Renoprotection Provided by Dipeptidyl Peptidase-4 Inhibitors in Combination with Angiotensin Receptor Blockers in Patients with Type 2 Diabetic Nephropathy.
Renoprotection Provided by Dipeptidyl Peptidase-4 Inhibitors in Combination with Angiotensin Receptor Blockers in Patients with Type 2 Diabetic Nephropathy.
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二肽基肽酶 4 抑制剂联合血管紧张素受体阻滞剂对 2 型糖尿病肾病患者提供肾脏保护。
DOI：
10.4103/0366-6999.245277
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发表时间：
2018-11-20
影响因子：
6.1
通讯作者：
Jiang S
中科院分区：
文献类型：
--
作者：
Qiu DD;Liu J;Shi JS;An Y;Ge YC;Zhou ML;Jiang S
二肽基肽酶-4抑制剂（DPP 4 i）和血管紧张素受体阻滞剂（ARB）治疗2型糖尿病肾病（DN）患者的特点尚不清楚。本研究旨在评估这种联合治疗对DN患者的肾脏保护作用。从2013年至2015年，在金陵医院（中国）国家肾脏病临床研究中心的前瞻性DN队列中回顾性入组了共计159例2型DN患者。57例患者接受DPP 4 i和ARB治疗，102例患者仅接受ARB治疗。所有患者均随访至少12个月。使用Stata版本12.0进行统计分析。基线时两组之间的年龄、性别、体重指数、糖尿病病程、空腹血糖（FBG）、血红蛋白A1 c（HbA 1c）和估计肾小球滤过率（eGFR）无显著差异。除钙通道拮抗剂外，各组抗高血压和抗糖尿病药物的使用相似（P = 0.032）。两组治疗后FBG、HbA 1c均无明显变化。12个月时，DPP 4 i + ARB组的eGFR下降速度慢于ARB组（Δ12个月：−2.48 ± 13.86 vs. −6.81 ± 12.52 ml·min-1·1.73m-2，P = 0.044）。此外，治疗24个月后，DPP 4 i + ARB组的蛋白尿比ARB组进一步减少（Δ24个月：−0.18 [−1.00，0.17] vs. 0.32 [−0.35，0.88]，P = 0.031）。有36例患者在24个月内eGFR下降超过30%。在调整FBG、HbA 1c和其他风险因素后，DPP 4 i + ARB治疗仍与eGFR降低20%或30%的发生率降低相关。DPP 4 i和ARB联合治疗上级ARB单药治疗，蛋白尿减少幅度更大，eGFR下降幅度更低。此外，DPP 4 i联合ARB的肾脏保护作用不依赖于血糖控制。
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–1·1.73m–2, 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.
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影响因子：
5.8
作者：
Taskinen, M. -R.;Rosenstock, J.;Woerle, H. -J.
通讯作者：
Woerle, H. -J.
影响因子：
13.2
作者：
Ferreira, Juan C. Arjona;Corry, Dalila;Goldstein, Barry J.
通讯作者：
Goldstein, Barry J.
影响因子：
16.2
作者：
Mosenzon, Ofri;Leibowitz, Gil;Raz, Itamar
通讯作者：
Raz, Itamar
DOI：
10.2147/dmso.s132537
发表时间：
2017
期刊：
Diabetes, metabolic syndrome and obesity : targets and therapy
影响因子：
--
作者：
Civantos E;Bosch E;Ramirez E;Zhenyukh O;Egido J;Lorenzo O;Mas S
通讯作者：
Mas S
影响因子：
16.2
作者：
Groop PH;Cooper ME;Perkovic V;Emser A;Woerle HJ;von Eynatten M
通讯作者：
von Eynatten M