卡格列净减轻新诊断2型糖尿病患者肾脏脂肪沉积改善肾脏氧合水平  

Canagliflozin alleviates renal fat deposition and improves renal oxygenation levels in patients with newly-diagnosed type 2 diabetes mellitus

作　　者：周赛君[1] 张玉琳 黄帅 王俊美 王彤丹 陶怔怔 张睿 刘红岩 于珮[1] Zhou Saijun;Zhang Yulin;Huang Shuai;Wang Junmei;Wang Tongdan;Tao Zhengzheng;Zhang Rui;Liu Hongyan;Yu Pei(NHC Key Laboratory of Hormones and Development,Tianjin Key Laboratory of Metabolic Diseases,Chu Hsien-I Memorial Hospital&Tianjin Institute of Endocrinology,Tianjin Medical University,Tianjin 300134,China;Department of Radiology,the First Center Hospital of Tianjin,Tianjin 300192,China)

机构地区：[1]天津医科大学朱宪彝纪念医院,国家卫生健康委员会激素与发育重点实验室,天津市代谢疾病重点实验室,300134 [2]天津市第一中心医院放射科,300192

出　　处：《中华内分泌代谢杂志》2021年第8期715-722,共8页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金(81600643);天津市自然科学基金(18JCZDJC32900,17JCYBJC27000)。

摘　　要：目的:评价卡格列净对新诊断2型糖尿病患者肾脏脂肪含量和氧合水平的影响。方法:23例新诊断2型糖尿病患者分为卡格列净组(11例)和格列美脲对照组(12例),分别于用药前、用药24周采用Dixon MRI、BOLD MRI功能序列检测患者肾脏脂肪含量和氧合水平情况,以及空腹血糖、HbA 1C、血尿酸、血脂、血压、体重等代谢指标的变化。进一步分析2型糖尿病患者体重的变化与肾脏内脂肪含量的变化关系、肾脏脂肪含量的变化与肾脏缺氧程度改善间的相关性。结果:两组新诊断2型糖尿病患者基线年龄、体重、空腹血糖、HbA 1C、血脂、血尿酸均无统计学差异,且两组患者分别在用药12周、24周时的空腹血糖、HbA 1C、胆固醇(CHO)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)差异无统计学意义,卡格列净组体重、血尿酸水平、舒张压自基线下降幅度均大于对照组(均P<0.05)。两组2型糖尿病患者基线肾脏内脂肪含量无明显差异,且患者体重指数与肾脏内脂肪蓄积程度无明显相关性,卡格列净用药24周可减少肾脏内脂肪含量,显著高于对照组。卡格列净组用药24周肾脏皮质和髓质R2*值自基线分别下降19.22%和22.63%(均P<0.05),而对照组用药前后肾脏皮质、髓质R2*值变化差异无统计学意义。卡格列净组肾脏内脂肪含量的减轻程度与肾脏皮质的氧合水平改善程度相关。结论:卡格列净可减轻肾功能正常的新诊2型糖尿病患者肾脏脂肪蓄积、改善肾脏缺氧状态。Objective To evaluate the effect of canagliflozin on intrarenal fat content and oxygenation in newly-diagnosed type 2 diabetes patients.Methods Twenty-three newly-diagnosed type 2 diabetes patients were divided into canagliflozin(n=11)and glimepiride control(n=12)groups.Both groups received MRI scanning with Dixon MRI and BOLD MRI sequence to assess patients′intrarenal fat content,oxygenation level before treatment and 24 weeks after treatment.Fasting blood glucose,glycosylated hemoglobin,blood uric acid,blood lipids,blood pressure,weight,and other metabolic index were also tested before and after treatment.Furthermore,the relationship between body mass index(BMI)and intrarenal fat content and the correlation between changes in intrarenal fat content and improvement in renal hypoxia were analyzed.Results No significant differences were found in baseline age,body weight,fasting blood glucose,glycosylated hemoglobin,blood lipid,and serum uric acid between the two groups.There was no significant difference in fasting blood glucose,glycosylated hemoglobin,cholesterol(CHO),low-density lipoprotein-cholesterol(LDL-C),and triglycerides(TG)levels in both groups after 12 and 24 weeks of treatment.The decrease in body weight,blood uric acid level,and diastolic blood pressure from baseline in the canagliflozin group was greater than those in the control group(P<0.05).Two groups of patients with type 2 diabetes at baseline had no obvious difference in intrarenal fat content,and the patients′BMI showed no obvious correlation with degree of intrarenal fat accumulation.Canagliflozin treatment for 24 weeks could reduce intrarenal fat content,which was higher than that of control group.The R2*values of renal cortex and medulla in the canagliflozin group decreased from baseline by 19.22%and 22.63%respectively(P<0.05),whereas no significant difference was seen in the glimepiride control group.The decrease of intrarenal fat content in the canagliflozin group was related to the improvement of renal cortex and medulla oxygenation.C

关 键 词：卡格列净 糖尿病 2型 肾脏脂肪含量 肾脏氧合水平 缺氧 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]