利拉鲁肽在早期糖尿病视网膜病变中的视网膜神经保护作用
|
摘要
目的:研究胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)类似物(利拉鲁肽)对轻、中度非增生期糖尿病视网膜病变(nonproliferative diabetic retinopathy,NPDR)患者的视网膜神经保护作用的临床疗效。方法:收集于我院内分泌科治疗的2型糖尿病合并轻、中度NPDR的患者60例。随机分为两组,试验组患者使用二甲双胍、胰岛素联合利拉鲁肽降血糖,对照组使用二甲双胍、胰岛素降血糖。比较两组患者治疗前和治疗后6mo糖化血红蛋白、图形视觉诱发电位(pattern visual evoked potential,P-VEP)的P100波幅值和P100潜伏期、全视野闪光视网膜电图(full field electroretinogram,F-ERG)的震荡电位(oscillatory potentials,Ops)总波幅值和明、暗适应3. 0的a波、b波的振幅变化。结果:治疗后6mo,试验组和对照组Ops总波幅值较治疗前均增加(均P<0. 01),试验组Ops总波幅较对照组高(P=0. 049)。治疗后试验组患者的明、暗适应3. 0的b波振幅较对照组高(P=0. 001、0. 014);但是治疗后两组患者糖化血红蛋白值、明、暗适应3. 0的a波振幅无差异(P=0. 505、0. 441、0. 193)。治疗后试验组明、暗适应3. 0的b波振幅较治疗前增加(P<0. 01、P=0. 019),明、暗适应的a波振幅较治疗前增加,然而差异无统计学意义(P=0. 130、0. 147)。结论:利拉鲁肽可以一定程度上改善轻、中度NPDR患者的视网膜神经细胞的功能,对DR的预后有着积极的作用。
AIM: To study glucagon-like peptide-1( GLP-1)analogues( liraglutide) in patients w ith m ild to m oderate nonproliferative diabetic retinopathy( NPDR) and the clinical efficacy of retinal neuroprotection.METHODS: Sixty patients with type 2 diabetes mellitus w ith m ild or m oderate NPDR w ere treated in our departm ent of endocrinology. They w ere random ly divided into tw o groups. Patients in the experim ental group used m etform in,insulin com bined w ith liraglutide to regulate blood glucose,w hile the control group used m etform in,insulin for hypoglycem ia. Com paring the tw o groups of patients before and after the treatm ent,including HbA1 c and pattern visual evoked potential( PVEP) P100 am plitude and P100 latency, full field electroretinogram( F-ERG) oscillatory potentials( Ops)total am plitude,and light and dark adaptation 3. 0 the am plitude of the a-,b-w ave varies.RESULTS: After 6mo treatment,the total amplitude of Ops in the experim ental and control groups increased com pared w ith that before treatm ent. The difference w as statistically significant( all P < 0. 01). And the total am plitude of Ops in the experim ental group w as higher than that of the control group, the difference w as statistically significant( P= 0.049). M eanw hile the b-w ave am plitudes of the light and dark adaptation 3. 0 in the experim ental group w ere higher than those in the control group( P = 0. 001,P = 0. 014); how ever,there w as no statistical significance in a-w ave am plitude betw een the light and dark adaptation 3. 0 in both groups after treatm ent( P = 0. 505,0. 441,0. 193,respectively). the b-w ave am plitudes of the experim ental group w ith dark and light adaptation 3. 0 increased com pared w ith that before treatm ent,and the difference w as statistically significant( P<0.01,P = 0.019). The a-wave amplitude of light and dark adaptation in the experim ental group increased com pared w ith that before treatm ent,but the difference w as not statistically significant( P= 0.130,0. 147). CONCLUSION: GLP-1 analogues can improve the function of retinal neurons in patients w ith m ild to m oderate NPDR to a certain extent,and have a positive effect on the prognosis of DR.
