The Effect Of Canagliflozin On UACR In Diabetic Nephropathy Patients And Its Mechanism

Objective:To investigate the effect of canagliflozin on urine albumin-to-creatinine ratio(UACR)in diabetic nephropathy patients and its mechanism.Methods:Clinical data of 83 cases of diabetic nephropathy treated in the department of endocrinology of our hospital from June 2018 to April 2019 were collected for retrospective analysis.According to the treatment method,the patients were divided into control group and observation group.The hypoglycemic regimen of the observation group(Can group)was: 100 mg of canagliflozin,1 time /d,1.0g of metformin,2 times /d,with diet and exercise intervention.The control group(Con group)was treated with metformin1.0g,2 times /d,diet and exercise intervention.The treatment period was 12 weeks.Gender,age,history of diabetes,blood pressure,complications,height and weight of patients at admission were recorded to obtain body mass index(BMI).Laboratory examination of relevant indicators before and after treatment,such as fasting blood glucose(FBG),glycosylated hemoglobin(HbAlc),serum creatinine(Scr),UACR,CRP,MLR,estimated glomerular filtration rate(eGFR),were collected from the two groups,and changes of indicators and correlation analysis before and after treatment were compared between the two groups.P<0.05 was considered statistically significant.Results: 1.There was no statistically significant difference in baseline data before treatment between the two groups(P>0.05).2.Comparison of indicators before and after treatment between the two groups: after 12 weeks of treatment,BMI,FBG and HbAlc in the two groups were lower than before,and the difference was statistically significant(P<0.05).In the Can group,SBP,UACR,CRP and MLR were decreased compared with those before,and the difference was statistically significant(P<0.05).3.Comparison of the difference between the two groups before and after treatment: the decrease of SBP,BMI,UACR,CRP and MLR in Can group after treatment was greater than that in Con group compared with that before treatment,and the difference was statistically significant(P < 0.05).4.Pearson correlation analysis revealed that UACR value was positively correlated with serum CRP(r-0.617,p-0.000)and MLR(r-0.588,p-0.000)levels in patients with diabetic nephropathy in the two groups.In the two groups of diabetic nephropathy patients,UACR value was used as the dependent variable,and BMI,SBP,DBP,HbAlc,FBG,CRP and MLR were used as independent variables to conduct multiple linear stepped-regression study.After 12 weeks of treatment with canagliflozin in the Can group,the degree of UACR reduction in patients with diabetic nephropathy was positively correlated with the degree of reduction in serum CRP(r-0.661,p-0.000)and MLR(r-0.529,p-0.000).Conclusions:Canagliflozin not only has the effects of lowering blood glucose,blood pressure and weight,but also can reduce UACR in patients with diabetic nephropathy.The latter mechanism may be related to the reduction of CRP and MLR.