中国临床药理学杂志

低剂量西格列汀联合达格列净治疗老年糖尿病肾病患者的临床研究

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曹单单 , 邓长财 , 杜彭

中国临床药理学杂志 | 临床与基础桥接研究 2025,41(19): 2723-2729

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中国临床药理学杂志 |临床与基础桥接研究 2025 , 41 (19) : 2723 -2729

低剂量西格列汀联合达格列净治疗老年糖尿病肾病患者的临床研究

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曹单单（1988-）女，硕士，主治医师，主要从事糖尿病肾病和腹膜透析方面的临床工作与研究

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曹单单（1988-）女，硕士，主治医师，主要从事糖尿病肾病和腹膜透析方面的临床工作与研究

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曹单单, 邓长财, 杜彭

作者信息

天津市第四中心医院肾内科，天津 300140

通讯作者:

邓长财，副主任医师，硕士生导师 MP: 13920173868 E-mail: cdengc@126.com

作者简介:

曹单单（1988-）女，硕士，主治医师，主要从事糖尿病肾病和腹膜透析方面的临床工作与研究

Clinical study of low-dose sitagliptin combined with dapagliflozin in the treatment of elderly patients with diabetic nephropathy

Dan-dan CAO, Chang-cai DENG, Peng Du

Affiliations

Department of Nephrology, Tianjin 4th Central Hospital, Tianjin 300140, China

出版时间: 2025-10-17 doi: 10.13699/j.cnki.1001-6821.2025.19.005

文章导航

摘要

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目的

观察低剂量西格列汀片联合达格列净片治疗老年糖尿病肾病（DKD）患者的临床疗效及安全性。

方法

将本院收治的老年DKD患者用随机数表法分为A组（用低剂量西格列汀片治疗，每次50 mg，每天1次）、B组（用达格列净片治疗，每次10 mg，每天1次）及C组（用低剂量西格列汀片联合达格列片治疗，剂量同A组和B组），均治疗3个月。比较3组的临床疗效、空腹血糖（FBG）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbA1c）、肾小球滤过率（eGFR）、肌酸酐（SCr）、尿素氮（BUN）、尿酸（UA）、单核细胞趋化蛋白-1（MCP-1）、脂联素（APN）、核因子-κB（NF-κB）及尿白蛋白与尿肌酸酐比值（UACR）水平变化，并进行安全性评价。

结果

本研究共纳入129例，无脱落病例。其中A组43例，B组43例，C组43例。治疗后，A组、B组和C组的有效率分别为79.07%（34例/43例）、81.40%（35例/43例）和95.35%（41/43例），C组显著高于A组和B组（均P<0.05）。治疗后，A组、B组和C组的HbA1c分别为（7.17±1.21）%、（6.64±1.06）%和（6.13±1.14）%；SCr分别为（94.37±12.16）、（86.19±11.45）和（80.45±10.37）μmol·L^-1；UACR分别为（80.04±8.36）、（71.19±7.72）和（53.04±6.81）mg·g^-1，与A组比较，B组和C组的上述指标均显著下降，且C组显著低于B组，在统计学上差异均有统计学意义（均P<0.05）。治疗后，A组、B组和C组的eGFR分别为（81.50±9.12）、（92.41±9.56）和（103.73±10.24）mL·min^-1·1.73 m^-2，与A组比较，B组和C组的上述指标均显著上升，且C组显著高于B组，在统计学上差异有统计学意义（P<0.05）。治疗后，A组、B组和C组MCP-1分别为（85.38±8.42）、（91.40±9.28）和（73.12±8.06）pg·mL^-1；NF-κB分别为（4.09±1.08）、（4.71±1.22）和（3.52±0.85）ng·mL^-1，与B组比较，A组和C组的上述指标均显著下降，且C组显著低于A组，在统计学上差异均有统计学意义（均P<0.05）。治疗后，A组、B组和C组的APN分别为（10.17±2.06）、（9.15±1.50）和（11.24±2.17）pg·mL^-1，与B组比较，A组和C组的上述指标均显著上升，且C组显著高于A组，在统计学上差异有统计学意义（P<0.05）。A组主要的药物不良反应为胃肠道不适和鼻咽炎，B组为胃肠道不适、低血压和泌尿生殖系统感染，C组为低血糖和胃肠道不适，A组、B组和C组的总药物不良反应发生率分别为30.23%、20.93%和27.91%，3组间总药物不良反应发生率对比，在统计学上差异均无统计学意义（均P>0.05）。Pearson相关分析显示，治疗后UACR下降幅度与NF-Κb、MCP-1水平降低及APN升高均呈正相关（r=0.419、0.524和0.485，均P<0.05）。

结论

低剂量西格列汀片联合达格列净片治疗老年DKD患者具有协同增效作用，可显著改善血糖代谢指标，提升肾功能，调节炎症因子水平，并有效降低UACR，且安全性良好。

关键词

西格列汀片 / 达格列净片 / 糖尿病肾病 / 老年 / 疗效

Abstract

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Objective

To observe clinical efficacy and safety of low-dose sitagliptin tablets combined with dapagliflozin tablets in the treatment of elderly patients with diabetic kidney disease (DKD).