AIM: To study glucagon-like peptide-1( GLP-1)analogues( liraglutide) in patients w ith m ild to m oderate nonproliferative diabetic retinopathy( NPDR) and the clinical efficacy of retinal neuroprotection.METHODS: Sixty patients with type 2 diabetes mellitus w ith m ild or m oderate NPDR w ere treated in our departm ent of endocrinology. They w ere random ly divided into tw o groups. Patients in the experim ental group used m etform in,insulin com bined w ith liraglutide to regulate blood glucose,w hile the control group used m etform in,insulin for hypoglycem ia. Com paring the tw o groups of patients before and after the treatm ent,including HbA1 c and pattern visual evoked potential( PVEP) P100 am plitude and P100 latency, full field electroretinogram( F-ERG) oscillatory potentials( Ops)total am plitude,and light and dark adaptation 3. 0 the am plitude of the a-,b-w ave varies.RESULTS: After 6mo treatment,the total amplitude of Ops in the experim ental and control groups increased com pared w ith that before treatm ent. The difference w as statistically significant( all P < 0. 01). And the total am plitude of Ops in the experim ental group w as higher than that of the control group, the difference w as statistically significant( P= 0.049). M eanw hile the b-w ave am plitudes of the light and dark adaptation 3. 0 in the experim ental group w ere higher than those in the control group( P = 0. 001,P = 0. 014); how ever,there w as no statistical significance in a-w ave am plitude betw een the light and dark adaptation 3. 0 in both groups after treatm ent( P = 0. 505,0. 441,0. 193,respectively). the b-w ave am plitudes of the experim ental group w ith dark and light adaptation 3. 0 increased com pared w ith that before treatm ent,and the difference w as statistically significant( P<0.01,P = 0.019). The a-wave amplitude of light and dark adaptation in the experim ental group increased com pared w ith that before treatm ent,but the difference w as not statistically significant( P= 0.130,0. 147). CONCLUSION: GLP-1 analogues can improve the function of retinal neurons in patients w ith m ild to m oderate NPDR to a certain extent,and have a positive effect on the prognosis of DR.
引文
1 Whiting DR, Guariguata L, Weil C, et al. IDF diabetes atlas:global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011;94(3):311-321
2 Simo R, Hernandez C.Neurodegeneration is an early event in diabetic retinopathy:therapeutic implications. Br J phthalmol 2012; 96(10):1285-1290
3雷雨,郑宏华,陈小红,等.GLP-1防治糖尿病视网膜病变的研究进展.眼科新进展2017:37(12):1193-1196
4 Du Q,Wang YJ,Yang S. Liraglutide for the treatment of type 2diabetes mellitus:a meta-analysis of randomized placebo-controlled trials. Adv Ther 2014; 31(11):1182-1195
5 Wilkinson CP,Ferris FL, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 2003; 110(9):1677-1682
6 Wan TT, Li XF, Sun YM,et al. Recent advances in understanding the biochemical and molecular mechanism of diabetic retinopathy. Biomed Pharmacother 2015;74:145-147
7李坤,龚向宁,郎卫华.糖尿病视网膜病变临床前期的视功能变化分析.国际眼科杂志2015;15(6):1094-1096
8金佩瑶,彭金娟,邹海东,等.上海市新泾社区2型糖尿病居民5年随访的前瞻性调查研究:糖尿病视网膜病变和糖尿病黄斑水肿的发病率及危险因素.中华实验眼科杂志2016;34(4):363-367
9 Berezin A. Metabolic memory phenomenon in diabetes mellitus:Achieving and perspectives. Diabetes Metab Syndr 2016; 10(2):176-183
10 Shin S,Le LJ,Everett LJ, et al. CREB mediates the insulinotropic and anti-apoptotic effects of GLP-1 signaling in adult mouse beta-cells.Mol Metab 2014;3(8):803-812
11 Armstrong MJ,Hull D, Guo K, et al. Glucagon-like peptide 1decreases lipotoxicity in non-alcoholic steatohepatitis.J Hepatol 2016; 64(2):399-408
12陈利荣,姚军平,张贻转,等.羟苯磺酸钙联合GLP-1类似物治疗糖尿病视网膜病变的临床意义.中国医院药学杂志2017; 37(15):1505-1508
13 Gongalves A, Lin CM, Muthusamy A, et al. Protective effect of a GLP-1 analog on ischemia-reperfusion induced blood-retinal barrier breakdown and inflammation. Invest Ophthalmol Vis Sci 2016; 57(6):2584-2592
