National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, China.
Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu 210002, China.
Chin Med J (Engl). 2018 Nov 20;131(22):2658-2665. doi: 10.4103/0366-6999.245277.
Treatment with the dipeptidyl peptidase-4 inhibitors (DPP4i) and angiotensin receptor blockers (ARBs) in patients with type 2 diabetic nephropathy (DN) has not been well characterized. This study aimed to assess the renoprotection of this combined treatment in DN patients.
A total of 159 type 2 DN patients from 2013 to 2015 were enrolled retrospectively from a prospective DN cohort at the National Clinical Research Center of Kidney Diseases, Jinling Hospital (China). Fifty-seven patients received DPP4i and ARB treatment, and 102 patients were treated with ARBs alone. All patients were followed up for at least 12 months. Statistical analyses were performed using Stata version 12.0.
There were no significant differences at baseline for age, sex, body mass index, duration of diabetes, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), and estimated glomerular filtration rate (eGFR) between the two groups. Antihypertensive and antidiabetic medication use was similar in each group except calcium channel antagonists (P = 0.032). No significant changes in FBG and HbA1c were observed in the two groups after treatment. The eGFR decreased slower in the DPP4i + ARB group than in the ARB group at 12 months (Δ12 months: -2.48 ± 13.86 vs. -6.81 ± 12.52 ml·min·1.73m, P = 0.044). In addition, proteinuria was decreased further in the DPP4i + ARB group than in the ARB group after 24 months of treatment (Δ24 months: -0.18 [-1.00, 0.17] vs. 0.32 [-0.35, 0.88], P = 0.031). There were 36 patients with an eGFR decrease of more than 30% over 24 months. After adjusting for FBG, HbA1c, and other risk factors, DPP4i + ARB treatment was still associated with a reduced incidence of an eGFR decrease of 20% or 30%.
The combined treatment of DPP4i and ARBs is superior to ARBs alone, as evidenced by the greater proteinuria reduction and lower eGFR decline. In addition, the renoprotection of DPP4i combined with ARBs was independent of glycemic control.
在 2 型糖尿病肾病（DN）患者中，使用二肽基肽酶-4 抑制剂（DPP4i）和血管紧张素受体阻滞剂（ARB）的治疗效果尚未得到充分描述。本研究旨在评估这种联合治疗对 DN 患者的肾脏保护作用。
本研究回顾性分析了 2013 年至 2015 年期间，来自南京军区南京总医院国家肾脏疾病临床医学研究中心前瞻性 DN 队列中的 159 例 2 型 DN 患者。57 例患者接受 DPP4i 和 ARB 治疗，102 例患者仅接受 ARB 治疗。所有患者的随访时间均至少为 12 个月。统计分析采用 Stata 版本 12.0。
两组患者的年龄、性别、体重指数、糖尿病病程、空腹血糖（FBG）、糖化血红蛋白（HbA1c）和估算肾小球滤过率（eGFR）等基线特征无显著差异。两组患者的降压和降糖药物使用情况除钙通道拮抗剂（P = 0.032）外均相似。两组患者治疗后 FBG 和 HbA1c 均无明显变化。12 个月时，DPP4i+ARB 组的 eGFR 下降速度慢于 ARB 组（Δ12 个月：-2.48±13.86 与-6.81±12.52ml·min·1.73m，P = 0.044）。此外，24 个月时，DPP4i+ARB 组的蛋白尿进一步减少（Δ24 个月：-0.18[-1.00，0.17]与 0.32[-0.35，0.88]，P = 0.031）。有 36 例患者的 eGFR 在 24 个月内下降超过 30%。在调整 FBG、HbA1c 和其他危险因素后，DPP4i+ARB 治疗仍与 eGFR 下降 20%或 30%的发生率降低相关。
DPP4i 联合 ARB 的治疗效果优于 ARB 单药治疗，表现在蛋白尿减少和 eGFR 下降程度更低。此外，DPP4i 联合 ARB 的肾脏保护作用不依赖于血糖控制。
