Korisni efekti liraglutida na periferne krvne sudove
Sažetak
Uvod/Cilj. Makroangiopatija je glavni uzrok smrti i invalidnosti kod bolesnika sa dijabetesom tipa 2. Studije su pokazale da liraglutid, agonist glucagon-like peptide 1 (GLP-1) receptora, može zaštititi kardiovaskularni sistem inhibicijom hroničnog zapaljenja prouzrokovanog dijabetesom. Međutim, efekti liraglutida na periferne krvne sudove i leukocite u perifernoj krvi nisu opisani do sada. Cilj ovog rada bio je da se, pored hipoglikemijskog dejstva liraglutida, ispita i njegov vaskuloprotektivni efekat, kao i mehanizam tog dejstva. Metode. U studiju je bilo uključeno 60 bolesnika sa dijabetesom tipa 2 hospitalizovanih od decembra 2013. do decembra 2014. godine u Prvoj bolnici Medicinskog univerziteta Dalian iz Kine. Pre početka terapije liraglutidom, svim bolesnicima su izmerene visina i telesna masa da bi se izračunao indeks telesne mase (ITM). Takođe, određene su i vrednosti uree u krvi (BUN) i drugi biohemijski parametri. Izračunate su vrednosti HOMA-IR (Homeostasis model assessment of insulin resistance) i HOMA-β (Homeostasis model assessment of islet β cell function) indeksa. Posle tri meseca primene liraglutida, ponovo su određeni svi indeksi. Efekti liraglutida na te indekse analizirani su t-testom zavisnih uzoraka. Rezultati. Posle tromesečnog lečenja liraglutidom, vrednosti glikoziliranog hemoglobina A1c ‒ HbA1c (8,46 ± 1,62% vs. 7,26 ± 1,40%) i nivoa glukoze u krvi 2 časa posle obroka (2hPBG) (11,95 mmol/L vs. 9,6 mmol/L) značajno su se smanjili (p < 0,05). Telesna masa (87,3 kg vs. 82,5 kg) i ITM (30,37 kg/m2 vs. 28,63 kg/m2) smanjili su se 5,5%, odnosno 5,7% (p < 0,05). Nivoi triglicerida (2,57 ± 1,54 mmol/L vs. 1,81 ± 0,70 mmol/L) i LDL-holesterola (2,92 ± 0,78 mmol/L vs. 1,89 ± 0,66 mmol/L) takođe su se značajno smanjili (p <0,05). Ankle-brachial index (ABI) smanjio se sa 1,24 ± 0,10 cm/s na 1,14 ± 0,06 cm/s ili za 8%, a brachial-ankle pulse wave velocity (ba-PWV) sa 1 442,15 ± 196,26 cm/s na 1 316,85 ± 146,63 cm/s ili za 8,7%, što je u oba slučaja bilo statistički značajno smanjenje (p <0,001). Zaključak. Liraglutid, sa dobrim hipoglikemijskim efektom, može značajno smanjiti nivo glukoze u krvi nakon obroka i vrednost HbA1c, ali ne utiče značajno na nivo glukoze u plazmi natašte, insulinsku rezistenciju i funkciju β ćelija Langerhansovih ostrvaca pankreasa. Takođe, lek značajno smanjuje telesnu masu, ITM i nivo triglicerida kao i vrednosti ba-PWV i ABI, pokazatelje zaštite perifernih krvnih sudova.
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