聚乙二醇洛塞那肽注射液与恩格列净治疗2型糖尿病早期糖尿病肾病的疗效比较  

Comparison of the efficacy of polyethylene glycol loxenatide injection with empagliflozin in the treatment of early diabetic kidney disease in type 2 diabetes mellitus

作　　者：王脉桃 宋卫红[1] 张亚萍[1] 周华 张成梅 万倩 惠辉[1] WANG Maitao;SONG Weihong;ZHANG Yaping;ZHOU Hua;ZHANG Chengmei;WAN Qian;HUI Hui(Department of Endocrionology,the First People′s Hospital of Chenzhou,Hunan Province,Chenzhou 423000,China)

机构地区：[1]湖南省郴州市第一人民医院内分泌科,423000

出　　处：《临床合理用药》2025年第1期21-24,28,共5页Chinese Journal of Clinical Rational Drug Use

基　　金：郴州市第一人民医院基金项目(N2020-11)。

摘　　要：目的比较聚乙二醇洛塞那肽注射液(PEX168)与恩格列净治疗2型糖尿病(T2DM)早期糖尿病肾病(DKD)的临床疗效。方法选取2020年2月—2021年2月入住郴州市第一人民医院内分泌科的T2DM早期(G2A2期)DKD患者60例,采用随机数字表法分为PEX168组(n=30)和恩格列净组(n=30),分别给予聚乙二醇洛塞那肽注射液与恩格列净治疗,2组均治疗24周。比较2组治疗前、治疗12周、24周后血糖指标[空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA_(1c))、胰岛素抵抗指数(HOMA-IR)]、血压[收缩压(SBP)、舒张压(DBP)]、肾功能指标[尿白蛋白—肌酐比值(UACR)、估算肾小球滤过率(eGFR)]、体质指数(BMI)、内脏脂肪面积,不良反应。结果治疗12周、24周后,2组血糖指标(FPG、2 hPG、HbA_(1c)、HOMA-IR)、血压(SBP、DBP)均低于治疗前,且PEX168组治疗12周、24周后的SBP和治疗24周后的HOMA-IR、DBP均低于恩格列净组(P<0.05或P<0.01),组间其他指标比较差异均无统计学意义(P>0.05)。治疗12周、24周后,2组eGFR高于治疗前,UACR、BMI及内脏脂肪面积低于治疗前,且PEX168组治疗24周后eGFR高于恩格列净组,UACR、BMI及内脏脂肪面积低于恩格列净组(P<0.05或P<0.01),2组治疗12周后eGFR、UACR、BMI及内脏脂肪面积比较差异均无统计学意义(P>0.05)。2组均无严重不良反应发生。结论聚乙二醇洛塞那肽注射液与恩格列净均有明显的降糖及肾脏保护作用,但聚乙二醇洛塞那肽注射液对超重及腹型肥胖的T2DM早期DKD患者的肾脏保护作用更好。Objective To compare the clinical efficacy of polyethylene glycol loxenatide injection(PEX168)with empagliflozin in the treatment of early DKD in T2DM.Methods Sixty patients with early DKD(G2A2 stage)in T2DM who were admitted to the Department of Endocrinology,the First People′s Hospital of Chenzhou from February 2020 to February 2021 were selected,and they were divided into the PEX168 group(n=30)and the empagliflozin group(n=30)using randomized numerical table method,which were given polyethylene glycol loxenatide injection and empagliflozin respectively,and both groups were treated for 24 weeks.Blood glucose indexes(FPG,2 hPG,HbA_(1c),HOMA-IR),Blood pressure(SBP,DBP),renal function index(UACR,eGFR),BMI,visceral fat area before treatment,and at 12 and 24 weeks post-treatment,and adverse reactions were compared between the two groups.Results After 12 and 24 weeks of treatment,blood glucose indexes(FPG,2 hPG,HbA 1c,HOMA-IR)and blood pressure(SBP,DBP)were lower than those before treatment in the two groups(P<0.05 or P<0.01),and there were no statistically significant difference between the other indexes of the two groups(P>0.05).After 12 and 24 weeks of treatment,the eGFR of the two groups were higher than that before treatment,and the UACR,BMI and visceral fat area were lower than those before treatment,and the eGFR of the PEX168 group was higher than that of the empagliflozin group,and the UACR,BMI and visceral fat area were lower than that of the empagliflozin group after 24 weeks of treatment(P<0.05 or P<0.01),and the differences in eGFR,UACR,BMI and visceral fat area were not statistically significant when comparing the two groups after 12 weeks of treatment(P>0.05).There were no serious adverse reactions in both groups.Conclusion Polyethylene glycol loxenatide injection and empagliflozin both have obvious hypoglycemic and nephroprotective effects,but polyethylene glycol losenatide injection has better nephroprotective effects in overweight and abdominal obese patients with early DKD in T2DM.

关 键 词：2型糖尿病 糖尿病肾病 聚乙二醇洛塞那肽注射液 恩格列净 肾小球滤过率 尿白蛋白—肌酐比值 

分 类 号：R692.9[医药卫生—泌尿科学] R587.2[医药卫生—外科学]