利拉鲁肽对2型糖尿病轻度认知功能损害患者认知功能、尿白蛋白与肌酐比值、足细胞标志蛋白的影响
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摘要
目的探讨利拉鲁肽对2型糖尿病轻度认知功能损害(mild cognitive impairment,MCI)患者蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评分、尿白蛋白与肌酐比值(albumin-creatinine ratio,ACR)、足细胞标志蛋白(podocyte proteins,PCX)的影响。方法将80例2型糖尿病MCI患者随机分为对照组(40例)和利拉鲁肽组(40例),对照组给予原治疗方案,利拉鲁肽组改用利拉鲁肽治疗,疗程均为24周。比较治疗前及治疗后24周时2组收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、糖化血红蛋白(hemoglobin A1c,HbA1c)、空腹血糖(fasting plasma glucose,FPG)、总胆固醇(total cholesterol,TC)、三酰甘油(triglycerides,TG)、尿ACR、PCX。应用MoCA评估患者认知功能。结果 2组治疗前、治疗后和2组治疗前后FPG、HbA1c、SBP、DBP、TG、TC差异均无统计学意义(P>0.05)。治疗前,2组MoCA评分、尿ACR、PCX差异均无统计学意义(P>0.05);治疗后,对照组MoCA评分、尿ACR、PCX与治疗前差异均无统计学意义(P>0.05),利拉鲁肽组MoCA评分显著高于治疗前,尿ACR、PCX显著低于治疗前,利拉鲁肽组MoCA评分显著高于对照组(P<0.05),尿ACR、PCX显著低于对照组,差异均有统计学意义(P<0.05)。结论利拉鲁肽可改善2型糖尿病MCI患者认知功能,降低其尿ACR和PCX水平。
Objective To explore the effects of liraglutide on score of Montreal Cognitive Assessment(MoCA),urine albumin-creatinine ratio(ACR)and urinary podocalyxin(PCX)in patients with type 2 diabetic mild cognitive impairment.Methods Eighty patients with type 2 diabetic mild cognitive impairment were collected and randomly divided into control group(n=40)and liraglutide group(n=40).Premixed insulin was administrated in control group for 24 weeks while liraglutide in liraglutide group.The systolic blood pressure(SBP),diastolic blood pressure(DBP),hemoglobin A1 c(HbA1 c),fasting plasma glucose(FPG),total cholesterol(TC),triglyceride(TG),urine ACR and urine PCX of were measured and compared before the treatment and 24 weeks after the treatment.Patients cognitive function was assessed by MoCA.Results There were no significant difference in FBG,HbA1 c,SBP,DBP,TG,and TC between two groups before the treatment and 24 weeks after the treatment,while there was no significant change in FBG,HbA1 c,SBP,DBP,TG,and TC after the treatment in the two groups(P>0.05).Before the treatment,there were no significant difference in the core of MoCA,urine ACR and PCX between two groups(P>0.05).After the treatment,there were no significant change in the core of MoCA,urine ACR and PCX as compared with that before treatment in control group(P>0.05),while the core of MoCA in liraglutide group were significantly higher(P<0.05)and urine ACR and PCX lower than that before treatment(P<0.05).At 24 weeks after the treatment,the core of MoCA in liraglutide group was significant higher(P<0.05)and urine ACR and PCX were significant lower than that of control group(P<0.05).Conclusion Liraglutide maybe improve cognitive function and reduce urine ACR and PCX in patients with type 2 diabetic mild cognitive impairment.
