达格列净对老年2型糖尿病肾病合并高血压患者同型半胱氨酸的影响及疗效分析  

Impact of dapagliflozin on Hcy and its efficacy in diabetic nephropathy elderly patients with hypertension

作　　者：许蔚强 陈瞳[1] 张利方[1] 耿凡琪 张杰涛[1] Xu Weiqiang;Chen Tong;Zhang Lifang;Geng Fanqi;Zhang Jietao(Department of General Medicine,the Affiliated Hospital of Qingdao University,Qingdao 266000,Shandong Province,China)

机构地区：[1]青岛大学附属医院全科医学科,266000

出　　处：《中华老年心脑血管病杂志》2024年第5期508-512,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探究达格列净对老年2型糖尿病(type 2diabetes mellitus,T2DM)肾病合并高血压患者同型半胱氨酸(Hcy)、尿酸、胱抑素C的影响及临床疗效。方法回顾性选取2022年12月至2023年6月青岛大学附属医院收治的T2DM肾病合并高血压患者292例,根据用药情况分为达格列净组147例和对照组145例。随访3个月,记录并比较2组治疗前后Hcy、尿酸、胱抑素C、尿微量白蛋白/尿肌酐比值(UACR)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)及其他代谢相关指标。用Pearson相关性分析Hcy与尿酸的相关性,logistic回归分析T2DM肾病合并高血压患者发生蛋白尿的危险因素。结果与治疗前比较,2组治疗后体质量指数(body mass index,BMI)、收缩压、舒张压、空腹血糖、糖化血红蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、尿酸、胱抑素C、Hcy、胰岛素抵抗指数(HOMA-IR)、UACR显著降低(P<0.05);达格列净组治疗后BMI、空腹血糖、LDL-C、尿酸、胱抑素C、Hcy、HOMA-IR、UACR显著低于对照组(P<0.05,P<0.01)。Pearson相关性分析显示,Hcy与尿酸在整个人群中(r=0.560,P<0.01)、在男性中(r=0.510,P<0.01)、在女性中(r=0.640,P<0.01)均呈正相关。多因素logistic回归分析显示,总胆固醇、eGFR、男性、糖尿病周围神经病变、Hcy≥15μmol/L为老年T2DM肾病合并高血压患者发生蛋白尿的独立危险因素(P<0.05,P<0.01)。结论达格列净作为一种新型降糖药物或许可通过降低T2DM肾病合并高血压患者Hcy和尿酸水平,发挥额外的肾脏保护作用,从而减缓患者的尿蛋白并改善结局。Objective To investigate the effect and clinical efficacy of dapagliflozin on homocysteine(Hcy),uric acid(UA),and cystatin C(Cys C)in elderly patients with type 2diabetes mellitus(T2DM)complicated by nephropathy and hypertension.Methods A total of 292patients diagnosed with T2DM nephropathy and hypertension admitted to our hospital between December 2022and June 2023were retrospectively recruited,and based on their medication regimens,they were divided into dapagliflozin group(147cases)and control group(145cases).After all of them were followed up for 3months,the serum levels of Hcy,UA,cys C,urinary microalbumin/urinary creatinine ratio(UACR),estimated glomerular filtration rate(eGFR),and other metabolismrelated indicators were measured and compared before and after treatment.Pearson correlation analysis was used to determine the correlation between Hcy and UA,while logistic regression analysis was employed to identify risk factors for proteinuria among the patients with T2DM nephropathy and hypertension.Results After treatment,the BMI,SBP,DBP,FBG,glycosylated Hb,TC,TG,LDL-C,UA,Cys C,Hcy,insulin resistance index(HOMA-IR),and UACR were all decreased in comparison to their levels before treatment(P<0.05).Dapagliflozin treatment resulted in more significant declines in BMI,FBG,LDL-C,UA,Cys C,Hcy,HOMA-IR,and UACR when compared with the control group(P<0.05,P<0.01).Pearson correlation analysis revealed that the relationship between Hcy and UA was positively correlated across the entire population(r=0.560,P<0.01),as well as among males(r=0.510,P<0.01)and females(r=0.640,P<0.01).Multivariate logistic regression analysis identified female gender,diabetic peripheral neuropathy,TC,eGFR,and Hcy≥15μmol/L as independent risk factors for proteinuria among elderly patients with T2DM nephropathy and hypertension(P<0.05,P<0.01).Conclusion Dapagliflozin,a novel antidiabetic agent,may offer further renal protection by lowering Hcy and UA levels in patients with T2DM nephropathy and hypertension.It can potentially decelerate the p

关 键 词：糖尿病肾病 高血压 高半胱氨酸 LOGISTIC模型 治疗 达格列净 

分 类 号：R587.2[医药卫生—内分泌] R692[医药卫生—内科学] R544.1[医药卫生—临床医学]