达格列净与沙格列汀对老年2型糖尿病患者炎症指标和肾功能的影响

Effects of dapagliflozin versus saxagliptin on inflammatory markers and renal function in elderly patients with type 2 diabetes mellitus

摘要:

目的 观察达格列净与沙格列汀对老年2型糖尿病(T2DM)患者炎症指标和肾功能的影响。方法 选取2018年9月至2020年11月于徐州医科大学附属医院诊治的144例老年T2DM患者为研究对象,将患者随机分为达格列净组和沙格列汀组。除外退出研究、失访等病例,达格列净组有50例患者纳入统计,沙格列汀组有67例患者纳入统计。比较2组患者治疗前后体质量、血压、血糖、炎症指标及肾功能水平,记录不良反应。采用SPSS 23.0统计软件进行数据分析。根据数据类型,分别采用t检验、Mann-Whitney U检验、Wilcoxon signed-rank检验、χ²检验或Fisher确切概率法检验进行比较。采用Spearman非参数相关分析评价中性粒细胞/淋巴细胞比值(NLR)、淋巴细胞/单核细胞比值(LMR)、单核细胞/高密度脂蛋白胆固醇比值(MHR)与肾功能之间的关系。结果 治疗24周后,达格列净组体质量、体质量指数、收缩压、舒张压、空腹血糖、餐后2h血糖、糖化血红蛋白、MHR、C反应蛋白(CRP)治疗后较治疗前下降幅度大于沙格列汀组,差异有统计学意义(P＜0.05)。达格列净组不良反应发生率为6.0％(3/50),沙格列汀组为4.5％(3/67),2组患者比较差异无统计学意义(P＞0.05)。NLR与年龄、CRP、血肌酐(SCr)呈正相关(r=0.229、0.214、0.223,P＜0.05)；LMR与年龄、体质量、CRP、SCr呈负相关(r=-0.261、-0.202、-0.184、-0.188,P＜0.05)；MHR与年龄、体质量、CRP、SCr、血尿酸、胱抑素C呈正相关(r=0.256、0.305、0.265、0.291、0.204、0.298,P＜0.05)。结论 老年T2DM患者应用达格列净或沙格列汀均能有效控制血糖水平,不良反应较少；达格列净在减轻体质量、降低血压、降低炎症反应、改善肾功能等方面优于沙格列汀。

Abstract:

Objective To observe the effects of dapagliflozin versus saxagliptin on inflammatory markers and renal function in elderly patients with type 2 diabetes mellitus (T2DM). Methods A total of 144 elderly T2DM patients admitted to the Affiliated Hospital of Xuzhou Medical University during September 2018 to November 2020 were prospectively recruited, and then randomly divided into dapagliflozin group and saxagliptin group. Excluding the cases withdrawn from the study or lost to follow-up, 50 patients in the dapagliflozin group and 67 patients in the saxagliptin group were finally included in the statistics. The changes of body mass, blood pressure, blood glucose, inflammatory markers, renal function and adverse events were compared between the two groups. SPSS statistics 23.0 was used for statistical analysis. Data comparison was performed using student′s t test, Mann-Whitney U test, Wilcoxon signed-rank test, Chi-square test, or Fisher exact probability test depending on date types. Spearman nonparametric correlation analysis was adopted to evaluate the relationship of neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), and monocyte/high-density lipoprotein cholesterol ratio (MHR) with renal function. Results After 24 weeks of treatment, more obvious declines of body mass, body mass index, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, 2h postprandial blood glucose, glycosylated hemoglobin A1c, MHR, and C-reactive protein (CRP) level were observed in the dapagliflozin group than the saxagliptin group (P<0.05). The incidence of adverse events was 6.0% (3/50) in the dapagliflozin group, and 4.5% (3/67) in the saxagliptin group, and there was no statistical difference between the two groups (P>0.05). NLR was positively correlated with age, CRP and serum creatinine (SCr) (r=0.229,0.214,0.223, P＜0.05). LMR had negative correlation with age, body mass, CRP and SCr (r=-0.261, -0.202, -0.184, -0.188, P<0.05). There was positive correlation of MHR with age, body mass, CRP, SCr, serum uric acid and Cystatin C (r=0.256,0.305,0.265,0.291,0.204,0.298, P<0.05). Conclusion For the elderly T2DM patients, both dapagliflozin and saxagliptin effectively control the blood glucose, with few adverse events. Dapagliflozin is superior to saxagliptin in body mass loss, decrease of blood pressure, reduction of inflammatory reaction and improvement of renal function.