Methods

According to random number table method, elderly patients with DKD admitted to the hospital were divided into group A (low-dose sitagliptin tables, 50 mg qd), group B (dapagliflozin tables, 10 mg qd) and group C (low-dose sitagliptin tables, 50 mg qd combined with dapagliflozin tables,10 mg qd). All patients were treated for 3 months. The clinical curative effect and changes in fasting blood glucose (FBG), 2 h postprandial blood glucose (2 h PG), glycosylated hemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), serum creatinine (SCr), blood urea nitrogen (BUN), uric acid (UA), monocyte chemoattractant protein-1 (MCP-1), adiponectin (APN), nuclear factor-κB (NF-κB) and urinary albumin creatinine ratio (UACR) were compared among the three groups, and the safety evaluation was performed.

Results

In this study, there was no shedding cases. Among the 129 patients, there were 43 cases in group A, 43 cases in group B and 43 cases in group C. After treatment, response rate of group C was 95.35% (41 cases /43 cases), which was significantly higher than that of group A [79.07% (34 cases /43 cases)] and group B [81.40% (35/43 cases)] (all P<0.05). After treatment, HbA1c levels in group A, group B and group C were (7.17±1.21)%, (6.64±1.06)% and (6.13±1.14)%; SCr levels were (94.37±12.16), (86.19±11.45) and (80.45±10.37) μmol·L^-1; and UACR were (80.04±8.36), (71.19±7.72) and (53.04±6.81) mg·g^-1, respectively. Compared with group A, the above indexes were statistically significantly decreased in group B and group C, and which were statistically significantly lower in group C than group B (all P<0.05). After treatment, eGFR in group A, group B and group C were (81.50±9.12), (92.41±9.56) and (103.73±10.24) mL·min^-1 · 1.73 m^-2, respectively. Compared with group A, eGFR was statistically significantly increased in group B and group C, and which was statistically significantly higher in group C than group B (P<0.05). After treatment, MCP-1 levels in group A, group B and group C were (85.38±8.42), (91.40±9.28) and (73.12±8.06) pg·mL^-1; NF-κB levels were (4.09±1.08), (4.71±1.22) and (3.52±0.85) ng·mL^-1, respectively. Compared with group B, the above indexes were statistically significantly decreased in group A and group C, and which were statistically significantly lower in group C than group A (both P<0.05). After treatment, APN levels in group A, group B and group C were (10.17±2.06), (9.15±1.50) and (11.24±2.17) pg·mL^-1, respectively. Compared with group B, APN was statistically significantly increased in group A and group C, and which was statistically significantly higher in group C than group A (P<0.05). The main adverse drug reactions in group A were gastrointestinal discomfort and nasopharyngitis; in group B were gastrointestinal discomfort, hypotension and urinary and reproductive system infection, and in group C were hypoglycemia and gastrointestinal discomfort. There was no significant difference in total incidence of adverse drug reactions among group A, group B and group C (30.23% vs. 20.93% vs. 27.91%, all P>0.05). Pearson correlation analysis showed that decrease of UACR after treatment was positively correlated with the decrease of NF-Κb and MCP-1 and the increase of APN (r=0.419, 0.524, 0.485, all P<0.05).

Conclusion

There is a synergistic effect of low-dose sitagliptin combined with dapagliflozin in the treatment of elderly patients with DKD, which can significantly improve blood glucose metabolism indexes, enhance renal function, regulate levels of inflammatory factors and effectively reduce UACR, with good safety.

Key words

sitagliptin tablets / dapagliflozin tablets / diabetic kidney disease / elderly / curative effect

引用本文

曹单单, 邓长财, 杜彭. 低剂量西格列汀联合达格列净治疗老年糖尿病肾病患者的临床研究. 中国临床药理学杂志, 2025 , 41 (19) : 2723 -2729 . DOI: 10.13699/j.cnki.1001-6821.2025.19.005

Dan-dan CAO, Chang-cai DENG, Peng Du. Clinical study of low-dose sitagliptin combined with dapagliflozin in the treatment of elderly patients with diabetic nephropathy[J]. Chinese Journal of Clinical Pharmacology, 2025 , 41 (19) : 2723 -2729 . DOI: 10.13699/j.cnki.1001-6821.2025.19.005

基金

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天津市第四中心医院青年科技人才基金资助项目(tjdszxyy20220015)

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2025年第41卷第19期

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doi: 10.13699/j.cnki.1001-6821.2025.19.005

接收时间：2025-07-31
首发时间：2026-08-05
出版时间：2025-10-17

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收稿日期：2025-07-31

基金

天津市第四中心医院青年科技人才基金资助项目(tjdszxyy20220015)

作者信息

天津市第四中心医院肾内科，天津 300140

通讯作者:

邓长财，副主任医师，硕士生导师 MP: 13920173868 E-mail: cdengc@126.com

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
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