2023 年第 4 期 第 18 卷

恩格列净与利格列汀治疗2型糖尿病的临床效果及对患者肾功能的影响对比

Comparison of clinical effects of empagliflozin and linagliptin in the treatment of type 2 diabetes mellitus and their effects on renal function

作者：林勇1阮丹丹1王寅1何伟康1叶浩1姚佳琦2曹文娟1郑露3郑英1

英文作者：Lin Yong1 Ruan Dandan1 Wang Yin1 He Weikang1 Ye Hao1 Yao Jiaqi2 Cao Wenjuan1 Zheng Lu3 Zheng Ying1

单位：1中国人民解放军联勤保障部队第九〇三医院药剂科，杭州310000；2中国人民解放军联勤保障部队第九〇三医院内分泌科，杭州310000；3杭州师范大学附属医院药剂科，杭州310000

英文单位：1Department of Pharmacy the 903rd Hospital of Joint Logistic Support Force of the Chinese People′s Liberation Army Hangzhou 310000 China; 2Department of Endocrinology the 903rd Hospital of Joint Logistic Support Force of the Chinese People′s Liberation Army Hangzhou 310000 China; 3Department of Pharmacy the Affiliated Hospital of Hangzhou Normal University Hangzhou 310000 China

关键词：2型糖尿病；恩格列净；利格列汀；肾功能

英文关键词：Type2diabetesmellitus;Empagliflozin;Linagliptin;Renalfunction

• 摘要：

• 目的 比较恩格列净与利格列汀治疗2型糖尿病（T2DM）的临床效果及对患者肾功能的影响。方法 收集2020年7月至2022年7月于中国人民解放军联勤保障部队第九〇三医院就诊随访的88例血糖控制欠佳的T2DM患者的临床资料进行回顾性分析。按治疗方法不同分为恩格列净组（43例）和利格列汀组（45例）。2组患者在服用吡格列酮二甲双胍片（1片/次，2次/d）的基础上，分别联用恩格列净片（10 mg/次，1次/d）或利格列汀片（5 mg/次，1次/d）治疗6个月。比较2组一般资料及治疗前后体重指数、血脂、血压、肾功能相关指标和不良反应发生情况。结果 治疗后，2组空腹血糖、餐后2 h血糖和糖化血红蛋白水平均低于治疗前（均P<0.001），但组间差异均无统计学意义（均P＞0.05）。治疗后，恩格列净组体重指数、三酰甘油、收缩压、舒张压均低于治疗前，且低于利格列汀组，差异均有统计学意义（均P＜0.05）。治疗后，恩格列净组血尿素氮、同型半胱氨酸、胱抑素C水平和尿微量白蛋白/尿肌酐比值均明显低于治疗前且低于利格列汀组，估算肾小球滤过率高于治疗前且高于利格列汀组［组间：（6.4±0.7）mmol/L比（7.2±1.0）mmol/L、（9.1±1.6）μmol/L比（10.4±1.7）μmol/L、（0.78±0.09）mg/L比（0.84±0.15）mg/L、（12±4）mg/g比（15±5）mg/g、（111±10）ml/(min·1.73 m2)比（102±8）ml/(min·1.73 m2)］，差异均有统计学意义（均P＜0.05）。2组不良反应发生率差异无统计学意义（P>0.05）。结论 恩格列净联合吡格列酮二甲双胍治疗T2DM的临床效果较利格列汀联合吡格列酮二甲双胍更为显著，不仅能有效控制血糖水平，而且对于肾功能也有一定的保护作用。

• Objective To compare the clinical effects of empagliflozin and linagliptin in the treatment of type 2 diabetes mellitus(T2DM) and their effects on renal function. Methods From July 2020 to July 2022, the clinical data of 88 patients with T2DM with poor blood glucose control admitted and followed up in the 903rd Hospital of Joint Logistic Support Force of the Chinese People′s Liberation Army were analyzed retrospectively. According to the different treatment Methods , the patients were divided into empagliflozin group(43 cases) and linagliptin group(45 cases). The patients in the two groups were treated with empagliflozin(10 mg/time, 1 time/d) or linagliptin (5 mg/time, 1 time/d) for 6 months respectively on the basis of pioglitazone metformin taken(1 piece/time, 2 times/d). The general data and body mass index, blood lipid, blood pressure, relevant indexes of renal function before and after treatment and adverse reactions in the two groups were compared. Results After treatment, the levels of fasting plasma glucose, 2 h postprandial plasma glucose and glycosylated hemoglobin in the two groups were lower than those before treatment(all P<0.001), but there were no significant differences between the two groups(all P>0.05). After treatment, the body mass index, triacylglycerol, systolic pressure and diastolic pressure in the empagliflozin group were lower than those before treatment and those in the linagliptin group(all P<0.05). After treatment, the levels of blood urea nitrogen, homocysteine, cystatin C, and urinary microalbumin/creatinine ratio in the empagliflozin group were significantly lower than those before treatment and those in the linagliptin group; the level of estimated glomerular filtration rate in the empagliflozin group was higher than that before treatment and that in the linagliptin group［between groups: (6.4±0.7)mmol/L vs (7.2±1.0)mmol/L, (9.1±1.6)μmol/L vs (10.4±1.7)μmol/L, (0.78±0.09)mg/L vs (0.84±0.15)mg/L, (12±4)mg/g vs (15±5)mg/g, (111±10)ml/(min·1.73 m2) vs (102±8)ml/(min·1.73 m2)］(all P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion Empagliflozin combined with pioglitazone metformin has better clinical effect than linagliptin combined with pioglitazone metformin on the treatment of T2DM, which can not only effectively control blood glucose level, but also have a certain protective effect on renal function.