沙格列汀对2型糖尿病合并微量白蛋白尿患者尿裂隙素和足细胞素排泄的影响  

Effects of saxagliptin on urinary nephrin and podocin excretion in type 2 diabetes mellitus patients with microalbuminuria

作　　者：胡圆圆 叶山东 邢燕 周婉 HU Yuan-yuan;YE Shan-dong;XING Yan;ZHOU Wan(Department of Endocrinology,Anhui Provincial Hospital/The First Affiliated Hospital of USTC,Division of Life Science and Medicine,University of Science and Technology of China,Hefei ANHUI 230001,China)

机构地区：[1]中国科学技术大学附属第一医院/安徽省立医院内分泌科,安徽合肥230001

出　　处：《中国新药与临床杂志》2021年第6期447-451,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：国家自然科学基金(81800713);中央引导地方科技发展专项资金项目(2017070802D147)。

摘　　要：目的观察沙格列汀对2型糖尿病(T2DM)合并微量白蛋白尿(MI)患者尿裂隙素和足细胞素排泄的影响,探讨沙格列汀的肾脏保护作用及可能机制。方法将160例合并MI且口服二甲双胍、血糖控制不佳的T2DM患者,随机分为沙格列汀组(Sa组)和磺酰脲类药物组(Su组),分别在二甲双胍治疗基础上给予沙格列汀(5 mg·d^(-1))或格列美脲、格列齐特、格列吡嗪等口服,疗程均为12周。观察治疗前后患者血糖、血脂、肾功能等指标变化,并以尿肌酐校正尿白蛋白、裂隙素和足细胞素指标,标记为尿白蛋白肌酐比值(UACR)、尿裂隙素肌酐比值(UNCR)及尿足细胞素肌酐比值(UPCR)。结果 Sa组和Su组各完成76例和75例。治疗12周末,Sa组和Su组空腹血糖、餐后2 h血糖、糖化血红蛋白均较治疗前显著降低(P <0.01),且组间比较无显著差异(P> 0.05)。Sa组三酰甘油和总胆固醇较治疗前下降(P <0.01),Su组无明显变化,组间差异显著(P <0.05)。Sa组UACR、UNCR及UPCR水平显著降低(P <0.01),且显著低于Su组(P <0.01),UNCR、UPCR均与UACR正相关(r = 0.554,r = 0.542,P <0.01)。治疗期间,2组均无严重不良反应发生。结论沙格列汀可降低T2DM合并MI患者的尿白蛋白排泄,具有一定的肾脏保护作用,其机制可能与减少足细胞裂隙素和足细胞素的丢失有关,且这一作用不完全依赖于其降糖作用。AIM To observe the effects of saxagliptin on the excretion of urinary nephrin and podocin in type 2 diabetes mellitus(T2DM) patients with microalbuminuria(MI), and to explore its renal protective effect and possible mechanism. METHODS Total 160 T2DM with MI patients who took metformin and poor blood glucose control, were randomly divided into group saxagliptin(group Sa) and group sulfonylurea(group Su). Saxagliptin(5 mg·d^(-1)) or sulfonylurea(glimepiride, gliclazide or glipizide) were given on the basis of metformin treatment in either group. All patients were followed up for 12 weeks. The changes of blood glucose, blood lipid and renal function were observed before and after treatment. Urinary albumin, nephrin and podocin were corrected by urinary creatinine(Cr) respectively, and labeled as urinary albumin/Cr ratio(UACR), urinary nephrin/Cr ratio(UNCR) and urinary podocin/Cr ratio(UPCR). RESULTS At the end of 12 weeks treatment, 76 cases in the group Sa and 75 cases in the group Su were remaining. Fasting blood glucose(FBG), two hours postprandial blood glucose(P2 hBG), glycosylated hemoglobin(HbA1 c) in the group Sa and group Su were all significantly lower than those before treatment(all P < 0.01), but no significant differences were found between the two groups(P > 0.05). Triglyceride and total cholesterol in the group Sa were lower than those before treatment(P < 0.01), but there was no significant change in the group Su, simultaneously, significant differences were found between the two groups(P < 0.05). The levels of UACR, UNCR and UPCR in the group Sa were significantly decreased(P < 0.01) at the end of the study, and significantly lower than those in group Su(P < 0.01). Significant positive correlation was found between UNCR, UPCR and UACR respectively(r = 0.554, r = 0.542, P < 0.01). During the treatment, no serious adverse reactions were found in both groups. CONCLUSION Saxagliptin has renal protective effects independent of its hypoglycemic effect in T2DM patients with MI, which may be related to al

关 键 词：沙格列汀 糖尿病 肾病 足细胞 裂隙素 足细胞素 

分 类 号：R977[医药卫生—药品]