2024 年第 1 期 第 19 卷

达格列净联合阿托伐他汀治疗糖尿病肾病的效果及对患者胰岛功能和机体微炎症状态的影响

The effect of dapagliflozin combined with atorvastatin in the treatment of diabetic nephropathy and its influence on the pancreatic islets function and the micro inflammation state of the body

作者：张菊云 蒙绪标 符兰芳 陈绵雄

英文作者：Zhang Juyun Meng Xubiao Fu Lanfang Chen Mianxiong

单位：中南大学湘雅医学院附属海口医院海南省海口市人民医院内分泌代谢科，海口570208

英文单位：Department of Endocrine Metabolism Haikou Hospital Affiliated to Xiangya Medical College of Central South University Haikou People′s Hospital Hainan Province Haikou 570208 China

关键词：糖尿病肾病；达格列净；阿托伐他汀；胰岛功能；微炎症状态

英文关键词：Diabeticnephropathy;Dapagliflozin;Atorvastatin;Pancreaticisletsfunction;Microinflammationstate

• 摘要：

• 目的  探究达格列净联合阿托伐他汀治疗糖尿病肾病（DN）的效果及对患者胰岛功能和机体微炎症状态的影响。方法  选取2021年2月至2022年2月海南省海口市人民医院收治的DN患者116例，按随机数字表法分为对照组和观察组，各58例。对照组采用阿托伐他汀钙片治疗，观察组在对照组基础上联合达格列净片治疗，2组均治疗3个月。比较治疗总有效率，治疗前后肾功能、胰岛功能指标和炎症因子水平。结果  观察组总有效率显著高于对照组［93.1%（54/58）比77.6%（45/58）］，差异有统计学意义（χ2=5.583，P=0.018）。治疗后2组血尿素氮、血肌酐、24 h尿蛋白定量均明显低于治疗前，且观察组均低于对照组，差异均有统计学意义（均P＜0.001）。治疗后2组稳态模型胰岛素抵抗指数均显著低于治疗前且观察组低于对照组［（2.43±0.28）比（2.67±0.31）］，稳态模型胰岛β细胞功能指数均显著高于治疗前且观察组高于对照组［（13.4±3.8）比（10.5±3.3）］，差异均有统计学意义（均P＜0.05）。治疗后2组白细胞介素6、肿瘤坏死因子α、高敏C反应蛋白水平均显著低于治疗前且观察组低于对照组，差异均有统计学意义（均P＜0.05）。结论  达格列净联合阿托伐他汀治疗DN临床效果较好，可以有效改善患者胰岛功能，减轻机体的微炎症状态。

• Objective  To investigate the effect of dapagliflozin combined with atorvastatin in the treatment of diabetic nephropathy(DN) and its influence on the pancreatic islets function and the micro inflammation state of the body. Methods  Totally 116 patients with DN admitted to Haikou People′s Hospital, Hainan Province from February 2021 to February 2022 were selected. Patients were divided into control group and observation group according to the random number table method, with 58 cases in each group. The control group was treated with atorvastatin calcium tablets, and the observation group was treated with dapagliflozin tablets on the basis of the control group. Both groups were treated for 3 months. The total effective rate of treatment, renal function, pancreatic islet function indicators and inflammatory factor levels before and after treatment were compared. Results  The total effective rate of the observation group was significantly higher than that of the control group ［93.1%(54/58) vs 77.6%(45/58)］(χ2=5.583, P=0.018). After treatment, levels of blood urea nitrogen, blood creatinine and 24 h urine protein of the two groups were significantly lower than those before treatment, and the observation group was lower than the control group(all P<0.001). After treatment, the homeostasis model assessment of insulin resistance index of the two groups were significantly lower than before treatment, and the observation group was lower than the control group［(2.43±0.28) vs (2.67±0.31)］; the homeostasis model assessment of pancreatic islets β cell function index in both groups was significantly higher than before treatment, and the observation group was higher than the control group［(13.4±3.8) vs (10.5±3.3)］(all P<0.05). After treatment, levels of interleukin-6, tumor necrosis factor-α and high sensitivity C-reactive protein in two groups were significantly lower than before treatment, and the observation group was lower than the control group(all P<0.05). Conclusion  Dapagliflozin combined with atorvastatin has a good clinical effect in patients with DN. It can effectively improve the pancreatic islets function, and reduce the micro inflammatory state of the body.