数升高、梗死面积减小。Tunel染色显示,CANA+MI组小鼠MI边缘区凋亡细胞数量较MI组显著减少,相应促凋亡蛋白Bax表达降低,抑凋亡蛋白Bcl-2表达升高。CANA+MI组小鼠CD3^(+)T细胞、F480^(+)巨噬细胞和LY6G^(+)中性粒细胞数量较MI组明显减少,相关蛋白p-P65、p-IκBα表达量明显降低。结论CANA抑制了MI后心脏炎症反应,减轻了细胞凋亡。

治疗2型糖尿病新药canagliflozin

Canagliflozin是一种钠-葡萄糖协同转运蛋白2抑制剂,能够阻断肾近曲小管对葡萄糖的重吸收,进而降低肾糖阈,增加尿糖排泄,降低血糖水平,是一种具有全新作用机制的降糖药物,临床上用于治疗2型糖尿病。多个临床前及临床研究证实其对2型糖尿病有明显疗效,可以显著改善患者的血糖水平,对体重、血脂等也有良性改善。不良反应主要有泌尿生殖道感染,发生率达10%,较少出现低血糖反应,不良反应总体较轻,患者耐受性良好。文中对canagliflozin的作用机制、药效学、药动学、药物相互作用、临床评价和安全性等进行综述。

SGLT2抑制剂Canagliflozin——Ⅱ型糖尿病治疗的新药

钠依赖的葡萄糖转运蛋白2(sodium-dependent glucose transporters 2,SGLT2)是一种低亲和力、高容量的转运体,主要分布在肾脏近曲小管S1部位,负责肾脏中约90%葡萄糖的重吸收。因此,抑制SGLT2,阻止近曲小管对葡萄糖的重吸收,通过增加尿糖的排出来降低血糖已经成为糖尿病治疗的一种新的策略。文章简述了目前处于临床阶段的SGLT2抑制剂,重点阐述了第1个被FDA批准的SGLT2抑制剂——Canagliflozin,包括它的合成、药动学、药效学、临床研究及不良反应等。

Berberine enhances antidiabetic effects and attenuates untoward effects of canagliflozin in streptozotocin-induced diabetic mice

The present study aimed at determining whether berberine can enhance the antidiabetic effects and alleviate the adverse effects of canagliflozin in diabetes mellitus. Streptozotocin-induced diabetic mice were introduced, and the combined effects of berberine and canagliflozin on glucose metabolism and kidney functions were investigated. Our results showed that berberine combined with canagliflozin(BC) increased reduction of fasting and postprandial blood glucose, diet, and water intake compared with berberine or canagliflozin alone. Interestingly, BC showed greater decrease in blood urea nitrogen and creatinine levels and lower total urine glucose excretion than canagliflozin alone. In addition, BC showed increased phosphorylated 5' AMP-activated protein kinase(p AMPK) expression and decreased tumor necrosis factor alpha(TNFα) levels in kidneys, compared with berberine or canagliflozin alone. These results indicated that BC was a stronger antidiabetic than berberine or canagliflozin alone with less negative side effects on the kidneys in the diabetic mice. The antidiabetic effect was likely to be mediated by synergically promoting the expression of p AMPK and reducing the expression of TNFα in kidneys. The present study represented the first report that canagliflozin combined with berberine was a promising treatment for diabetes mellitus. The exact underlying mechanisms of action should be investigated in future studies.

Canagliflozin,an inhibitor of sodium-glucose co-transporter 2,advances in the treatment of type 2 diabetes

Canagliflozin(CANA)is a sodium-glucose co-transporter 2 inhibitor.One of the important mechanisms of CANA is the inhibitory effect on the glucose uptake in the proximal tubule of the nephron,and the other mechanism can be the reduction of inflammatory cytokine expression monocytes and macrophages.It is proved by FDA for the management of type 2 diabetes.In the present work,we summarized the publication and clinical evidence of the CANA on healthy individuals and those with related metabolic diseases,such as type 1 and 2 diabetes,obesity,or cardiovascular and kidney diseases.This drug has been reported to offer potential advantages in regulating body weight and reducing heart failure,hypoglycemia,and stroke risk in patients with type 2 diabetes.Some in vitro and animal experiments also show that this drug has good effects on cancer treatment.However,some case reports and experiments also show the side effect of CANA,such as amputation,fracture,and pancreatitis,while the mechanism is still unknown.Overall,CANA has a good effect on the management of type 2 diabetes by reducing the risk of kidney failure,cardiovascular diseases,and stroke.However,as a new drug,more clinical trials and experiments of CANA should be carried out in the future.

