2型糖尿病肾脏疾病患者使用达格列净的代谢改善效果观察

Observation of the Metabolic Improvement Effects of Dapagliflozin in Patients with Type 2 Diabetic Kidney Disease

摘要: 目的：观察达格列净治疗2型糖尿病肾病的作用机制，探讨2型糖尿病肾病患者使用达格列净后糖代谢、体重和肾功能方面的调节模式。方法：64例符合标准的2型糖尿病肾病患者按照随机数字法分为2组，对照组采用常规控制血糖、血压治疗(胰岛素/二甲双胍 + ACEI/ARB)，干预组加用10 mg的达格列净，1次/d，治疗6个月，对比随访期间2组的糖化血红蛋白、空腹血糖、体质量指数、估算的肾小球滤过率、尿白蛋白/肌酐比值等指标的变化及低血糖或泌尿生殖道感染的情况，评估2种治疗的差异性。结果：联合组患者的糖化血红蛋白水平降低值较常规组增加0.8%，P < 0.001，体重降低值较常规组增加5.7 ± 2.1 kg，P < 0.001，尿白蛋白/肌酐比值降低值较常规组增加40.5 ± 12.7 mg/g，P < 0.001，估算的肾小球滤过率降低速度较常规组缓慢3.3 mL/min/1.73m²，P = 0.032，泌尿系统感染发病率较常规组提高18.7%，P = 0.021。结论：在常规控制血糖、血压的同时联用达格列净表现出多方面的糖代谢、体重、肾功能的调节作用，能够对患者进行有效治疗，但泌尿生殖道感染风险应引起重视，并建议强化防治策略和随访。

Abstract: Objective: To observe the mechanism of action of dapagliflozin in the treatment of type 2 diabetic nephropathy and to explore the regulatory patterns of glucose metabolism, body weight, and renal function in patients with type 2 diabetic nephropathy after using dapagliflozin. Method: Sixty-four patients with type 2 diabetic nephropathy meeting the criteria were randomly divided into two groups. The control group received conventional treatment to control blood glucose and blood pressure (insulin/metformin, ACEI/ARB), while the intervention group received an additional 10 mg of dapagliflozin once daily for 6 months. The changes in glycated hemoglobin, fasting blood glucose, body mass index, estimated glomerular filtration rate, urine albumin/creatinine ratio, and the occurrence of hypoglycemia or genitourinary infections during the follow-up period were compared to evaluate the differences between the two treatments. Results: In the combination therapy group, the reduction in HbA1c was 0.8% greater than in the conventional group (P < 0.001), weight loss was 5.7 ± 2.1 kg greater (P < 0.001), the decrease in urine albumin-to-creatinine ratio was 40.5 ± 12.7 mg/g greater (P < 0.001), the decline in estimated glomerular filtration rate was 3.3 mL/min/1.73m² slower (P = 0.032), and the incidence of urinary tract infections was 18.7% higher (P = 0.021) compared to the conventional group. Conclusion: When used in combination with regular control of blood glucose and blood pressure, dapagliflozin shows multifaceted regulatory effects on glucose metabolism, body weight, and kidney function, providing effective treatment for patients. However, the risk of genitourinary infections should be noted, and it is recommended to strengthen prevention strategies and follow-up.