长期服用达格列净对糖尿病患者交感神经活性的影响及其机制  

EFFECTS OF LONG-TERM DAPAGLIFLOZIN ADMINISTRATION ON SYMPATHETIC NERVOUS ACTIVITY IN PATIENTS WITH DIABETES AND UNDERLYING MECHANISM

作　　者：张敏 邹林海 杨丽丽[3] 徐春雪 冀立霞 ZHANG Min;ZOU Linhai;YANG Lili;XU Chunxue;JI Lixia(Department of Pharmacy,Faculty of Medicine,Qingdao University,Qingdao 266073,China)

机构地区：[1]青岛大学医学部药学院,山东青岛266073 [2]菏泽市牡丹人民医院临床药学科 [3]青岛大学附属医院中医院门诊

出　　处：《精准医学杂志》2023年第3期223-227,共5页Journal of Precision Medicine

基　　金：国家自然科学基金面上项目(82270847)。

摘　　要：目的 探讨长期服用达格列净对糖尿病患者交感神经活性的影响及其机制。方法 选取菏泽市牡丹人民医院2021年6月—2022年7月收治的100例2型糖尿病患者,接受常规治疗(二甲双胍或阿卡波糖)者为糖尿病组(50例),常规治疗基础上加用达格列净(10 mg,每天1次)治疗者为达格列净组(50例),两组均治疗3个月,收集治疗前后两组患者的体质量、体质量指数(BMI)、糖代谢、胰岛功能、肾功能、心功能等指标的资料,检测患者治疗前后血清交感神经活性,分析患者交感神经活性与达格列净心、肾及胰岛保护作用的关系。结果 治疗结束时,两组患者体质量、糖代谢、胰岛功能、心功能指标治疗前后差值比较,差异均有显著性(t=-5.57~4.65,P<0.05),两组患者治疗前后肾功能、交感神经活性比较,差异均有显著性(Z=-7.02~-4.38,P<0.05)。相关性分析提示,达格列净组患者血清酪氨酸羟化酶(TH)与胰岛功能、肾功能、心功能指标呈正相关(r=0.29~0.31,P<0.05);多元线性回归提示,两组患者胰岛功能与糖代谢指标相关(β=-2.15~-1.40,t=-2.95~-2.23,P<0.05);糖尿病组肾功能、心功能与糖代谢指标相关(β=0.92、0.65,t=2.42、2.51,P<0.05);达格列净组胰岛功能、肾功能、心功能与交感神经活性指标相关(β=-0.01~0.01,t=-2.29~2.92,P<0.05)。治疗结束时达格列净组30~39岁与60~69岁患者比较,血清去甲肾上腺素(NE)水平治疗前后差值比较差异有显著性(P<0.05)。结论T2DM患者长期服用达格列净可抑制其升高的交感神经活性,且与其心、肾和胰岛功能保护作用间存在相关性。Objective To investigate the effect of long-term dapagliflozin administration on sympathetic nervous activity in patients with diabetes and the underlying mechanism.Methods We included 100 patients with type 2 diabetes admitted to Heze Mudan People’s Hospital from June 2021 to July 2022.They were divided into diabetes group(50 cases)and dapagliflozin group(50 cases).The diabetes group received conventional treatment(metformin or acarbose),while the dapagliflozin group received conventional treatment plus dapagliflozin(10 mg,once daily).Both groups were treated for three months.We collected cli-nical data on body mass,body mass index,glucose metabolism,pancreatic islet function,renal function,cardiac function,and se-rum sympathetic nervous activity before and after treatment.The relationship between sympathetic activity and the protective effects of dapagliflozin on cardiac,renal and islet functions was analyzed.Results The two groups significantly differed in the differences in body mass,glucose metabolism,pancreatic islet function,and cardiac function(t=-5.57-4.65,P<0.05)and renal function,sympathetic activity indicators(Z=-7.02--4.38,P<0.05)before and after treatment.The correlation analysis showed that serum tyrosine hydroxylase was positively correlated with pancreatic islet function,renal function,and cardiac function indicators in the dapagliflozin group(r=0.29-0.31,P<0.05).The multiple linear regression analysis revealed that islet function was correlated with glucose metabolism in both groups(β=-2.15--1.40,t=-2.95--2.23,P<0.05);renal function and cardiac function were correlated with glucose metabolism in the diabetes group(β=0.92,0.65,t=2.42,2.51,P<0.05);islet function,renal function,and cardiac function were correlated with sympathetic activity in the dapagliflozin group(β=-0.01-0.01,t=-2.29-2.92,P<0.05).In the dapagliflozin group,the difference in serum norepinephrine level before and after treatment was significantly different between the patients aged 30-39 years and those aged 60-69 years(P<0.0

关 键 词：糖尿病 2型 肾上腺皮质激素类 交感神经系统 肾 心脏 胰岛素 治疗结果 

分 类 号：R587.1[医药卫生—内分泌]