GLP-1RA与DPP-4i治疗2型糖尿病的疗效及对患者并发症的影响  

Efficacy of GLP-1RA versus DPP-4i in the treatment of type 2 diabetes mellitus and diabetic complications

作　　者：颜建军[1] 胡杨 李利萍 程木子 张丽莎 张楠 YAN Jianjun;HU Yang;LI Liping(First Department of Endocrinology,Handan First Hospital,Hebei,Handan 056002,China)

机构地区：[1]河北省邯郸市第一医院内分泌一科,056002

出　　处：《河北医药》2024年第14期2135-2139,共5页Hebei Medical Journal

基　　金：河北省医学科学研究课题计划(编号:20220486)。

摘　　要：目的探讨胰高糖素样肽1受体激动剂(GLP-1RA)与二肽基肽酶4抑制剂(DPP-4i)治疗2型糖尿病(T2MD)的疗效及对患者并发症的影响。方法选取2020年6月至2022年6月邯郸市第一医院收治的110例T2MD随机分为GLP-1RA组和DPP-4i组,每组55例,GLP-1RA组采用利拉鲁肽或艾塞那肽治疗,DPP-4i组采用西格列汀或利格列汀治疗。对比2组临床疗效,治疗前后糖脂代谢指标[空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇、三酰甘油]、炎症指标[白介素-6(IL-6)、C反应蛋白(CRP)、中性粒细胞/淋巴细胞(NLR)]、肾功能[尿素氮、肌酐、胱抑素C];观察并统计2组并发症及不良反应。结果2组总有效率、并发症总发生率比较差异均无统计学意义(P>0.05)。治疗18周后,2组FPG、HbA1c、三酰甘油、总胆固醇水平低于治疗前,且GLP-1RA组低于DPP-4i组(P<0.05)。治疗18周后,2组IL-6、CRP、NLR水平低于治疗前(P<0.05),但2组间差异无统计学意义(P>0.05)。2组治疗前和治疗18周后尿素氮、肌酐、胱抑素C水平比较差异均无统计学意义(P>0.05)。GLP-1RA组不良反应总发生率高于DPP-4i组(P<0.05)。结论GLP-1RA与DPP-4i均能改善T2MD患者糖脂水平,减轻炎性反应,保护肾功能,预防并发症发生,但GLP-1RA在控制血糖、调脂方面优于DPP-4i,而DPP-4i耐受性更好。Objective To investigate the efficacy of glucagon-like peptide-1 receptor agonist(GLP-1RA) versus dipeptidyl peptidase-4 inhibitor(DPP-4i) in the treatment of type 2 diabetes mellitus(T2MD) and diabetic complications.Methods One hundred and ten T2MD patients admitted to Handan First Hospital from June 2020 to June 2022 were enrolled.They were randomly divided into GLP-1RA group(n=55,received liraglutide or exenatide) and DPP-4i group(n=55,received sitagliptin or linagliptin).The aim was to compare glycolipid metabolic indexes(fasting plasma glucose [FPG],glucose hemoglobin [HbA1c],total cholesterol [TC],triacylglycerols [TAG]),inflammatory indexes(interleukin-6 [IL-6],C-reactive protein [CRP],neutrophil-lymphocyte ratio [NLR]),renal function(urea nitrogen [UN],creatinine,cystatin C [cysC]),complications,adverse reactions between groups before and after treatment.The curative effect was assessed.Results The overall effective rate and total incidence of complications in the GLP-1RA group were comparable to those in the DPP-4i group(P>0.05).FPG,HbA1c,TAG,TC at week 18 of treatment in the both groups were significantly decreased,which decreased notably in the GLP-1RA group versus the DPP-4i group(P<0.05).At week 18,the levels of IL-6,CRP,NLR in the both groups were significantly decreased than before treatment(P<0.05),but no statistically significant difference in the levels of IL-6,CRP,NLR between groups(P>0.05).The intergroup differences were not statistically significant in levels of UN,creatinine,and cysC between before treatment and at week 18 of treatment(P>0.05).The overall incidence of adverse reactions was significantly higher in the GLP-1RA group versus the DPP-4i group(P<0.05).Conclusion Both GLP-1RA and DPP-4i can improve lipid levels,reduce inflammatory response,protect renal function and prevent complications in patients with T2MD,but GLP-1RA has better efficacy than DPP-4i,and DPP-4i i has better tolerated.

关 键 词：2型糖尿病 胰高糖素样肽-1受体激动剂 二肽基肽酶4抑制剂 临床疗效 并发症 

分 类 号：R969.4[医药卫生—药理学]