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

Retinal neuroprotective effect of GLP-1 analogs liraglutide in early diabetic retinopathy

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。

Abstract:

AIM: To study glucagon-like peptide-1(GLP-1)analogues(liraglutide)in patients with mild to moderate nonproliferative diabetic retinopathy(NPDR)and the clinical efficacy of retinal neuroprotection.

METHODS: Sixty patients with type 2 diabetes mellitus with mild or moderate NPDR were treated in our department of endocrinology. They were randomly divided into two groups. Patients in the experimental group used metformin, insulin combined with liraglutide to regulate blood glucose, while the control group used metformin, insulin for hypoglycemia. Comparing the two groups of patients before and after the treatment, including HbA1c and pattern visual evoked potential(P-VEP)P100 amplitude and P100 latency, full field electroretinogram(F-ERG)oscillatory potentials(Ops)total amplitude, and light and dark adaptation 3.0 the amplitude of the a-, b-wave varies.

RESULTS: After 6mo treatment, the total amplitude of Ops in the experimental and control groups increased compared with that before treatment. The difference was statistically significant(all P<0.01). And the total amplitude of Ops in the experimental group was higher than that of the control group, the difference was statistically significant(P=0.049). Meanwhile the b-wave amplitudes of the light and dark adaptation 3.0 in the experimental group were higher than those in the control group(P=0.001, P=0.014); however, there was no statistical significance in a-wave amplitude between the light and dark adaptation 3.0 in both groups after treatment(P=0.505, 0.441, 0.193, respectively). the b-wave amplitudes of the experimental group with dark and light adaptation 3.0 increased compared with that before treatment, and the difference was statistically significant(P<0.01, P=0.019). The a-wave amplitude of light and dark adaptation in the experimental group increased compared with that before treatment, but the difference was not statistically significant(P=0.130, 0.147).

CONCLUSION: GLP-1 analogues can improve the function of retinal neurons in patients with mild to moderate NPDR to a certain extent, and have a positive effect on the prognosis of DR.