Dell'Oro Raffaella, Maloberti Alessandro, Nicoli Francesco, Villa Paolo, Gamba Pierluigi, Bombelli Michele, Mancia Giuseppe, Grassi Guido
Clinica Medica, Dipartimento di Medicina e Chirurgia, Università Milano-Bicocca, Via Pergolesi 33, 20090, Monza, Italy.
IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
High Blood Press Cardiovasc Prev. 2017 Dec;24(4):393-400. doi: 10.1007/s40292-017-0215-2. Epub 2017 Jun 12.
Pharmacological inhibition of dipeptidyl-peptidase-4 may represent a promising therapeutic approach for glucose control and vascular protection. No information is available on the effects of saxagliptin (S) on aortic pulse wave velocity, carotid intima-media thickness and flow-mediated dilation (FMD, brachial artery) in diabetes.
We investigated the long-term effects of S, as add-on therapy to metformin, on the above mentioned variables.
In 16 patients with decompensated diabetes aortic pulse wave velocity, carotid intima-media thickness and FMD, office and 24-h ambulatory blood pressure, anthropometric, biochemical and metabolic parameters were measured at baseline and after 6 and 12 months of treatment. A group of 16 compensated diabetics served as controls.
The two groups showed superimposable values of the different parameters, with the exception of glycated hemoglobin, blood glucose significantly (P < 0.05) greater in the S-treated patients. In the S-group glucose metabolism and FMD significantly improved during the follow-up (from 169.3 ± 8 to 157.1 ± 9 mg/dl, P < 0.05, from 7.9 ± 0.1 to 6.9 ± 0.2%, P < 0.001 and from 3.6 ± 0.3 to 7.4 ± 0.8%, respectively P < 0.05). No significant difference was detected in the other parameters, including blood pressure.
Thus treatment with S added-on to metformin results in beneficial effects on endothelial function, related at least in part to the concomitant improvement in glucose metabolism. This may represent a first step in the chain of events leading to a reduction in the progression of the vascular atherogenic process.
二肽基肽酶 -4 的药理抑制作用可能是控制血糖和保护血管的一种有前景的治疗方法。关于沙格列汀（S）对糖尿病患者主动脉脉搏波速度、颈动脉内膜中层厚度和血流介导的血管舒张（FMD，肱动脉）的影响尚无相关信息。
我们研究了作为二甲双胍附加治疗的 S 对上述变量的长期影响。
对 16 例失代偿性糖尿病患者在基线以及治疗 6 个月和 12 个月后测量主动脉脉搏波速度、颈动脉内膜中层厚度和 FMD、诊室和 24 小时动态血压、人体测量学、生化和代谢参数。16 例代偿性糖尿病患者作为对照组。
除糖化血红蛋白外，两组不同参数的值具有可比性，接受 S 治疗的患者血糖显著更高（P < 0.05）。在 S 组中，随访期间葡萄糖代谢和 FMD 显著改善（从 169.3 ± 8 降至 157.1 ± 9 mg/dl，P < 0.05；从 7.9 ± 0.1 升至 6.9 ± 0.2%，P < 0.001；分别从 3.6 ± 0.3 升至 7.4 ± 0.8%，P < 0.05）。包括血压在内的其他参数未检测到显著差异。
因此，二甲双胍联合 S 治疗对内皮功能有有益影响，至少部分与葡萄糖代谢的同时改善有关。这可能是导致血管动脉粥样硬化进程进展减缓的一系列事件中的第一步。
