Department of Medicine, Division of Metabolic Diseases, University of Padova, Padova, Italy
Department of Medicine, Division of Metabolic Diseases, University of Padova, Padova, Italy.
Diabetes Care. 2014 Oct;37(10):2884-94. doi: 10.2337/dc14-0865.
We performed a review of the literature to determine whether the dipeptidyl peptidase-4 inhibitors (DPP4-I) may have the capability to directly and positively influence diabetic microvascular complications. The literature was scanned to identify experimental and clinical evidence that DPP4-I can ameliorate diabetic microangiopathy. We retrieved articles published between 1 January 1980 and 1 March 2014 in English-language peer-reviewed journals using the following terms: ("diabetes" OR "diabetic") AND ("retinopathy" OR "retinal" OR "nephropathy" OR "renal" OR "albuminuria" OR "microalbuminuria" OR "neuropathy" OR "ulcer" OR "wound" OR "bone marrow"); ("dipeptidyl peptidase-4" OR "dipeptidyl peptidase-IV" OR "DPP-4" OR "DPP-IV"); and ("inhibition" OR "inhibitor"). Experimentally, DPP4-I appears to improve inflammation, endothelial function, blood pressure, lipid metabolism, and bone marrow function. Several experimental studies report direct potential beneficial effects of DPP4-I on all microvascular diabetes-related complications. These drugs have the ability to act either directly or indirectly via improved glucose control, GLP-1 bioavailability, and modifying nonincretin substrates. Although preliminary clinical data support that DPP4-I therapy can protect from microangiopathy, insufficient evidence is available to conclude that this class of drugs directly prevents or decreases microangiopathy in humans independently from improved glucose control. Experimental findings and preliminary clinical data suggest that DPP4-I, in addition to improving metabolic control, have the potential to interfere with the onset and progression of diabetic microangiopathy. Further evidence is needed to confirm these effects in patients with diabetes.
我们对文献进行了回顾，以确定二肽基肽酶-4 抑制剂（DPP4-I）是否有可能直接和积极地影响糖尿病微血管并发症。扫描文献以确定 DPP4-I 可改善糖尿病微血管病变的实验和临床证据。我们使用以下术语检索了 1980 年 1 月 1 日至 2014 年 3 月 1 日期间在英语同行评审期刊上发表的文章：（“糖尿病”或“糖尿病”）和（“视网膜病变”或“视网膜”或“肾病”或“肾脏”或“蛋白尿”或“微量白蛋白尿”或“神经病”或“溃疡”或“伤口”或“骨髓”）；（“二肽基肽酶-4”或“二肽基肽酶-IV”或“DPP-4”或“DPP-IV”）；和（“抑制”或“抑制剂”）。在实验中，DPP4-I 似乎改善了炎症、内皮功能、血压、脂代谢和骨髓功能。几项实验研究报告了 DPP4-I 对所有与微血管糖尿病相关的并发症的直接潜在有益作用。这些药物通过改善葡萄糖控制、GLP-1 生物利用度和改变非胰岛素底物，具有直接或间接作用的能力。尽管初步的临床数据支持 DPP4-I 治疗可以预防微血管病变，但尚无足够的证据表明该类药物可以独立于改善葡萄糖控制而直接预防或减少人类的微血管病变。实验结果和初步临床数据表明，DPP4-I 除了改善代谢控制外，还有可能干扰糖尿病微血管病变的发生和进展。需要进一步的证据来证实这些在糖尿病患者中的作用。