Objective To explore the effects of liraglutide on score of Montreal Cognitive Assessment(MoCA),urine albumin-creatinine ratio(ACR)and urinary podocalyxin(PCX)in patients with type 2 diabetic mild cognitive impairment.Methods Eighty patients with type 2 diabetic mild cognitive impairment were collected and randomly divided into control group(n=40)and liraglutide group(n=40).Premixed insulin was administrated in control group for 24 weeks while liraglutide in liraglutide group.The systolic blood pressure(SBP),diastolic blood pressure(DBP),hemoglobin A1 c(HbA1 c),fasting plasma glucose(FPG),total cholesterol(TC),triglyceride(TG),urine ACR and urine PCX of were measured and compared before the treatment and 24 weeks after the treatment.Patients cognitive function was assessed by MoCA.Results There were no significant difference in FBG,HbA1 c,SBP,DBP,TG,and TC between two groups before the treatment and 24 weeks after the treatment,while there was no significant change in FBG,HbA1 c,SBP,DBP,TG,and TC after the treatment in the two groups(P>0.05).Before the treatment,there were no significant difference in the core of MoCA,urine ACR and PCX between two groups(P>0.05).After the treatment,there were no significant change in the core of MoCA,urine ACR and PCX as compared with that before treatment in control group(P>0.05),while the core of MoCA in liraglutide group were significantly higher(P<0.05)and urine ACR and PCX lower than that before treatment(P<0.05).At 24 weeks after the treatment,the core of MoCA in liraglutide group was significant higher(P<0.05)and urine ACR and PCX were significant lower than that of control group(P<0.05).Conclusion Liraglutide maybe improve cognitive function and reduce urine ACR and PCX in patients with type 2 diabetic mild cognitive impairment.
引文
[1] Wennberg AM,Gottesman RF,Kanfmann CN,et al.Diabetesand cognitive outcomes in a nationally representative sample:the National Health and Aging Trends Study[J].IntPsychogeriatr,2014,26(10):1729-1735.
[2] Umemura T,Kawamura T,Umegakj H,et al.Association ofchronic kidney disease and cerebral small vessel disease withcognitive impairment in elderIy patients with type 2diabetes[J].Dement Geriatr Cogn Disord Extra,2013,3(1):212-222.
[3] 董闪闪,张洁,刘璠,等.2型糖尿病肾病患者尿足细胞标志蛋白和血管内皮生长因子水平与氧化应激的相关性[J].重庆医学,2016,45(10):1334-1336.
[4] 刘璠,董闪闪,康岩,等.2型糖尿病患者尿白蛋白/肌酐比值对认知功能的影响[J].现代中西医结合杂志,2017,26(16):1725-1727.
[5] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,6(7):447-498.
[6] Samaras K,Lutgers HL,Kochan NA,et al.The impact ofglucose disorders on cognition and brain volumes in theelderly:the Sydney Memory and Ageing Study[J].AGE(Dordr),2014,36(2):977-993.
[7] 李梅,马兰,范鹰,等.2型糖尿病患者轻度认知功能改变特点及其相关因素的研究[J].中华老年多器官疾病杂志,2016,15(1):6-10.
[8] 温智峰,蒲蔚荣,刘香春,等.利拉鲁肽对不同海拔地区糖调节受损肥胖患者血管内皮功能障碍的影响[J].中国新药与临床杂志,2016,35(8):576-580.
[9] 郑坤杰,武革,耿建林,等.不同降糖药物对2型糖尿病大鼠胰岛β细胞凋亡及再生作用的影响[J].河北医科大学学报,2017,38(11):1260-1264.
[10] 中华医学会糖尿病学学会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[11] 李芝,陈宏.2型糖尿病患者轻度认知功能障碍与低血糖的相关性[J].中国老年学杂志,2015,35(14):3899-3901.
[12] 张萌,张璐,李玉中,等.利拉鲁肽对2型糖尿病患者认知功能的影响及可能机制[J].中华糖尿病杂志,2014,6(2):91-96.
[13] 刘璠,杨爱格,董闪闪,等.2型糖尿病轻度认知功能障碍患者MoCA评分与尿白蛋白肌酐比值及足细胞标志蛋白的相关性[J].中国医师杂志,2017,19(12):1820-1823.
[14] Maezawa Y,Takemoto M,Yokote K.Cell biology of diabeticnephropathy:roles of endothelial cells,tubulointerstitial cellsand podocytes[J].J Diabetes Investig,2015,6(1):3-15.
[15] Barzilay JI,Lovato JF,Murray AM,et al.Albuminuria andcognitive decline in people with diabetes and normal renalfunction[J].Clin J Am Soc Nephrol,2013,8(11):1907-1914.
[16] 刘璠,张趁儒,周慧敏,等.人GLP-1类似物对2型糖尿病患者血清IL-6、TNF-α、CRP及脂联素的影响[J].中国现代医学杂志,2014,24(33):27-30.
