二甲双胍与心力衰竭

Metformin and Heart Failure

二甲双胍因其良好的降糖作用使其成为一线降糖药物,同时一系列研究揭示其具有其他传统降糖药物所无法比拟的心血管保护作用。尤其是在一贯认为二甲双胍的使用禁忌证心力衰竭中,它并没有增加乳酸酸中毒的风险,可以预防糖尿病患者心力衰竭的发生,降低心力衰竭相关死亡及再住院风险,重要的是延长心力衰竭患者2年生存率。它的抗心力衰竭作用与其提高心肌细胞膜葡萄糖转运蛋白1和葡萄糖转运蛋白4的产生,降低脂肪酸的过氧化作用有关,更主要与腺苷环磷酸蛋白激酶的激活有关。因此,鉴于二甲双胍在心力衰竭中使用的安全性,使其在心血管疾病中的广泛应用具有深远意义。

Metformin has become a cornerstone in the treatment regime for type 2 diabetes mellitus because of its ability to control the amount of glucose in the blood. A series of studies have shown that it also confers greater cardiovascular protection than traditional antidiabetic agents. Other studies showed that there was a risk of heart failure （HF） due to metformin-associated lactic acidosis. More recent evidence, however, has shown no corresponding increase in the incidence of metformin-associated lactic acidosis. Indeed, studies have demonstrated that metformin may even reduce the risk of HF and mortality in diabetic patients. Its cardioprotective actions are connected to an increase of glucose transporter GLUT1 and GLUT4 production in heart cells, and inhibiting fatty acid oxidation. Importantly, the pleiotrophic actions of metforr0in are thought to be mediated by the activation of AMP-activated protein kinase （ AMPK ）. Based on these findings, the cardioprotec- rive nature of metformin has clinical implications and may encourage its widespread use in cardiovascular diseases.