卡格列净联合度拉糖肽对老年糖尿病肾病患者血糖水平及肾功能的影响

目的:研究卡格列净联合度拉糖肽治疗对老年糖尿病肾病患者血糖及肾功能的影响。方法:将我院2021年1月至2022年8月收治的82例老年糖尿病肾病患者,随机分为对照组、观察组(n=41),分别采用度拉糖肽(皮下注射,1.5 mg·次^(-1),1次·w^(-1))以及卡格列净(口服,100 mg·次-1,Qd)联合度拉糖肽治疗。治疗3 m后比较两组临床疗效,采用葡萄糖氧化酶法检测空腹血糖(Fasting blood glucose,FBG)、餐后2 h血糖(Postprandial blood glucose 2 hour,2hPBG)水平,采用比浊法检测24 h尿蛋白,采用全自动生化分析仪检测血肌酐(Serum creatinine,Scr)、尿素氮(Urea nitrogen,BUN)水平,采用双抗体夹心酶联免疫法检测血清转化生长因子-β1(Recombinant transforming growth factor beta 1,TGF-β1)、长正五聚蛋白3(Pentraxin 3,Ptx3)、α-klotho蛋白水平,采用放射免疫分析法测定肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)水平、不良反应发生率。结果:治疗3 m后,观察组临床总有效率高于对照组,血糖水平、肾功能指标、血清TGF-β1、TNF-α、Ptx3水平低于对照组,α-klotho蛋白水平高于对照组(P<0.05);两组不良反应发生率对比,无显著差异(P>0.05)。结论:卡格列净联合度拉糖肽治疗老年糖尿病肾病患者疗效显著,可有效控制血糖,改善肾功能,促进病情恢复,且安全可行。

卡格列净与阿米洛利或苯扎米尔联用对肾病综合征大鼠骨代谢的影响

目的探讨钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)卡格列净和上皮钠通道阻滞剂阿米洛利或苯扎米尔联用对阿霉素诱导的肾病综合征(NS)模型大鼠骨代谢的影响。方法取49只雄性SD大鼠,随机抽取7只为对照组(NG组)。其余42只通过尾静脉注射阿霉素造模并随机分为模型组(MG组)、卡格列净组(KG组)、苯扎米尔组(BH组)、阿米洛利组(AL组)、卡格列净+苯扎米尔组(KB组)、卡格列净+阿米洛利组(KA组),每组7只。各用药组每日定时按大鼠体质量予以灌胃,NG组和MG组给予等量生理盐水,疗程6周。治疗前1 d检测各组大鼠的24 h尿蛋白(24 h-UTP),验证模型制备成功。治疗后第6周,分别检测各组大鼠的24 h-UTP、尿钠(UNa)、尿钾(UK)以及血清白蛋白(ALB)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、血钙(SCa)、血钠(SNa)、血钾(SK)、25-羟维生素D(25-OH-D)、碱性磷酸酶(ALP)、甲状旁腺素(PTH)、Ⅰ型前胶原氨基端原肽(PINP)和Ⅰ型胶原羧基端肽β特殊序列(β-CTX)水平。结果造模成功后,MG组的24 h-UTP、TG、TC、LDL、SCa水平均升高,ALB、25-OH-D、ALP、PINP、PTH水平均降低,差异有统计学意义(P<0.05或P<0.01)。药物干预6周后,KG组大鼠体质量下降,差异有统计学意义(P<0.05)。与MG组比较,各药物组的24 h-UTP、TC、TG、LDL、SCa水平降低,ALB水平升高,差异有统计学意义(P<0.05或P<0.01)。与MG组比较,KA组的25-OH-D、ALP、PINP、β-CTX水平升高,差异有统计学意义(P<0.05或P<0.01)。造模及药物治疗对UNa、UK、SK、SNa水平无影响(P>0.05)。结论单用卡格列净、苯扎米尔组、阿米洛利以及卡格列净分别联合苯扎米尔、阿米洛利用药均可改善阿霉素诱导的NS模型大鼠的大量蛋白尿、低蛋白血症和高脂血症。联用卡格列净和阿米洛利具有显著的促成骨作用或促破骨作用,其可能通过形成新的成骨/破骨平衡,进而发挥降低NS大鼠骨折风险的作用。