Renoprotection Provided by Dipeptidyl Peptidase-4 Inhibitors in Combination with Angiotensin Receptor Blockers in Patients with Type 2 Diabetic Nephropathy / 中华医学杂志(英文版)

Background@#Treatment with the dipeptidyl peptidase-4 inhibitors (DPP4i) and angiotensin receptor blockers (ARBs) in patients with type 2 diabetic nephropathy (DN) has not been well characterized. This study aimed to assess the renoprotection of this combined treatment in DN patients.@*Methods@#A total of 159 type 2 DN patients from 2013 to 2015 were enrolled retrospectively from a prospective DN cohort at the National Clinical Research Center of Kidney Diseases, Jinling Hospital (China). Fifty-seven patients received DPP4i and ARB treatment, and 102 patients were treated with ARBs alone. All patients were followed up for at least 12 months. Statistical analyses were performed using Stata version 12.0.@*Results@#There were no significant differences at baseline for age, sex, body mass index, duration of diabetes, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), and estimated glomerular filtration rate (eGFR) between the two groups. Antihypertensive and antidiabetic medication use was similar in each group except calcium channel antagonists (P = 0.032). No significant changes in FBG and HbA1c were observed in the two groups after treatment. The eGFR decreased slower in the DPP4i + ARB group than in the ARB group at 12 months (Δ12 months: -2.48 ± 13.86 vs. -6.81 ± 12.52 ml·min·1.73m, P = 0.044). In addition, proteinuria was decreased further in the DPP4i + ARB group than in the ARB group after 24 months of treatment (Δ24 months: -0.18 [-1.00, 0.17] vs. 0.32 [-0.35, 0.88], P = 0.031). There were 36 patients with an eGFR decrease of more than 30% over 24 months. After adjusting for FBG, HbA1c, and other risk factors, DPP4i + ARB treatment was still associated with a reduced incidence of an eGFR decrease of 20% or 30%.@*Conclusions@#The combined treatment of DPP4i and ARBs is superior to ARBs alone, as evidenced by the greater proteinuria reduction and lower eGFR decline. In addition, the renoprotection of DPP4i combined with ARBs was independent of glycemic control.

Effect of low-frequency suprathreshold repetitive transcranial magnetic stimulation of the unaffected hemisphere on recovery of motor function in patients with acute stroke / 中华神经医学杂志

Objective To study the effect of low-frequency suprathreshold repetitive transcranial magnetic stimulation (rTMS) of the unaffected hemisphere on recovery of motor function in patients with acute stroke. Methods A total of 26 patients with middle cerebral artery territory infarction were randomly assigned to unaffected hemisphere stimulation group and control group (not receiving any stimulation,n=13).The patients in the stimulation group were treated with rTMS 3 to 5 d after the onset of symptoms with the frequency of 1 Hz and 70％ of the intensity (about 2.1T actual output) and the 1200 pulses per day for 10 consecutive d.The motor evoked potential (MEP) latency,central motor conduction time (CMCT),scores of National Institutes of Health Stroke Scale (NIHSS) and modified Barthel index (MBI) of the affected brain region were recorded on the 1 st of experiment (before the treatment),10 and 40 d after treatment. Results The scores of clinical futction scale and neuroelectrophysiologic parameters before treatment had no statistical significance between the 2 groups (P＞0.05).The scores of clinical function scale after the treatment in the 2 groups were obviously higher than those before treatment (P＜0.05). And the improvement of motor function in the unaffected hemisphere stimulation group was statistically obvious as compared with that in the control group (P＜0.05):the score of NIHSS and the MBI in the stimulation group were obviously higher than those in the control group (P＜0.05).The neuroelectricity physiological indexs in the 2 groups after treatment gained improvement in comparision to those before treatment:the MEP latency on the 40th d of treatment and CMCT on the 10th and 40th d of treatment in the unaffected hemisphere stimulation group was significantly different as compared with those before treatment (P＜0.05); the CMCT on the 10th and 40th d of treatment in the unaffected hemisphere stimulation group was shorter as compared with that in the control group. Conclusion The frequency of 1 Hz and 70％ of the intensity (about 2.1T actual output) in rTMS of the unaffected hemisphere can shorten CMCT and improve the motor function in patients with acute stroke.