达格列净在2型糖尿病肾病中的应用效果

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摘要目的探讨达格列净在2 型糖尿病肾病中的应用效果。方法选取2020年7月至2021年7月南京鼓楼医院集团宿迁医院肾内科收治的40 例2 型糖尿病肾病患者作为研究对象，采用随机数字表法将其分为对照组（20例）和观察组（20 例）。对照组患者采用达格列净以外的降糖药物治疗，观察组患者采用达格列净（10 mg，1 次/d）降糖治疗。两组患者均予以饮食控制和运动干预。比较两组患者治疗前、治疗12 周后的体重指数（BMI）、收缩压（SBP）、舒张压（DBP）、血清空腹血糖（FPG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、血肌酐（SCr）、胱抑素C（CysC）、尿酸（SUA）、B 型脑利钠肽（BNP）、肾小球滤过率（eGFR）、尿蛋白/肌酐比值（UACR）、24 h 的尿蛋白定量（24 h UAlb）、左心室射血分数（LVEF）；比较两组患者的不良反应发生情况。结果治疗12 周后，观察组患者治疗12 周后的FPG、HbA1c、UACR、24 h UAlb、SUA、BNP 低于治疗前，LVEF 高于治疗前，差异有统计学意义（P＜0.05）。治疗12 周后，观察组患者的HbA1c、UACR、24 h UAlb、SUA、BNP 低于对照组，LVEF 高于对照组，差异有统计学意义（P＜0.05）。两组患者治疗12 周后的SBP、DBP、体重、BMI、FPG、TC、TG、HDL、LDL、SCr、eGFR、CysC 比较，差异无统计学意义（P＞0.05）。观察组患者的低血糖发生率低于对照组，差异有统计学意义（P＜0.01）。两组患者的泌尿道感染发生率比较，差异无统计学意义（P＞0.05）。观察组患者的不良反应总发生率低于对照组，差异有统计学意义（P＜0.05）。结论达格列净可降低2 型糖尿病肾病患者的UACR、24 h UAlb、HbA1c、BNP、SUA，提高LVEF，对于2 型糖尿病肾病患者的心、肾功能均具有保护作用。

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关键词 ：达格列净, 2 型糖尿病肾病, 蛋白尿, 心脏功能

Abstract：Objective To explore the application effect of Dapagliflozin in type 2 diabetic kidney disease. Methods A total of 40 patients with type 2 diabetic kidney disease admitted to the Department of Nephrology, Suqian Hospital,Nanjing Gulou Hospital Group from July 2020 to July 2021 were selected as the research subjects. They were divided into control group (n=20) and observation group (n=20) by random number table method. The control group was treated with hypoglycemic drugs besides Dapagliflozin, while the observation group was treated with Dapagliflozin 10 mg once a day. Both groups were given diet control and exercise intervention. The body mass index (BMI), systolic blood pressure(SBP), diastolic blood pressure (DBP), serum fasting glucose (FPG), glycosylated hemoglobin (HbA1c), total cholesterol(TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), serum creatinine (SCr), cystatin C(CysC), serum uric acid (SUA), type B brain natriuretic peptide (BNP), estimated glomerular filtration rate (eGFR), urinary protein/creatinine ratio (UACR), 24-hour urinary albumin quantification (24 h UAlb), left ventricular ejection fraction (LVEF) were compared between the two groups before treatment and 12 weeks after treatment. The incidence of adverse reactions was compared between the two groups. Results After 12 weeks of treatment, FPG, HbA1c, UACR,24 h UAlb, SUA and BNP in the observation group were lower than those before treatment, while LVEF in the observation group after 12 weeks of treatment was higher than that before treatment, the differences were statistically significant (P＜0.05). After 12 weeks of treatment, HbA1c, UACR, 24 h UAlb, SUA and BNP in the observation group were lower than those in the control group, while LVEF in the observation group was higher than that in the control group,the differences were statistically significant (P＜0.05). After 12 weeks of treatment, there were no significant differences in SBP, DBP, body weight, BMI, FPG, TC, TG,HDL, LDL, SCr, eGFR and CysC between the two groups(P＞0.05). The incidence of hypoglycemia in observation group was lower than that in control group, and the difference was statistically significant (P＜0.01). There was no significant difference in the incidence of urinary tract infection between the two groups (P＞0.05). The total incidence of adverse reactions in observation group was lower than control group, and the difference was statistically significant (P＜0.05). Conclusion Dapagliflozin can decrease UACR, 24 h UAlb, HbA1c, BNP, SUA and increase LVEF in patients with type 2 diabetic kidney disease, and has protective effect on heart and kidney function in patients with type 2 diabetic kidney disease.

Key words： Dapagliflozin Type 2 diabetic kidney disease Proteinuria Cardiac function

基金资助:徐州医科大学附属医院发展基金资助项目（XYFY2020018）。

作者简介: 徐晓宏（1983-），女，江苏沭阳人，苏州大学医学院2018 级内科学在读博士研究生，副主任医师，研究方向：代谢相关性肾病。

引用本文:

徐晓宏；张策；米侠；张弛；周飞红；王军升；朱爱民. 达格列净在2型糖尿病肾病中的应用效果[J]. 中国当代医药, 2022, 29(16): 5-10.
XU Xiaohong；ZHANG Ce；MI Xia；ZHANG Chi；ZHOU Feihong；WANG Junsheng； ZHU Ai′min. Application effect of Dapagliflozin in type 2 diabetic kidney disease. 中国当代医药, 2022, 29(16): 5-10.

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https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2022/V29/I16/5

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