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二肽基肽酶-4抑制剂对2型糖尿病患者的肾脏保护作用:一项队列研究

Renal Protective Effect of DPP-4 Inhibitors in Type 2 Diabetes Mellitus Patients: A Cohort Study.

作者信息

Kim Young-Gun, Byun JungHyun, Yoon Dukyong, Jeon Ja Young, Han Seung Jin, Kim Dae Jung, Lee Kwan-Woo, Park Rae Woong, Kim Hae Jin

机构信息

Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.

Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea.

出版信息

J Diabetes Res. 2016;2016:1423191. doi: 10.1155/2016/1423191. Epub 2016 Dec 29.

Abstract

. Dipeptidyl-peptidase IV inhibitors (DPP-4i) are among the most popular oral antidiabetic agents. However, the effects of DPP-4i on diabetic nephropathy are not well-established. The aim of this study was to determine the renoprotective effects of DPP-4i, using albuminuria and glomerular filtration rate (GFR) as indicators, in type 2 diabetes mellitus (T2DM) patients. . This retrospective observational cohort study used the clinical database of a tertiary hospital. The changes of urine albumin/creatinine ratio (UACR), estimated GFR (eGFR), and metabolic parameters after treatment were compared with the changes of those parameters before treatment using paired Student's -test. . The mean UACR in the entire study population decreased to approximately 45 mg/g 1 year after DPP-4i treatment, while it was increased approximately 39 mg/g 1 year before DPP-4i treatment ( < 0.05). Patients with macroalbuminuria showed a significant reduction in albumin levels after DPP-4i treatment ( < 0.05); however, patients with microalbuminuria and normoalbuminuria did not show improvements in albuminuria levels after treatment. Although eGFR was not changed 1 year after DPP-4i treatment, reductions in eGFR were slowed in patients with microalbuminuria and reversed in the macroalbuminuria or normoalbuminuria groups, 4 years after treatment. . Administration of DPP-4i reduces urine albumin excretion and mitigates reduction of eGFR in T2DM patients.

摘要

二肽基肽酶IV抑制剂(DPP - 4i)是最常用的口服抗糖尿病药物之一。然而,DPP - 4i对糖尿病肾病的影响尚未完全明确。本研究的目的是,以蛋白尿和肾小球滤过率(GFR)为指标,确定DPP - 4i对2型糖尿病(T2DM)患者的肾脏保护作用。

这项回顾性观察队列研究使用了一家三级医院的临床数据库。采用配对t检验,比较治疗后尿白蛋白/肌酐比值(UACR)、估算肾小球滤过率(eGFR)和代谢参数的变化与治疗前这些参数的变化。

在整个研究人群中,DPP - 4i治疗1年后平均UACR降至约45mg/g,而在DPP - 4i治疗前1年约升高39mg/g(P<0.05)。大量蛋白尿患者在DPP - 4i治疗后白蛋白水平显著降低(P<0.05);然而,微量蛋白尿和正常白蛋白尿患者治疗后蛋白尿水平未改善。虽然DPP - 4i治疗1年后eGFR未改变,但治疗4年后,微量蛋白尿患者的eGFR下降减缓,大量蛋白尿或正常白蛋白尿组的eGFR下降逆转。

给予DPP - 4i可减少T2DM患者的尿白蛋白排泄,并减轻eGFR的降低。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f183/5228170/f56a8869932b/JDR2016-1423191.001.jpg

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