钠-葡萄糖共转运体2抑制剂在糖尿病肾病中的应用

Application of sodium-glucose cotransporter 2 inhibitors in diabetic nephropathy

目前降糖药物并不足以延缓糖尿病肾病的进展,既能有效控制血糖、又能保护肾脏的降糖药物值得研发。在糖尿病肾病动物模型中,常规剂量钠-葡萄糖共转运体2(SGLT-2)抑制剂可通过降低肾小球高滤过,改善肾小球、肾小管及肾间质纤维化,抑制炎症反应和氧化应激反应,起到保护肾脏的作用。临床研究显示,SGLT-2抑制剂可降低糖尿病肾病患者的尿蛋白、延缓肾小球滤过率的下降,但已上市的SGLT-2抑制剂肾脏事件风险有所不同。SGLT-2抑制剂对肾脏的确切保护作用及其机制仍需进一步研究探讨,目前几项相关大型随机对照试验正在进行中。

At present, hypoglycemic drugs are not enough to delay the progress of diabetic nephropathy（ DN）. So it is urged to develop novel drugs to control the blood glucose with renal protection. In DN animal models, conventional dose of sodium-glucose cotransporter（ SGLT-2） inhibitors have been demonstrated to protect the kidneys by reducing glomerular hyperfiltration, improving glomerular, renal tubular and renal interstitial fibrosis, and inhibiting inflammatory and oxidative stress responses. Clinical studies have shown that SGLT-2 inhibitors can ameliorate albuminuria and put off the decline of glomerular filtration rate in patients with DN. However, renal event risks are different in listed SGLT-2 inhibitors. The exact renoprotection of SGLT-2 inhibitors and its mechanism still need further study. Fortunately, several related large-scale randomized controlled trial are underway.