二肽基肽酶4抑制剂在控制2型糖尿病透析患者代谢指标中的作用

目的：研究3种不同二肽基肽酶4（DPP-4）抑制剂对终末期肾病合并2型糖尿病患者代谢参数的影响。方法：对200例应用DPP-4抑制剂（西格列汀、维格列汀或利格列汀）治疗2型糖尿病的终末期肾病患者进行前瞻性队列研究。DPP-4抑制剂治疗12周前后评估糖化血红蛋白（HbA1c）、空腹血糖和代谢指标的变化。结果：西格列汀、维格列汀、利格列汀治疗组HbA1c水平下降无显著性差异（分别为-0.74±1.57、-0.39±1.45和-0.08±1.40，P=0.076），空腹血糖及血脂变化亦无显著差异。在血液透析患者（n=115）中，3组间HbA1c水平变化无差异。相比之下，腹膜透析患者（n=85）用西格列汀治疗12周后，HbA1c比用维格列汀和利格列汀治疗12周降低得更多（分别为-1.58±0.95，-0.46±0.98，-0.04±1.22，P=0.001）。结论：在终末期肾病患者中使用不同DPP-4抑制剂的降糖作用差异无显著性。在腹膜透析患者中，西格列汀比其他DPP-4抑制剂可使HbA1c水平降低更多。

The role of dipeptidyl peptidase-4 (DPP-4) inhibitors in controlling metabolic indices in type 2 diabetic dialysis patients

OBJECTIVE To study the effects of three different DPP-4 inhibitors on metabolic parameters in ESRD patients with T2DM.METHODS 200 ESRD patients with T2DM treated with DPP-4 inhibitors (sitagliptin, vildagliptin or linagliptin) were retrospectively analyzed. The changes of glycosylated hemoglobin (HbA1c), fasting blood glucose and metabolic parameters were assessed before and after 12 weeks of treatment with DPP-4 inhibitors.RESULTS There was no significant difference in the levels of HbA1c in the treatment group of sitagliptin, vildagliptin and linagliptin (-0.74±1.57, -0.39±1.45 and -0.08±1.40, respectively, P=0.076). There was no significant difference in fasting blood glucose and lipid. In HD patients (n=115), there was no difference in HbA1c levels among the three groups. In contrast, HbA1c in PD patients (n=85) decreased more after 12 weeks of treatment with sitagliptin than those with vildagliptin and linagliptin (-1.58±0.95, -0.46±0.98, -0.04±1.22, respectively, P=0.001).CONCLUSION There was no significant difference in the hypoglycemic effect of different DPP-4 inhibitors in patients with end-stage renal disease. In peritoneal dialysis patients, sitagliptin reduces HbA1c levels more than other DPP-4 inhibitors.