吡格列酮、瑞格列奈和二甲双胍对初发2型糖尿病患者血尿酸及肾功能的影响

Effects of Pioglitazone, Repaglinide or Metformin on Blood Uric Acid and Renal Function in Recent-onset Type 2 Diabetes

关键词:  吡格列酮  瑞格列奈  二甲双胍  血尿酸  肾功能

Key words:  pioglitazone  repaglinide  metformin  serum uric acid  renal function

摘要:

目的 比较吡格列酮、瑞格列奈和二甲双胍对初发2型糖尿病患者的血糖、血尿酸及肾功能的影响。方法 选取75名初发2型糖尿病合并高尿酸血症患者，每组25人，监测、分析3种药物12周治疗前后空腹血糖、餐后2 h血糖、糖化血红蛋白(HbA1c)、血尿酸、尿微量白蛋白(MAU)、尿素氮(BUN)、肌酐(Cr)、总胆固醇(TC)和甘油三酯(TG)。结果 吡格列酮组试验后空腹血糖、餐后2 h血糖、HbA1c、血尿酸、MAU、BUN、Cr、TC和TG均较试验前下降(P<0.05)。瑞格列奈组试验后空腹血糖、餐后2 h血糖、HbA1c均较试验前显著下降(P<0.05)。二甲双胍组试验后空腹血糖、餐后2 h血糖、HbA1c、TC、TG和MAU较试验前下降(P<0.05)。瑞格列奈组试验后空腹血糖、餐后2 h血糖和HbA1c均低于吡格列酮组和二甲双胍组(P<0.05)。吡格列酮组降低血尿酸改善肾功能的作用显著高于瑞格列奈组和二甲双胍组(P<0.05)。吡格列酮组对尿微量白蛋白的影响比二甲双胍组显著(P<0.05)。结论 瑞格列奈的降糖作用最强。吡格列酮显著降低血尿酸，改善肾功能。2型糖尿病初发患者，同时伴有肾病、高尿酸血症或痛风时，宜选用吡格列酮。

Abstract:

OBJECTIVE To compare the effects of pioglitazone, metformin and repaglinide on blood glucose, serum uric acid and renal function in recent-onset type 2 diabetes. METHODS Seventy-five recent-onset type 2 diabetes with hyperuricemia were analyzed. Fasting glucose, 2-hour glucose, glycation hemoglobin(HbA1c), serum uric acid, microalbuminuria(MAU), blood urea nitrogen(BUN), serum creatinine(Cr), total cholesterol(TC) and triglyceride(TG) were measured before and after 12 weeks of treatment with pioglitazone(n=25), repaglinide(n=25) or metformin(n=25). RESULTS Fasting glucose, 2-hour glucose, HbA1c, serum uric acid, MAU, BUN, Cr, TC and TG decreased significantly at 12 weeks in patients receiving pioglitazone(P<0.05). Fasting glucose, 2-hour glucose and HbA1c decreased significantly at 12 weeks in patients receiving repaglinide(P<0.05). Fasting glucose, 2-hour glucose, HbA1c, MAU, TC and TG decreased significantly at 12 weeks in patients receiving metformin(P<0.05). At 12 weeks, the repaglinide group had lower fasting glucose, 2-hour glucose and HbA1c, than the pioglitazone group and the metformin group(P<0.05). The pioglitazone group had lower serum uric acid , BUN and Cr, than the repaglinide group and the metformin group(P<0.05). The pioglitazone group had lower MAU than the metformin group(P<0.05). CONCLUSION Repaglinide lead to a decrease on blood glucose decrease; pioglitazone lead to a decrease on serum uric acid, and improved renal function. For recent-onset type 2 diabetes who also have diabetic nephropathy, hyperuricemia or gout, pioglitazone is a better choice.