The Effects Of Urine PCX Excretion For Type 2 Diabetic Patients With Early Nephropathy With Treatment Of Sitagliptin

Objective:1、Detect early of type 2 diabetes nephropathy patients who take orally sitagliptin treatment before and after the change of urine glomerular podocyte specific marker protein PCX, serum malondialdehyde(MDA) and serum superoxide dismutase(SOD);2、Discuss the protective effect and possible mechanism about early renal damage with type 2 diabetes in patients with sitagliptin, and provide theoretical and clinical basis for treatment of diabetic nephropathy.Methods:Collected the early nephropathy in type 2 diabetes patients came from out-patients clinic and in hospital in the Shanxi Province people’s hospital endocrinology from May to December in 2015.Selected 60 patients with early nephropathy in type 2 diabetes according to the inclusion criteria and exclusion criteria, randomly assigned to sitagliptin intervention group(15 cases of male and 15 cases of female, age 53.67±4.65, duration8.63±1.79 years) and the control group(15 cases of male and 15 cases of female, age53.10±3.96, duration 8.80±1.79 years).Sitagliptin(MSD China pharmaceutical co., LTD.)intervention group patients were on the basis of the original hypoglycemic therapy plus sitagliptin tablet 100 mg, once daily, continuous taking orally 12 weeks.The control group was on the basis of the original hypoglycemic scheme can increase the drug doses or joint in addition to the DPP 4 inhibitors of hypoglycemic drugs to keep blood sugar under control.Two groups of patients during the subjects were low-fat bland diet, proper exercise after a meal, monitoring the blood sugar, adjusting the hypoglycemic drug dosage, blood pressure control is less than 140/80 mm Hg. Two groups of patients into groups before and after treatment for 12 weeks by the Shanxi Province people’s hospital inspection biochemical analyzer tested fasting blood glucose(FBG), glycosylated hemoglobin(Hb A1c), urine trace albumin/uric creatinine(ACR), 24 h urine protein,urea nitrogen(BUN), serum creatinine(SCr), triglycerides(TG), total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C), and laboratory tested in the center of the Shanxi Province people’s hospital urinary podocyte PCX, serum MDA, serum SOD(both for quantitative test of enzyme-linked immune adsorption test).Results:1 、 Patients of Sitagliptin intervention group and control group in age, gender,duration, blood glucose, blood pressure and Hb A1 c, ACR, BUN, SCR, TG, TC, LDL-C,24 h urine protein, urinary PCX, serum MDA, serum SOD were no obvious difference(P > 0.05).2、The control group were treated for 12 weeks,FBG(7.23±0.25), Hb A1c(7.24±0.22),ACR(129.20±34.73), 24 h urine protein(0.20±0.03) were decreased,compared with FBG(9.51±0.31),Hb A1c(8.61±0.26),ACR(136.40±40.7),24 h urine protein(0.21±0.03)before treatment,with statistical difference(P < 0.05).Urine PCX(7.60±0.52), serum MDA(75.23±4.43),serum SOD(75.09±3.93) after treatment were no statistical difference(P < 0.05),compared with urine PCX(7.49±0.53),serum MDA(74.08±3.98),serum SOD(74.80±3.99) before treatment. There was no statistical difference in blood pressure,BUN, SCr, TG, TC and LDL-C between the two(P>0.05).3 、 Patients of intervention group were taking orally sitagliptin treatment for 12 weeks,FBG(7.08±0.36),Hb A1c(7.22±0.22),ACR(56.17±16.80),24 h urine protein(0.09±0.02),urine PCX(7.25±0.76), serum MDA(71.10±9.79) were decreased,compared with FBG(9.49±0.39),Hb A1c(8.60±0.24),ACR(131.09±39.66),24 h urine protein(0.20±0.04),urine PCX(7.75±0.53),serum MDA(75.60±5.19)before treatment(P < 0.05).Serum SOD(80.93±10.35) was increased compared with serum SOD(76.08±4.41) before treatment(P < 0.05). There was no statistical difference in blood pressure, BUN, SCr, TG,TC and LDL-C between the two(P>0.05).4 、 After treatment,the intervention group patients, ACR, 24 h urine protein quantitative, urine PCX, serum MDA were decreased compared with control group after treatment(P < 0.05), serum SOD was increased after the treatment(P < 0.05). Blood pressure, FBG, Hb A1 c, BUN, SCr, TG, TC, LDL-C had no significant difference compared with the control group after treatment(P > 0.05).Conclusion:1、Urine PCX of control group patients had no obvious difference between before and after treatment.Intervention group patients took orally sitagliptin treatment for 12 weeks, urine PCX level was declined, and decreased compaired with the control group after treatment. It prompted that sitagliptin may protect renal function by reducing glomerular podocyte damage in type 2 diabetes early nephropathy patients,which may be independent of the improvement of the blood glucose, blood pressure and blood lipids.2、Serum MDA and serum SOD had no obvious difference between before and after treatment.Intervention group patients taking orally sitagliptin treatment, serum MDA decreased, serum SOD increased, and there was difference with the control group after treatment. These prompted that the renal protective function of sitagliptin for type 2diabetes mellitus patients with early nephropathy,which may be associated with the improvement of renal oxidative stress.