钠-葡萄糖共转运蛋白2抑制剂与泌尿生殖系统感染

Urogenital system infections after treatment with sodium-glucose co-transporter 2 inhibitors

钠-葡萄糖共转运蛋白2(SGLT2)抑制剂是一种新型降血糖药物,通过选择性抑制肾脏近曲小管SGLT2活性、减少其对葡萄糖的重吸收而降低血糖。SGLT2抑制剂的主要安全性问题之一是因泌尿生殖道局部葡萄糖浓度增加而可能发生的泌尿生殖系统感染。达格列净、卡格列净、恩格列净和埃格列净治疗的患者泌尿系统感染发生率分别为4.4%~11.4%、4.9%~8.3%、5.0%~15.6%和3.2%~7.2%,生殖系统感染发生率分别为6.2%~13.0%、6.2%~13.4%、2.3%~9.5%和2.1%~10.0%。泌尿系统感染多表现为尿道炎、膀胱炎,常规抗感染治疗有效。生殖系统感染的致病菌多为念珠菌。女性多表现为外阴/阴道炎,少数为盆腔炎和生殖器疣,多发生在用药初始的4个月内;男性多表现为龟头炎和龟头包皮炎,少数为附睾睾丸炎和生殖器疣,多发生在用药的第1年内。发生泌尿生殖系统感染的患者经过治疗大多数很快痊愈,极少导致SGLT2抑制剂停药。但也有SGLT2抑制剂致严重生殖系统感染(如Fournier坏疽)的报道。使用SGLT2抑制剂治疗期间应加强对患者的监测和相关知识教育,尽量减少泌尿生殖系统感染的诱发因素,一旦发生感染应及时治疗。

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are new antihyperglycemics, which reduce blood glucose by selectively inhibiting the activity of SGLT2 and reducing the reabsorption of glucose in proximal convoluted tubules. One of the major safety problems of SGLT-2 inhibitors is the possibility of urogenital system infections due to increased local glucose levels in the urogenital tract. The incidences of urinary tract infections in patients with dapagliflozin, canagliflozin, empagliflozin, and ertugliflozin treatments were 4.4%-11.4%, 4.9%-8.3%, 5.0%-15.6%, and 3.2%-7.2%, respectively;and the incidences of genital infections were 6.2%-13.0%, 6.2%-13.4%, 2.3%-9.5%, and 2.1%-10.0%, respectively. The main manifestations of urinary tract infection are urethritis and cystitis and conventional anti-infection therapy are effective. Candida is the most common pathogen in reproductive system infections. The clinical features of reproductive system infections in most females are vulvovaginitis, in fewer females are pelvic inflammation and genital warts, which occur mostly within the first 4 months of medication;while the clinical features in most males are balanitis and balanoposthitis, in fewer males are epididymo-orchitis and genital warts, which mostly occur in the first year of medication. Urogenital system infections in most patients cure quickly after treatments, rarely leading to withdrawal of SGLT2 inhibitors. However, severe reproductive system infections (such as Fournier′s gangrene) caused by SGLT2 inhibitors have also been reported. During the treatment with SGLT2 inhibitors, it is necessary to strengthen patient monitoring and the education on related knowledge so as to minimize the inducing factors of urogenital system infections. Once an infection occurs, it should be treated timely.