Endocrinology and Metabolism, Tsunemi-cho Clinic, Ashikaga, Tochigi, Japan.
Endocr J. 2011;58(1):69-73. doi: 10.1507/endocrj.k10e-382. Epub 2010 Dec 28.
We investigated the inhibitory effect of sitagliptin on albuminuria in patients with type 2 diabetes. Thirty-six patients (19 men and 17 women) whose HbA1c was higher than 6.5% (NGSP) despite receiving education on diet and exercise and medical treatment for at least 6 months at our clinic were enrolled into this study and were successfully followed over 6 months of sitagliptin treatment. Sitagliptin (50 mg/day) treatment significantly lowered both systolic and diastolic blood pressures, fasting blood glucose and postprandial blood glucose, HbA1c, and glycated albumin at 3 months and 6 months. Significant reductions in highly sensitive C-reactive protein and soluble vascular cell adhesion molecule 1 were also observed at 6 months. Urinary albumin excretion (measured as urinary albumin-to-creatinine ratio (ACR: mg/g Cr)) did not change in the 6 months before sitagliptin treatment (ΔACR: 2.3 ± 19.9) and decreased in the 6 months after sitagliptin treatment (ΔACR: -20.6 ± 24.6); these differences were statistically significant. At 6 months, the ACR decreased from 11.6 ± 8.4 to 4.5 ± 5.0 in 13 patients with normoalbuminuria (ACR < 30), from 98.4 ± 79 to 24.9 ± 20 in 15 patients with microalbuminuria (30 < ACR < 300), and from 1263 ± 492 to 561 ± 89 in 8 patients with macroalbuminuria (ACR > 300). Thus, the present findings strongly suggest that sitagliptin reduces albuminuria without lowering the estimated glomerular filtration rate, most likely depending on known factors such as blood sugar reduction, blood pressure reduction, and inflammation reduction, as well as yet undetermined factors caused by an increase in active glucagon-like peptide-1.
我们研究了西他列汀对 2 型糖尿病患者白蛋白尿的抑制作用。36 名患者（19 名男性，17 名女性）在我们诊所接受饮食和运动教育以及至少 6 个月的药物治疗后，HbA1c 仍高于 6.5%（NGSP），成功接受了 6 个月的西他列汀治疗。西他列汀（50mg/天）治疗可显著降低收缩压和舒张压、空腹血糖和餐后血糖、HbA1c 和糖化白蛋白，在 3 个月和 6 个月时均有显著降低。6 个月时还观察到高敏 C 反应蛋白和可溶性血管细胞黏附分子 1 的显著降低。在西他列汀治疗前 6 个月（ACR 变化：2.3 ± 19.9），尿白蛋白排泄量（以尿白蛋白/肌酐比值（ACR：mg/g Cr）表示）没有变化，在西他列汀治疗后 6 个月（ACR 变化：-20.6 ± 24.6）下降；这些差异具有统计学意义。在 6 个月时，13 名正常白蛋白尿患者（ACR < 30）的 ACR 从 11.6 ± 8.4 降至 4.5 ± 5.0，15 名微量白蛋白尿患者（30 < ACR < 300）的 ACR 从 98.4 ± 79 降至 24.9 ± 20，8 名大量白蛋白尿患者（ACR > 300）的 ACR 从 1263 ± 492 降至 561 ± 89。因此，目前的研究结果强烈表明，西他列汀可降低白蛋白尿，而不降低估算的肾小球滤过率，这可能主要取决于已知因素，如血糖降低、血压降低和炎症降低，以及尚未确定的因素，即活性胰高血糖素样肽-1 的增加。
