度拉糖肽对T2DM合并CKD患者糖代谢与肾功能的影响  

Effects of dulaglutide on glucose metabolism and renal function in T2DM patients with CKD

作　　者：田杰 李丽娟 吴春梅 李慧 TIAN Jie;LI Lijuan;WU Chunmei;LI Hui(Department of Endocrinology,Chongqing Yubei District People's Hospital,Chongqing 401120,China;Department of Nephrology,Chongqing Yubei District People's Hospital,Chongqing 401120,China)

机构地区：[1]重庆市渝北区人民医院内分泌科,重庆401120 [2]重庆市渝北区人民医院肾病内科,重庆401120

出　　处：《中南医学科学杂志》2025年第2期312-315,330,共5页Medical Science Journal of Central South China

基　　金：重庆市渝北区人民医院医学科研项目(ybyk2023-13)。

摘　　要：目的观察度拉糖肽对2型糖尿病(T2DM)合并慢性肾脏病(CKD)患者糖代谢及肾功能的影响。方法将本院就诊的T2DM并CKD患者100例随机均分为对照组(口服降糖药+皮下注射胰岛素)、度拉糖肽组(在对照组基础上加用度拉糖肽治疗)。比较两组治疗前后血糖[糖化血红蛋白(HbA1C)、空腹血糖(FBG)、餐后2h血糖(2hPG)]、血脂[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)]、肾功能指标[估算的肾小球滤过率(eGFR)、血肌酐(Scr)、尿白蛋白肌酐比(ACR)、尿酸(UA)、血尿素氮(BUN)]水平以及两组出院后2周内血糖波动情况和血糖控制情况。比较度拉糖肽组不同分期CKD患者治疗前后的血糖、肾功能指标水平。结果治疗后,对照组HbA1c水平下降(P<0.05);度拉糖肽组TG、BUN、UA、ACR、FBG、2hPG及HbA1c下降(P<0.05),且低于对照组(P<0.05)。度拉糖肽组血糖波动指标水平低于对照组(P<0.05),血糖控制情况优于对照组(P<0.05)。治疗后,度拉糖肽组不同CKD分期患者FBG、2hPG、HbA1c及CKD 3~4期ACR均明显降低(P<0.05);CKD 3~4期患者ACR、2hPG、HbA1c低于CKD 1~2期(P<0.05)。结论度拉糖肽可以降低T2DM合并CKD患者的血糖,稳定血糖水平,同时可以降低ACR,且在CKD 3~4期上更为明显。Aim To identify the effects of dulaglutide on glucose metabolism and renal function in patients with type 2 diabetes mellitus(T2DM) and chronic kidney disease(CKD).Methods Totally 100 T2DM and CKD patients who received treatment at our hospital were randomly divided into a control group(oral hypoglycemic drugs+subcutaneous injection of insulin) and a dulaglutide group(received dulaglutide treatment in addition to the control group).The levels of blood glucose [glycosylated hemoglobin(HbA1C),fasting blood glucose(FBG),2 h postprandial blood glucose(2hPG)],blood lipids [triglycerides(TG),total cholesterol(TC),low density lipoprotein(LDL),high density lipoprotein(HDL)],renal function indicators [estimated glomerular filtration rate(eGFR),sersum creatinine(Scr),urinary albumin to creatinine ratio(ACR),uric acid(UA),blood urea nitrogen(BUN)] before and after treatment between two groups,as well as the blood glucose fluctuations and blood glucose control between two groups within 2 weeks after discharge,were compared.The levels of blood glucose and renal function indicators before and after treatment in CKD patients of different stages in the dulaglutide group were also compared.Results After treatment,the HbA1c level in the control group were decreased(P<0.05);The levels of TG,BUN,UA,ACR,FBG,2hPG,and HbA1c in the dulaglutide group were decreased(P<0.05),which were lower than those in the control group(P<0.05).The blood glucose fluctuation index level in the dulaglutide group was lower than that in the control group(P<0.05),and the blood glucose control was better than that in the control group(P<0.05).After treatment,FBG,2hPG,HbA1c levels in patients with different CKD stages,and CKD stage 3-4 ACR in the dulaglutide group were significantly reduced(P<0.05);ACR,2hPG,and HbA1c in CKD 3-4 stage patients were lower than those in CKD 1-2 stage(P<0.05).Conclusion Dulaglutide can lower blood glucose levels in T2DM patients with CKD,stabilize blood glucose levels,and reduce urinary protein,especially in CKD stages 3-4.

关 键 词：2型糖尿病 慢性肾脏病 度拉糖肽 糖代谢 肾功能 

分 类 号：R587.2[医药卫生—内分泌]