[17] Bauer IE,Pascoe MC, Wollenhaupt-Aguiar B,et al.Inflammatory mediators of cognitive impairment in bipolardisorder[J].J Psychiatr Res,2014,56:18-27.
[18] 韦凌云,杨丕坚,李舒敏,等.炎症及内皮功能障碍与糖尿病肾病患者尿蛋白的相关性[J].中国老年学杂志,2014,34(9):2445-2447.
[19] Faria MC,Goncalves GS,Rocha NP,et al.Increased plasmalevels of BDNF and inflammatory markers in Alzheimer′sdisease[J].J Psychiatr Res,2014,53:166-172.
[2] Umemura T,Kawamura T,Umegakj H,et al.Association ofchronic kidney disease and cerebral small vessel disease withcognitive impairment in elderIy patients with type 2diabetes[J].Dement Geriatr Cogn Disord Extra,2013,3(1):212-222.
[3] 董闪闪,张洁,刘璠,等.2型糖尿病肾病患者尿足细胞标志蛋白和血管内皮生长因子水平与氧化应激的相关性[J].重庆医学,2016,45(10):1334-1336.
[4] 刘璠,董闪闪,康岩,等.2型糖尿病患者尿白蛋白/肌酐比值对认知功能的影响[J].现代中西医结合杂志,2017,26(16):1725-1727.
[5] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,6(7):447-498.
[6] Samaras K,Lutgers HL,Kochan NA,et al.The impact ofglucose disorders on cognition and brain volumes in theelderly:the Sydney Memory and Ageing Study[J].AGE(Dordr),2014,36(2):977-993.
[7] 李梅,马兰,范鹰,等.2型糖尿病患者轻度认知功能改变特点及其相关因素的研究[J].中华老年多器官疾病杂志,2016,15(1):6-10.
[8] 温智峰,蒲蔚荣,刘香春,等.利拉鲁肽对不同海拔地区糖调节受损肥胖患者血管内皮功能障碍的影响[J].中国新药与临床杂志,2016,35(8):576-580.
[9] 郑坤杰,武革,耿建林,等.不同降糖药物对2型糖尿病大鼠胰岛β细胞凋亡及再生作用的影响[J].河北医科大学学报,2017,38(11):1260-1264.
[10] 中华医学会糖尿病学学会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[11] 李芝,陈宏.2型糖尿病患者轻度认知功能障碍与低血糖的相关性[J].中国老年学杂志,2015,35(14):3899-3901.
[12] 张萌,张璐,李玉中,等.利拉鲁肽对2型糖尿病患者认知功能的影响及可能机制[J].中华糖尿病杂志,2014,6(2):91-96.
[13] 刘璠,杨爱格,董闪闪,等.2型糖尿病轻度认知功能障碍患者MoCA评分与尿白蛋白肌酐比值及足细胞标志蛋白的相关性[J].中国医师杂志,2017,19(12):1820-1823.
[14] Maezawa Y,Takemoto M,Yokote K.Cell biology of diabeticnephropathy:roles of endothelial cells,tubulointerstitial cellsand podocytes[J].J Diabetes Investig,2015,6(1):3-15.
[15] Barzilay JI,Lovato JF,Murray AM,et al.Albuminuria andcognitive decline in people with diabetes and normal renalfunction[J].Clin J Am Soc Nephrol,2013,8(11):1907-1914.
[16] 刘璠,张趁儒,周慧敏,等.人GLP-1类似物对2型糖尿病患者血清IL-6、TNF-α、CRP及脂联素的影响[J].中国现代医学杂志,2014,24(33):27-30.
[17] Bauer IE,Pascoe MC, Wollenhaupt-Aguiar B,et al.Inflammatory mediators of cognitive impairment in bipolardisorder[J].J Psychiatr Res,2014,56:18-27.
[18] 韦凌云,杨丕坚,李舒敏,等.炎症及内皮功能障碍与糖尿病肾病患者尿蛋白的相关性[J].中国老年学杂志,2014,34(9):2445-2447.
[19] Faria MC,Goncalves GS,Rocha NP,et al.Increased plasmalevels of BDNF and inflammatory markers in Alzheimer′sdisease[J].J Psychiatr Res,2014,53:166-172.