【摘要】 目的 研究钠-葡萄糖共转运蛋白2(SGLT2)抑制剂达格列净对老年早期糖尿病肾病(diabetic kidney disease, DKD)患者肾功能及肾素-血管紧张素-醛固酮系统(RAAS)的影响。方法 选取2019年9月1日—2021年8月1日就诊于我院的老年2型糖尿病(T2DM)患者97例，根据尿微量白蛋白与肌酐比值(UACR)分为UACR正常组和早期DKD组，进一步采用随机数字表法划分决定上述两组中每例患者是否使用达格列净治疗，并将患者分为UACR正常达格列净组(A组)、UACR正常对照组(B组)、早期DKD达格列净组(C组)和早期DKD对照组(D组),比较4组患者治疗前及治疗1年后各项临床指标的差值。结果 治疗1年后，A组患者的体质量指数(BMI)、收缩压、舒张压、UACR、立位醛固酮与立位肾素比值(ARR)及空腹血糖、空腹胰岛素水平较治疗前差异显著(t=2.098～7.122,P<0.05),B组患者的UACR、肾小球滤过率(eGFR)及空腹血糖、空腹胰岛素水平较治疗前差异显著(t=-4.094～4.833,P<0.05),A组患者的收缩压、UACR、eGFR以及空腹胰岛素、立位肾素水平治疗前后差值较B组差异显著(t=-3.364～7.203,P<0.05)。C组患者的BMI、收缩压、UACR及空腹血糖、空腹胰岛素水平较治疗前差异显著(t=2.168～6.421,P<0.05),D组患者的UACR、eGFR及空腹血糖、空腹胰岛素水平较治疗前差异显著(t=-3.422～4.951,P<0.05),C组患者的BMI、UACR、eGFR以及立位肾素水平治疗前后差值较D组差异显著(t=-4.178～6.023,P<0.05)。A组患者舒张压、UACR、ARR及空腹胰岛素水平治疗前后差值较C组差异显著(t=-5.297～3.217,P<0.05)。结论 SGLT2抑制剂达格列净可以降低老年T2DM患者的收缩压、UACR,改善肾功能，对合并早期DKD患者的RAAS无影响。更多还原

【Abstract】 Objective To investigate the effect of the sodium-glucose cotransporter 2(SGLT2) inhibitor dapagliflozin on renal function and renin-angiotensin-aldosterone system(RAAS) in elderly patients with early diabetic kidney disease(DKD). Methods A total of 97 elderly patients with type 2 diabetes mellitus(T2DM) who attended our hospital from September 1, 2019 to August 1, 2021 were enrolled, and according to urinary albumin-to-creatinine ratio(UACR), they were divided into normal UACR group and early DKD group. A random number table was further used to determine whether each patient in the above two groups was treated with dapagliflozin. Finally, all patients were divided into normal-UACR dapagliflozin group(group A), normal-UACR control group(group B), early-DKD dapagliflozin group(group C), and early-DKD control group(group D), and these four groups were compared in terms of the changes in related clinical indices at 1 year after treatment. Results After 1 year of treatment, group A had significant changes in body mass index(BMI), systolic blood pressure, diastolic blood pressure, UACR, annualized relapse rate(ARR), fasting blood glucose, and fasting insulin(t=2.098-7.122,P<0.05), while group B had significant changes in UACR, estimated glomerular filtration rate(eGFR), fasting blood glucose, and fasting insulin(t=-4.094-4.833,P<0.05), and compared with group B, group A had significantly greater changes in systolic blood pressure, UACR, eGFR, fashing insulin, and renin level in the standing position after treatment(t=-3.364-7.203,P<0.05). After treatment, group C had significant changes in BMI, systolic blood pressure, UACR, fasting blood glucose, and fasting insulin(t=2.168-6.421,P<0.05), while group D had significant changes in UACR, eGFR, fasting blood glucose, and fasting insulin(t=-3.422-4.951,P<0.05), and compared with group D, group C had significantly greater changes in BMI, UACR, eGFR, and renin level in the standing position after treatment(t=-4.178-6.023,P<0.05). Compared with group C, group A had significantly greater changes in diastolic blood pressure, UACR, ARR, and fasting insulin after treatment(t=-5.297-3.217,P<0.05). Conclusion The SGLT2 inhibitor dapagliflozin can reduce systolic blood pressure and UACR and improve renal function in elderly patients with T2DM. But The SGLI2 inhibitor dapagliflozin has no effect on RAAS in T2DM patients with early DKD.更多还原