Динаміка метаболічних параметрів та вмісту VEGF в сироватці крові хворих на діабетичну хворобу нирок під впливом комплексної нефропротекторної терапії

Abstract

The goal of many studies around the world is to find preventive agents that may slow the progression of diabetic nephropathy in patients with type 2 diabetes mellitus at different stages of the disease, accordingly to preventing the progression of chronic kidney disease. The purpose of the work was to study the effect of complex nephroprotective therapy with the use of an inhibitor of the sodium glucose co-transporter 2 and spathogenetic therapy on metabolic parameters and the level of vasculoendothelial growth factor in blood serum of diabetic nephropathy patients at different stages of the disease. Materials and methods. 78 patients with type 2 diabetes mellitus were examined. Depending on the presence of albuminuria and glomerular filtration rate level, patients with diabetes mellitus were divided into the following groups: group I – patients with type 2 diabetes mellitus with normal glomerular filtration rate and albuminuria (n=62), group II – patients with type 2 diabetes mellitus with decreased glomerular filtration rate and albuminuria (n=16). The concentration of the vasculoendothelial growth factor was determined by enzyme-linked immunosorbent assay before and after 12 months of pathogenetic therapy. The glomerular filtration rate was calculated using the CKD EPI formula (KDIGO 2012). Patients of the first cohort received basic therapy, which included: blockers of the renin-angiotensin-aldosterone system, a coenzyme A reductase inhibitor and metformin, patients of the second cohort additionally received a sodium glucose co-transporter 2 inhibitor. Results and discussion. A decrease in vasculoendothelial growth factor levels in blood serum was found in all groups of examined patients, both under the influence of standard nephroprotective therapy, and with the use of complex treatment with an additional prescription of the sodium glucose co-transporter 2 inhibitor dapagliflozin. The highest level of response to treatment was observed in the group with the early stages of nephropathy. The therapy led to a significant improvement in the lipid spectrum of blood serum (increase of high-density lipoprotein cholesterol, decrease of total cholesterol, triglycerides and low-density lipoproteins) in all study groups. Conclusion. A decrease in serum vasculoendothelial growth factor levels against the background of an improvement in the basic clinical and laboratory parameters indicates not only an improvement kidneys function, but also a decrease in cardiovascular risk in this category of patients. The results of investigation indicate the feasibility of practical use of study vasculoendothelial growth factor serum level of diabetic nephropathy patients as an early diagnostic marker of cardiac disorders, prognosis assessment and improvement of the cardionephroprotective strategy