维格列汀联合二甲双胍治疗2型糖尿病肾病患者疗效及其对血清炎性因子的影响

摘要

目的：观察维格列汀联合二甲双胍对2型糖尿病肾病患者血清炎性因子的影响及疗效。方法选择2014年1月—2015年6月四川省攀枝花市中西医结合医院老年医学科治疗的2型糖尿病肾病患者64例作为研究对象。按照随机数字表法将患者分为联合组与对照组，每组32例。2组患者均给予糖尿病综合管理和治疗，对照组给予二甲双胍缓释片，联合组使用维格列汀联合二甲双胍治疗，治疗时间均为6个月。治疗前后测定血清中肿瘤坏死因子－α（TNF－α）、白细胞介素－6（IL－6）、白细胞介素－8（IL－8）、空腹血糖（FPG）、餐后2 h 血糖（2hPG）及尿白蛋白排泄率（UREA），治疗结束后判定治疗效果。结果治疗后联合组总有效率为93．75％，显著高于对照组的71．88％（χ2＝5．379， P ＜0．05）。治疗前，2组血清 TNF－α、IL－6及 IL－8含量比较无显著差异（ P ＞0．05）。与治疗前比较，联合组治疗后各项指标均降低（ P ＜0．05），而对照组治疗后改变不明显（ P ＞0．05）。2组患者治疗前 FPG、2hPPG 及 UREA比较差异无统计学意义（ P ＞0．05），治疗后，2组均显著降低，且联合组较对照组降低更明显（ P ＜0．05）。2组均出现消化道反应、皮肤过敏及低血糖，但差异无统计学意义（ P ＞0．05）。结论维格列汀联合二甲双胍治疗2型糖尿病肾病可降低血清 TNF－α、IL－6及 IL－8水平，更好地控制患者血糖，安全性良好，可以深入推广使用。%Objective To observe the effects of vildagliptin metformin in patients with type 2 diabetic nephropathy se-rum inflammatory factors and curative effect.Methods In this research, we choose some patients with type 2 diabetic ne-phropathy who came to our hospital from January 2014 to June 2015.They were randomly divided into combined group and control group, each group of 32 people.Every patient received conventional diabetes treatment of "Five Keys", including Ex-ercise therapy, medical education, diet, blood glucose monitoring and medications.The control group takes metformin and the combined group adds vildagliptin on the basis of the former.They continue this treatment for 6 months.Before and after re-ceiving treatment, monitor all patients with serum TNF-α, IL-6 and IL-8 level and fasting plasma glucose and 2 hour postpran-dial blood glucose, also including urinary albumin excretion rate.When the end of treatment, all patients were to determine the efficacy.Results Combined treatment group, the total effective rate was 93.75%, significantly higher than the control group 71.88% (χ2 =5.379, P <0.05).Before treatment, there was no significant difference in serum levels of TNF-α, IL-6 and IL-8 between the 2 groups ( P >0.05).Compared with before treatment,the combination group after treatment were lower ( P <0.05), while the control group was not changed significantly after treatment ( P >0.05).There was no signifi-cant difference in FPG, 2h PPG and UREA between the 2 groups before treatment.After treatment, the 2 groups were signifi-cantly reduced, and the combined group was significantly lower than the control group ( P <0.05).Digestive tract reaction, skin allergy and hypoglycemia were found in the 2 groups, but the difference was not statistically significant ( P >0.05). Conclusion Vildagliptin and metformin in treatment of type 2 diabetic nephropathy can reduce serum TNF-α, IL-6 and IL-8 levels, had better glycemic control effect and good safety, can further promote the use of it.