The study of protective effects of dipeptidyl peptidase Ⅳ inhibitor on early diabetic nephropathy patients
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摘要: 目的 观察不同剂量二肽基肽酶Ⅳ抑制剂磷酸西格列汀对早期糖尿病肾病患者的肾脏保护作用。 方法 120例糖尿病肾病Ⅲ期患者随机分为试验组1、试验组2和对照组,每组40例。所有患者均给予氯沙坦钾片+二甲双胍缓释片治疗,4周后,试验组1加用磷酸西格列汀片50 mg,1次/d;试验组2加用磷酸西格列汀片100 mg,1次/d;对照组加用格列齐特缓释片30 mg,2次/d。 结果 治疗后,3组的体重指数、FPG、2hPG、HbA1c至第24周均较治疗前显著下降(P<0.05)。治疗后试验组1、试验组2的mALB、尿蛋白肌酐比值、血清胱抑素C均显著低于对照组同一时间点相应水平(P<0.05),试验组2较试验组1下降更加明显(P<0.05)。3组的hs-CRP、IL-6、TNF-α、NF-κB p65磷酸化水平均较治疗前显著下降,试验组下降更加明显(P<0.05)。相关分析显示尿微量白蛋白水平与体重指数、FPG、2hPG、HbA1c无明显相关性(P>0.05),与hs-CRP、IL-6、TNF-α、NF-κB均呈显著正相关(P<0.01)。 结论 磷酸西格列汀有独立于降糖作用之外的肾脏保护作用,机制可能为磷酸西格列汀通过抑制机体的炎症状态,减少炎症因子的释放,从而进一步改善肾脏的炎症损伤,达到肾脏保护作用,且其疗效呈剂量依赖性。Abstract: Objective To observe the protective effects of dipeptidyl peptidase Ⅳ inhibitor on early diabetic nephropathy patients and to explore the mechanism of renal protection. Methods Total 120 patients suffered with Diabetic nephropathy Ⅲ were randomly divided into test group 1,test group 2,and control group,40 cases in each group.All patients were treated with losartan potassium tablets 50 mg qd+Metformin Sustained Release Tablets 0.5 g bid for 4 weeks.On this basis,the test group 1 plus sitagliptin phosphate tablets 50 mg qd;test group 2 plus sitagliptin phosphate tablets 100 mg qd; the control group were treated with gliclazide MR 30 mg bid. Results Twenty-four weeks after treatment,BMI,FPG,2HPG,HbA1c were significantly decreased compared with before treatment of the three groups(P<0.05).Compared to the control group,the mAlb,urine protein/creatinine ratio,serum cystatin C of test group 1 and test group 2 were all significantly lower than those of the control group at the same time(P<0.05).The test group 2 decreased more significantly than the test group 1(P<0.05).After treatment,hs-CRP,IL-6,TNF-α,NF-κB p65 phosphorylation levels of the three groups were significantly decreased,and these factors of test group 2 were significantly lower than that of the test group 1(P<0.05).Correlation analysis showed that mALB and BMI,FPG,2hPG,HbA1c had no significant correlation(P>0.05),and hs-CRP,IL-6,TNF-α,NF-κB p65 phosphorylation levels were significantly positively correlated(P<0.01). Conclusion The protective effect of phosphate on renal function is independent of the hypoglycemic effect.It is possible to reduce the release of inflammatory cytokines by inhibiting the inflammatory state of the body,which can further improve the inflammatory damage of the kidney and protect the kidney,and the effect is dose dependent.
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