| Background and ObjectivesDiabetic kidney disease(DKD)is one of the common microvascular complications in patients with type 2 diabetes,and it has become the main cause of end-stage renal disease.With the deepening of research on diabetic nephropathy,in addition to weight,blood sugar,blood pressure,blood lipids,etc.,in recent years,many studies have confirmed that NLR,cys-c,bilirubin,uric acid,etc.are also closely related to the occurrence and development of diabetic nephropathy.Taking active intervention measures to prevent the occurrence and development of kidney disease in patients with type 2 diabetes has always been the focus of basic and clinical researchers.Dapagliflozin is a SGLT-2 inhibitor,a relatively new type of hypoglycemic drug in the clinic.With the wide application of SGLT-2inhibitors in clinical practice and the deepening of research work,its antihyperglycemic effects have gradually Find.Studies have shown that dapagliflozin exerts renal protection from affecting the body’s hemodynamics,metabolism and inflammatory pathways,but there is currently no comprehensive analysis and evaluation of dapagliflozin’s influence on risk factors related to type 2 diabetic nephropathy and the mechanism of action.Sufficient,especially the effect on uric acid and its mechanism of action are still controversial.Therefore,this project aims to explore the changes in risk factors of diabetic nephropathy after dapagliflozin treatment in patients with type 2 diabetes by observing the changes in related clinical indicators before and after treatment with dapagliflozin,and further explore its specific mechanism of action.Object and MethodsA total of 130 patients with type 2 diabetes who were hospitalized in the Endocrinology Department of the Second Affiliated Hospital of Zhengzhou University from December 2019 to December 2020 were selected as the research objects,and were divided into a dapagliflozin group and a conventional treatment group with 65 cases each by random number method.In the dapagliflozin group,add dapagliflozin 10mg/d on the basis of the original treatment.In the conventional treatment group,adjust the hypoglycemic regimen based on the original treatment regimen according to individual conditions(adjust the dose of insulin and oral hypoglycemic drugs or combination Use non-SGLT-2 inhibitors).After admission,the two groups of patients were measured for height,weight,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),glycosylated hemoglobin(Hb A1c),fasting blood glucose(FPG),total cholesterol(TC),triglycerides(TG),high-density lipoprotein(HDL-C),low-density lipoprotein(LDL-C),neutrophil/lymphocyte absolute value(NLR),direct bilirubin(DBIL),total bilirubin(TBIL),Cystatin C(Cys-c),blood uric acid(SUA),and 24-hour urine uric acid(24h UUA)were quantified.The changes in the above indicators were observed after 24 weeks of treatment.The SPSS 19.0 software was used to perform statistical analysis on the research data,and the Kolmogorov-Smirnov test was performed on the measurement data,and the normal distribution was used as the mean ±standard deviation(x ±s);the paired sample t-test was used for comparison between the two groups;Paired-sample t-test was used for internal comparison;[M(QR)] was used for non-normal distribution,and the comparison between the two groups was performed by non-parametric test.Enumeration data is expressed as constituent ratio,and Pearson chi-square test is used for comparison between groups.The difference was statistically significant with P<0.05.Results(1)There was no statistically significant difference between the dapagliflozin group and the conventional treatment group in general data and various clinical observation indexes before treatment(P>0.05).(2)After treatment,there was no statistically significant difference in body weight,BMI,SBP,DBP,Hb A1 c,TC,TG,HDL-C,LDL-C,DBIL,TBIL,NLR,SUA between the two groups of patients(P>0.05);the level of Cys-c in the dapagliflozin group was lower than that of the conventional treatment group,and the difference was statistically significant(P<0.05);the FPG level in the dapagliflozin group was higher than that of the conventional treatment group,and the difference was statistically significant(P<0.05);The level of24 h UUA in the dapagliflozin group was higher than that in the conventional treatment group,and the difference was statistically significant(P<0.001).(3)The body weight and BMI of the dapagliflozin group after treatment were lower than before treatment,the difference was statistically significant(P<0.05);the weight and BMI of patients in the conventional treatment group were compared before and after treatment,the difference was not statistically significant(P>0.05)).(4)The systolic blood pressure and diastolic blood pressure of the dapagliflozin group after treatment were lower than before treatment,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the systolic and diastolic blood pressure of patients in the conventional treatment group before and after treatment.(P>0.05).(5)Glycosylated hemoglobin and fasting blood glucose levels after treatment in the dapagliflozin group were lower than before treatment,and the difference was statistically significant(P<0.05);after treatment in the conventional treatment group,glycosylated hemoglobin and fasting blood glucose were both lower than before treatment.The difference was statistically significant(P<0.05).There was no significant difference between the two groups in the absolute value of glycosylated hemoglobin and fasting blood glucose decrease(P>0.05).(6)The level of triglycerides in the dapagliflozin group after treatment was lower than before treatment,and the difference was statistically significant(P<0.05).There was no statistical difference in total cholesterol,high-density lipoprotein,and low-density lipoprotein levels before and after treatment.Scientific significance(P>0.05);the conventional treatment group triglyceride,total cholesterol,high-density lipoprotein,low-density lipoprotein levels before and after treatment,the difference was not statistically significant(P>0.05).(7)There was no significant difference in Cys-c,NLR,DBIL before and after treatment in the dapagliflozin group(P>0.05),The level of TBIL was lower than before treatment,and the difference was statistically significant(P<0.05);the difference between Cys-c,NLR,DBIL and TBIL before and after treatment in the conventional treatment group was not statistically significant(P>0.05).(8)SUA after treatment in the dapagliflozin group was lower than before treatment,the difference was statistically significant(P<0.05),and 24 UUA was higher than before treatment,the difference was statistically significant(P<0.05);the conventional treatment group SUA,24 h UUA before and after treatment,the difference was not statistically significant(P>0.05)。Conclusion(1)Dapagliflozin can lower blood sugar,lower triglycerides,reduce weight,and lower blood pressure.(2)Dapagliflozin can increase 24-hour uric acid excretion and reduce blood uric acid levels. |
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