14 Hernandez C, Bogdanov P, Corraliza L,et al.Topical administration of GLP-1 receptor agonists prevents retinal neurodegeneration in experimental diabetes. Diabetes 2016;65(1):172-187
15 Pang BY,Zhou HR, Kuang HY.The potential benefits of glucagon-like peptide-1 receptor agonists for diabetic retinopathy. Peptides 2018; 100:123-126
16方晏红,陈晓曦,宗元娟,等.NPDR患者黄斑区视网膜厚度、视网膜神经纤维层厚度与全视野闪光ERG的变化.眼科新进展2012;32(9):855-858
17 Javad,Akram E, Nasser S,et al. Pattern Visual Evoked Potentials in Patients with TypeⅡDiabetes Mellitus. J Ophthalmic Vis Res 2012; 7(3):225-230
18张芳霞,杨巧玲,曹宏亮.糖尿病视网膜病变前期视网膜电图和视觉诱发电位分析.国际眼科杂志2009;9(1):78-79
19黄爱国,尹卫靖,李全忠,等.糖尿病患者视网膜电图和视觉诱发电位变化.中国实用眼科杂志2004;43(12):1036-1037
20 Karlica D,Galetovi D,Ivanisevi M,et al. Visual evoked potential can be used to detect a prediabetic form of diabetic retinopathy in patients with diabetes mellitus type I. Coll Antropol 2010; 34(2):525
21邹大进.人胰升糖素样肽1类似物利拉鲁肽减轻2型糖尿病患者体质量的作用.中华内分泌代谢杂志2011;27(8):703-706
22 Raman R,Rani PK, Gnanamoorthy P,et al. Association of obesity with diabetic retinopathy:Sankara Nethralaya Diabetic Retinopathy Epidemiologyand Molecular Genetics Study(SN-DREAMS Report no.8).Acta Diabetol 2010;47(3):209-215
2 Simo R, Hernandez C.Neurodegeneration is an early event in diabetic retinopathy:therapeutic implications. Br J phthalmol 2012; 96(10):1285-1290
3雷雨,郑宏华,陈小红,等.GLP-1防治糖尿病视网膜病变的研究进展.眼科新进展2017:37(12):1193-1196
4 Du Q,Wang YJ,Yang S. Liraglutide for the treatment of type 2diabetes mellitus:a meta-analysis of randomized placebo-controlled trials. Adv Ther 2014; 31(11):1182-1195
5 Wilkinson CP,Ferris FL, Klein RE, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology 2003; 110(9):1677-1682
6 Wan TT, Li XF, Sun YM,et al. Recent advances in understanding the biochemical and molecular mechanism of diabetic retinopathy. Biomed Pharmacother 2015;74:145-147
7李坤,龚向宁,郎卫华.糖尿病视网膜病变临床前期的视功能变化分析.国际眼科杂志2015;15(6):1094-1096
8金佩瑶,彭金娟,邹海东,等.上海市新泾社区2型糖尿病居民5年随访的前瞻性调查研究:糖尿病视网膜病变和糖尿病黄斑水肿的发病率及危险因素.中华实验眼科杂志2016;34(4):363-367
9 Berezin A. Metabolic memory phenomenon in diabetes mellitus:Achieving and perspectives. Diabetes Metab Syndr 2016; 10(2):176-183
10 Shin S,Le LJ,Everett LJ, et al. CREB mediates the insulinotropic and anti-apoptotic effects of GLP-1 signaling in adult mouse beta-cells.Mol Metab 2014;3(8):803-812
11 Armstrong MJ,Hull D, Guo K, et al. Glucagon-like peptide 1decreases lipotoxicity in non-alcoholic steatohepatitis.J Hepatol 2016; 64(2):399-408
12陈利荣,姚军平,张贻转,等.羟苯磺酸钙联合GLP-1类似物治疗糖尿病视网膜病变的临床意义.中国医院药学杂志2017; 37(15):1505-1508
13 Gongalves A, Lin CM, Muthusamy A, et al. Protective effect of a GLP-1 analog on ischemia-reperfusion induced blood-retinal barrier breakdown and inflammation. Invest Ophthalmol Vis Sci 2016; 57(6):2584-2592
14 Hernandez C, Bogdanov P, Corraliza L,et al.Topical administration of GLP-1 receptor agonists prevents retinal neurodegeneration in experimental diabetes. Diabetes 2016;65(1):172-187
15 Pang BY,Zhou HR, Kuang HY.The potential benefits of glucagon-like peptide-1 receptor agonists for diabetic retinopathy. Peptides 2018; 100:123-126
16方晏红,陈晓曦,宗元娟,等.NPDR患者黄斑区视网膜厚度、视网膜神经纤维层厚度与全视野闪光ERG的变化.眼科新进展2012;32(9):855-858
17 Javad,Akram E, Nasser S,et al. Pattern Visual Evoked Potentials in Patients with TypeⅡDiabetes Mellitus. J Ophthalmic Vis Res 2012; 7(3):225-230
18张芳霞,杨巧玲,曹宏亮.糖尿病视网膜病变前期视网膜电图和视觉诱发电位分析.国际眼科杂志2009;9(1):78-79
19黄爱国,尹卫靖,李全忠,等.糖尿病患者视网膜电图和视觉诱发电位变化.中国实用眼科杂志2004;43(12):1036-1037
20 Karlica D,Galetovi D,Ivanisevi M,et al. Visual evoked potential can be used to detect a prediabetic form of diabetic retinopathy in patients with diabetes mellitus type I. Coll Antropol 2010; 34(2):525
21邹大进.人胰升糖素样肽1类似物利拉鲁肽减轻2型糖尿病患者体质量的作用.中华内分泌代谢杂志2011;27(8):703-706
22 Raman R,Rani PK, Gnanamoorthy P,et al. Association of obesity with diabetic retinopathy:Sankara Nethralaya Diabetic Retinopathy Epidemiologyand Molecular Genetics Study(SN-DREAMS Report no.8).Acta Diabetol 2010;47(3):209-215
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |