DPP-4抑制剂对左心室重塑糖尿病患者的治疗作用及其对心肌标志物表达的影响-现代医学

DPP-4抑制剂对左心室重塑糖尿病患者的治疗作用及其对心肌标志物表达的影响

单位：武汉科技大学附属普仁医院内分泌科, 湖北武汉 430081

分类号：R587.1

出版年·卷·期（页码）：2017·36·第三期（340-343）

摘要：

目的：探讨DPP-4抑制剂在左心室重塑的糖尿病患者中的治疗作用及其对心肌标志物表达水平的影响。方法：2014年3月至2016年3月随机选择128例就诊于武汉科技大学附属普仁医院的2型糖尿病患者，按照随机对照原则分为研究组及对照组，研究组在胰岛素治疗基础上联合使用DPP-4抑制剂治疗，持续治疗3个月后超声评价两组患者左心室舒张末径（LVEDD）、左心室收缩末径（LVESD）、左心室射血分数（LVEF）等指标，检测治疗前后患者血清心肌标志物水平以及空腹血糖水平，并进行统计学分析。结果：两组患者空腹血糖未见明显差异，但研究组患者LVEDD、LVESD明显小于对照组，而LVEF明显增加，CK-MB显著高于对照组，cTnI明显低于对照组，差异具有统计学意义（P<0.05）。结论：在2型糖尿病患者中，联合使用DPP-4抑制剂可以减缓心室肌重塑的进程、减轻心肌损伤，此外，在胰岛素治疗基础上，DPP-4抑制剂并不明显降低患者空腹血糖水平，对于稳定患者空腹血糖水平具有重要临床意义。

Objective: To investigate the therapeutic effect of DPP-4 inhibitors on left ventricular remodeling in patients with diabetes mellitus and the expression level of myocardial markers. Methods: Since March 2014 to March 2016, 128 cases of patients with diabetes 2 were randomly selected in PuRen Affiliated Hospital of Wuhan University of Science and Technology. Accorded to the random and control standard the patients were divided into study group and control group, a combination of DPP-4 inhibitors was added in study group. After 3 months, ultrasonic evaluation was used to detect the left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVESD) and left ventricular ejection ejection fraction (LVEF), all the above index were detected before and after treatment and the serum myocardial markers levels and fasting blood glucose levels were statistically analysed.Results: There was no obvious changes in patients with fasting blood glucose in both of the two groups, but the LVEDd, LVESD in study group were significantly lower than those inthe control group, the LVEF increased significantly in study group, the CK-MB instudy group was significantly higher than that of the control group, cTnI and other signs were significantly lower than those of the control group, the difference had statistical significance (P<0.05). Conclusion: In patients with type 2 diabetes, using a combination of DPP-4 inhibitors can slow down the process of ventricular remodeling, and alleviate the myocardial injury. In addition, the DPP-4 inhibitors does not obviously decrease the fasting blood glucose of patients and has important clinical significance for stable fasting blood glucose.

参考文献：

[1] YIN M, SILLJÉ H H,MEISSNER M,et al.Early and late effects of the DPP-4 inhibitor vildagliptin in a rat model of post-myocardial infarction heart failure[J].Cardiovasc Diabetol,2011,10:85.
[2] POULSEN S H.Clinical aspects of left ventricular diastolic function assessed by Doppler echocardiography following acute myocardial infarction[J].Dan Med Bull,2001,48(4):199-210.
[3] DEACON C F,MANNUCCI E,AHRÉN B.Glycaemic efficacy of glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors as add-on therapy to metformin in subjects with type 2 diabetes-a review and meta analysis[J].Diabetes Obes Metab,2012,14(8):762-767.
[4] FOLEY J E,BHOSEKAR V,KAWAMORI R.Does the treatment of type 2 diabetes mellitus with the DPP-4 inhibitor vildagliptin reduce HbA1c to a greater extent in Japanese patients than in Caucasian patients?[J].Vasc Health Risk Manag,2016,21(12):9-12.
[5] KAMBLE M,GUPTA R,REHAN H S,et al.Neurobehavioral effects of liraglutide and sitagliptin in experimental models[J].Eur J Pharmacol,2016,774:64-70.
[6] CHEN C,YU Q,ZHANG S,et al.Assessing the efficacy and safety of combined DPP-4 inhibitor and insulin treatment in patients with type 2 diabetes:a meta-analysis[J].Int J Clin Exp Pathol,2015,8(11):14141-14150.
[7] WANG Y,WU X,CHENG Y,et al.A fluorescent switchable AIE probe for selective imaging of dipeptidyl peptidase-4 in vitro and in vivo and its application in screening DPP-4 inhibitors[J].Chem Commun (Camb),2016,52(17):3478-3481.
[8] TAKATORI S,HAMADA Y,TANAKA A,et al.Factors contributing to the clinical effectiveness of the DPP-4 inhibitor sitagliptin in patients with type 2 Diabetes[J].Clin Ther,2016,38(2):398-403.
[9] TANAKA Y,KUME S,CHIN-KANASAKI M,et al.Renoprotective effect of DPP-4 inhibitors against free fatty acid-bound albumin-induced renal proximal tubular cell injury[J].Biochem Biophys Res Commun,2016,470(3):539-545.
[10] WU L,GONG Q,NA R.Dipeptidyl peptidase 4 concentration influenced by serum insulin levels rather than arterial stiffness index in type 2 diabetics[J].Int J Clin Exp Med,2015,8(4):6236-6241.
[11] TAKADA S,MASAKI Y,KINUGAWA S,et al.Dipeptidyl peptidase-4 inhibitor improved exercise capacity and mitochondrial biogenesis in mice with heart failure via activation of GLP-1 receptor signaling[J].Cardiovasc Res,2016,4:21.
[12] SCHERNTHANER G,CAHN A,RAZ I.Is the use of DPP-4 inhibitors associated with an increased risk for heart failure? Lessons From EXAMINE,SAVOR-TIMI 53,and TECOS[J].Diabetes Care,2016,39(Suppl 2):S210-218.
[13] ANDONEGUI G,GORING K,LIU D,et al.Characterization of S.pneumoniae pneumonia-induced multiple organ dysfunction syndrome:an experimental mouse model of gram-positive sepsis[J].Shock,2009,31(4):423-428.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录