钠-葡萄糖耦联转运体2抑制剂降低早期糖尿病肾病患者的尿酸水平

doi:10.16138/j.1673-6087.2025.05.04

摘要/Abstract

摘要：

目的：观察钠-葡萄糖耦联转运体2（sodium-glucose linked transporter 2, SGLT-2）抑制剂达格列净对2型糖尿病（type 2 diabetes mellitus, T2DM）早期肾病伴高尿酸血症患者血尿酸（serum uric acid，SUA）水平的影响，探讨SGLT-2抑制剂对于高尿酸血症的治疗价值。方法：选取2020年6月至2023年6月于我院就诊的T2DM早期肾病伴高尿酸血症患者65例，在原降糖方案基础上加用达格列净。治疗4周后，采用配对样本t检验比较治疗前后SUA、糖化血红蛋白（glycated hemoglobin, HbA_1c）、空腹血糖（fasting plasma glucose, FPG）、血肌酐（serum creatinine, SCr）、总胆固醇（total cholesterol, TC）、甘油三酯（triglycerides,TG）、尿微量白蛋白/肌酐比值（urine albumin-to-creatinine ratio, UACR）及体重等指标变化。采用线性回归分析治疗后SUA的变化与基线SUA水平的关系。结果：65例患者经达格列净治疗4周后，SUA[(436.07±39.53) μmol/L 比(392.18±32.18) μmol/L,P<0.001]、FPG[(7.66±2.23) mmol/L比(6.40±1.06) mmol/L,P<0.001] 、UACR[(211.31±73.21) mg/g比(177.83±88.28) mg/g,P=0.005]、体重[(63.08±9.74) kg比(62.68±9.29) kg，P=0.038]较前明显下降，差异均具有统计学意义。收缩压、舒张压、HbA_1c、TC、TG、SCr、估算肾小球滤过率（estimated glomerular filtration rate, eGFR）等水平较前差异无统计学意义（P>0.05）。线性回归分析显示，治疗后SUA下降幅度与基线SUA水平呈正相关（β=0.634，R²=0.401，P<0.001）。结论：SGLT-2抑制剂不仅能有效控制T2DM早期肾病患者血糖，还可显著降低患者SUA和尿微量白蛋白水平，提示其具有潜在的长期肾脏保护作用。

关键词: 血尿酸, 糖尿病肾病, 钠-葡萄糖耦联转运体2抑制剂

Abstract:

Objective To explore the reducing serum uric acid (SUA) effects of dapagliflozin, a sodium-glucose linked transporter 2 (SGLT2) inhibitor in patients with type 2 diabetes mellitus (T2DM) with early nephropathy and hyperuricemia. Methods Sixty-five patients with early T2 diabetic nephropathy and hyperuricemia admitted to our hospital from June 2020 to June 2023 were enrolled. After 4 weeks of treatment with dapagliflozin, a paired-sample T-test was used to analyze the changes in SUA, glycosylated hemoglobin (HbA_1c), fasting plasma glucose (FPG), serum creatinine (SCr), total cholesterol (TC), triglyceride (TG), urine albumin-to-creatinine ratio (UACR), body weight and other clinical indexes. Linear regression analysis was performed to determine the relationship between the changes of SUA before (baseline) and after treatment. Results In this group of 65 T2DM patients with early nephropathy and hyperuricemia, 4 weeks of dapagliflozin reduced SUA [(436.1±39.5)vs (392.2±32.2) μmol/L,P<0.001], FPG [(7.66±2.23)vs (6.40±1.06) mmol/L,P<0.001], UACR [(211.3±73.2)vs (177.8±88.3) mg/g,P=0.005], and body weight [(63.1±9.7)vs (62.7±9.3) kg,P=0.038] significantly. Systolic blood pressure, diastolic blood pressure, HbA_1c, TC, TG, SCr, estimated glomerular filtration rate (eGFR), and other levels were not changed (P>0.05). Linear regression analysis showed that the decreased levels of SUA positively correlated with the baseline levels of SUA (β=0.634,R²=0.401,P<0.001). Conclusions SGLT2 could effectively decrease blood glucose levels in patients with early T2DM nephropathy, and significantly reduce serum uric acid and urinary microalbumin.

Key words: Serum uric acid, Diabetic nephropathy, Sodium-glucose linked transporter 2 inhibitors

中图分类号:

R587.1
R692

吴茜茜, 郭洁, 王依凡, 刘丽, 王锋. 钠-葡萄糖耦联转运体2抑制剂降低早期糖尿病肾病患者的尿酸水平[J]. 内科理论与实践, 2025, 20(05): 371-375.

WU Qianqian, GUO Jie, WANG Yifan, LIU Li, WANG Feng. Sodium-glucose linked transporter 2 inhibitors reduce serum uric acid in type 2 diabetic mellitus patients with early nephropathy[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(05): 371-375.

图/表 2

参考文献 21

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项目	治疗前	治疗后	∆_m	t/Z	P
∆_m=治疗后−治疗前均数; 1 mmHg=0.133 kPa。
收缩压（mmHg）	126.45±31.91	125.60±22.38	−0.85±37.05	0.18	0.854
舒张压（mmHg）	82.23±13.93	81.86±12.53	−3.69±17.21	0.17	0.863
体重（kg）	63.08±9.74	62.68±9.29	−0.40±1.50	2.12	0.038
SCr（μmol/L）	80.97±13.97	79.06±14.54	−1.91±17.13	0.90	0.373
eGFR[mL/(min·1.73m²)]	86.48±20.51	90.16±24.92	3.68±22.17	−1.34	0.185
尿素氮（mmol/L）	9.14±2.66	8.69±2.45	−0.45±2.88	1.27	0.209
SUA（μmol/L）	436.07±39.53	392.18±32.18	−43.89±15.04	23.53	<0.001
FBG（mmol/L）	7.66±2.23	6.40±1.06	−1.27±1.46	6.99	<0.001
HbA_1c（%）	7.51±1.22	7.34±0.91	−0.17±0.97	1.39	0.170
TC（mmol/L）	4.61±1.32	4.43±1.21	−0.19±1.91	0.79	0.433
TG（mmol/L）	1.68±1.01	1.81±1.10	0.13±1.54	0.68	0.491
UACR（mg/g）	211.31±73.21	177.83±88.28	−33.48±92.33	2.92	0.005