摘要
目的 分析利拉鲁肽联合达格列净治疗糖尿病肾病(DN)患者的疗效及超声心动图参数变化.方法 前瞻性选取2020年10月至2021年11月中南大学湘雅医学院附属海口医院内分泌科就诊的120例DN患者,依据信封法将其分为对照组(n=59)和观察组(n=61).对照组采用胰岛素联合利拉鲁肽治疗,观察组在对照组基础上联合达格列净治疗.比较两组治疗效果,治疗前、治疗8周后的血糖指标[糖化血红蛋白(HbA1c)、空腹血糖、餐后2 h血糖(2 h PG)]、胰岛素抵抗指数(HOMA-IR)、肾功能[肾小球滤过率(eGFR)、尿白蛋白排泄率(UAER)、尿白蛋白与肌酐比值(UACR)及24 h尿蛋白定量]、超声心动图参数[左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF)]及并发症发生情况.结果 观察组治疗总有效率为95.08％,高于对照组(83.05％),差异有统计学意义(P＜0.05).观察组治疗 8 周后的 HbA1c、FPG、2 h PG 及 HOMA-IR 分别为(6.80±1.13)％、(6.12±0.43)mmol/L、(7.58±1.25)mmol/L、2.64±0.41,均低于对照组[(7.34±1.26)％、(6.39±0.54)mmol/L、(8.11±1.32)mmol/L、2.96±0.38],差异均有统计学意义(P＜0.05).观察组治疗 8 周后的 eGFR 为(100.54±10.19)min·1.73 m2,高于对照组[(96.36±8.54)min·1.73 m2],UAER、UACR 及 24h 尿蛋白定量分别为(86.95±6.57)μg/min、(87.69±7.32)mg/g、(153.64±10.18)mg/24 h,均低于对照组[(89.63±6.49)μg/min、(90.54±6.87)mg/g、(158.34±11.85)mg/24 h],差异均有统计学意义(P＜0.05).观察组治疗8周后的LVEDD 及 LVESD分别为(46.13±3.22)、(30.15±1.85)mm,均低于对照组[(47.42±3.34)、(30.95±1.95)mm],LVEF 为(65.94±2.12)％,高于对照组[(65.05±2.36)％],差异均有统计学意义(P＜0.05).两组总并发症发生率比较,差异无统计学意义(P＞0.05).结论 利拉鲁肽联合达格列净治疗DN患者,治疗效果更好,能明显改善患者血糖、肾功能及心功能,且安全性高.
Abstract
Objective To analyze the efficacy of liaraglutide combined with dagliflozin in the patients with diabetic nephropathy(DN).Methods From October 2020 to December 2021,120 patients with DN were selected from the Department of Endocrinology,Haikou Hospital,Xiangya Medical College,Central South University,and divided into the control group(n=59)and the observation group(n=61)according to the envelope method.The control group was treated with insulin combined with liraglutide,and the observation group was treated with daglipra-zin combined with the control group.The therapeutic effect,blood glucose index[hemoglobin A1c(HbA1c),fasting blood glucose,postprandial 2-hour blood glucose(2 h PG)],Homeostasis model assessment for insulin resistance(HOMA-IR),renal function[glomerular filtration rate(eGFR),urinary albumin excretion rate(UAER),urinary albumin to creatinine ratio(UACR),and 24-hour urine protein quantification],echocardiographic parameters[left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular e-jection fraction(LVEF)]before treatment and after 8 weeks of treatment and complication rate of the two groups were compared.Results The to-tal effective rate of the observation group was 95.08％,which was higher than that of the control group(83.05％),and the difference was statisti-cally significant(P＜0.05).After 8 weeks of treatment,the HbA1c,FPG,2 h PG,and HOMA-IR in the observation group were(6.80±1.13)％,(6.12±0.43)mmol/L,(7.58±1.25)mmol/L,and 2.64±0.41,respectively,lower than those in the control group[(7.34±1.26)％,(6.39±0.54)mmol/L,(8.11±1.32)mmol/L,and 2.96±0.38],and the differences were statistically significant(P＜0.05).After 8 weeks of treatment,the eGFR of the observation group was(100.54±10.19)min·1.73 m2,which was higher than that of the control group[(96.36±8.54)min·1.73 m2],the UAER,UACR,and 24-hour urine protein quantification were(86.95±6.57)μg/min,(87.69±7.32)mg/g,and(153.64±10.18)mg/24 h,respectively,which were lower than those of the control group[(89.63±6.49)μg/min,(90.54±6.87)mg/g,and(158.34±11.85)mg/24 h],and the differences were statistically significant(P＜0.05).After 8 weeks of treat-ment,the LVEDD and LVESD of the observation group were(46.13±3.22)and(30.15±1.85)mm,respectively,which were lower than those of the control group[(47.42±3.34)and(30.95±1.95)mm],and the LVEF was(65.94±2.12)％,which was higher than that of the control group[65.05±2.36)％],and the differences were statistically significant(P＜0.05).There was no statistically significant difference in the overall incidence of complications between the two groups(P＞0.05).Conclusion Lraglutide combined with dagagliflozin showed better treatment effect in DN patients,significantly improved blood glucose,renal function and cardiac function,and high safety.
维普
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