Effects Of Dapagliflozin On Urine Protein And Urinary Angiotensinogen In Elderly Patients With Early Diabetic Nephropathy

Objectives:To observe the changes of various clinical indicators before and after treatment of dagligliflozin in elderly patients with early diabetic nephropathy through clinical experiments,to evaluate its clinical efficacy and adverse reactions,and to analyze the relative effects of dagligliflozin on urinary protein and urinary angiotensinogen in elderly patients with early diabetic nephropathy.Methods:Firstly,The subjects were 49 elderly patients with early diabetic nephropathy,who met the inclusion criteria as inpatients at Endocrinology Department of the Hunan Provincial People's Hospital from January 2019 to December 2019.Then,according to the sequence of visits,the patients were randomized into three groups: 17 cases in the conventional group(conventional treatment),16 cases in the control group(irbesartan was given on the basis of conventional treatment),and16 cases in the observation group(dapagliflozin was given on the basis of conventional treatment),treatment time is 12 weeks.The indexes of the blood glucose,blood pressure,blood lipid,body mass index,creatinine,uric acid,cystatin C,urine albumin excretion rate,urinary angiotensinogen in all elderly diabetic nephropathy patients before and after treatment were observed and compared;meanwhile adverse reactions during treatment were recorded.Results:1.Before treatment,there was no statistical difference in general conditions(age,sex,course of disease)and various clinical indicators(FBG,2hPBG,HbA1 c,TG,TC,LDL-C,HDL-C,BMI,Cr,UA,Cys-C,UAER,UAGT)among the three groups(P>0.05),which was comparable.2.The blood glucose indexes(FBG,2hPBG,and HbA1c)of the three groups all decreased compared with before treatment(P<0.05),and the blood glucose indexes(FBG,2hPBG,and HbA1c)in the three groups after treatment had no significant difference(P>0.05).SBP of observation group and control group decreased compared with before treatment(P<0.05),SBP and DBP of the observation group,the control group and the conventional group showed no significant changes,and the difference was not statistically significant(P>0.05).The levels of TG and LDL-C in the observation group significantly were lower than those before treatment(P<0.05),while there were no significant changes in TC and HDL-C(P>0.05);compared with before treatment,TG in the control group decreased(P<0.05),TC,LDL-C and HDL-C indicators showed no statistical difference(P>0.05);the levels of TG,TC and LDL-C in the observation group decreased more significantly compared with the control group(P<0.05).BMI in the observation group decreased compared with before treatment(P<0.05),while there was no significant difference between the control group and the conventional group(P>0.05).Compared with before treatment,the levels of UA and Cys-C in the observation group reduced(P<0.05),the level of Cr in the observation group showed no significant difference(P>0.05);there were no significant changes in Cr,UA and Cys-C between the control group and the conventional group before and after treatment(P>0.05).3.The levels of UAER and UAGT in the observation group and control group decreased compared with before treatment(P<0.05);compared with the control group,the UAER and UAGT in the observation group had no significant changes(P>0.05);the UAER andUAGT of the conventional group had no significant changes compared with before treatment,and the difference was not statistically significant(P>0.05).4.In terms of safety during treatment,compared with the control group and the conventional group,there was no significant difference in the incidence of hypoglycemic events,genitourinary infection and hypotension events in the observation group(P>0.05).Conclusions:1.Dapagliflozin can lower the level of urinary protein in elderly patients with early diabetic nephropathy,which may be related to inhibiting the activation of intrarenal renin-angiotensin system,reducing the production of urinary angiotensinogen,and the regulation of blood lipid metabolism as well as other kidney protection.2.Dapagliflozin had no obvious adverse reactions in the treatment of elderly patients with early diabetic nephropathy.