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目的探讨利拉鲁肽治疗早期糖尿病肾病的临床疗效及其对患者肾功能、脂肪细胞因子的影响。方法选取博尔塔拉蒙古自治州人民医院2012年6月—2016年1月收治的早期糖尿病肾病1~2期患者162例,根据治疗方法不同将所有患者分为对照组(n=73)和观察组(n=89)。对照组患者给予常规降糖治疗,观察组患者在对照组基础上给予利拉鲁肽治疗,两组患者均持续治疗8周。比较两组患者治疗后血糖代谢指标[空腹血糖(FBG)、餐后2 h血糖(PBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)]、肾功能指标[胰岛素样生长因子1(IGF-1)、视黄醇结合蛋白(RBP)、分泌型卷曲相关蛋白5(SFRP5)、同型半胱氨酸(Hcy)、脑钠肽(BNP)、尿清蛋白排泄率(UAER)、尿微量清蛋白肌酐比值(ACR)、尿肝型脂肪酸结合蛋白(L-FABP)]、脂肪细胞因子[脂肪细胞因子(Chemerin、Letin)、内脂素(Visfatin)、饱食分子(Nesfatin-1)、人网膜素-1(Omentin-1)]。结果观察组患者FBG、PBG、FINS及HOMA-IR低于对照组,HOMA-β高于对照组(P<0.05);观察组患者IGF-1、RBP、Hcy、BNP及UAER、ACR、L-FABP低于对照组,SFRP5高于对照组(P<0.05);观察组患者Chemerin、Letin、Visfatin低于对照组,Nesfatin-1、Omentin-1高于对照组(P<0.05)。结论利拉鲁肽治疗早期糖尿病肾病效果确切,可有效控制血糖水平,增加胰岛素敏感性,明显改善肾功能并具有调节脂肪细胞因子分泌的作用。
Objective To investigate the clinical efficacy of liraglutide in the treatment of early diabetic nephropathy and its effect on renal function and adipocytokines. Methods 162 patients with early stage diabetic nephropathy who were admitted to Bortala Mongolian Autonomous Prefecture People’s Hospital from June 2012 to January 2016 were enrolled. All patients were divided into control group (n = 73) and observation group according to different treatment methods Group (n = 89). Patients in the control group were given regular glucose-lowering therapy. Patients in the observation group were treated with liraglutide on the basis of the control group, and both groups were treated for 8 weeks. The levels of fasting blood glucose (FBG), postprandial blood glucose (PBG), fasting insulin (FINS), insulin resistance index (HOMA-IR) and islet β cell function index (HOMA-β) were compared between the two groups after treatment ], Renal function indexes such as insulin-like growth factor 1 (IGF-1), retinol binding protein (RBP), secreted curl-associated protein 5 (SFRP5), homocysteine (Hcy), brain natriuretic peptide ), Urinary albumin excretion rate (UAER), urinary albumin creatinine ratio (ACR), urinary liver fatty acid binding protein (L-FABP)], adipocytokines [Chemerin, Letin, Visfatin, Nesfatin-1, Omentin-1]. Results The levels of FBG, PBG, FINS and HOMA-IR in observation group were lower than those in control group and HOMA-β was higher than that in control group (P <0.05). IGF-1, RBP, Hcy, BNP and UAER, ACR, FABP lower than the control group, SFRP5 higher than the control group (P <0.05); Chemerin, Letin, Visfatin in the observation group was lower than the control group, Nesfatin-1 and Omentin-1 were higher than the control group (P <0.05). Conclusion Liraglutide is effective in treating diabetic nephropathy in early stage. It can effectively control blood sugar level, increase insulin sensitivity, significantly improve renal function and regulate the secretion of adipocytes.