钠-葡萄糖共转运蛋白2抑制剂相关心血管获益机制的研究进展

Novel Advances in the Mechanism of Cardiovascular Benefit of Sodium-glucose Co-transporter 2 Inhibitors

钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)是一类新型的口服降糖药,其通过抑制钠-葡萄糖共转运蛋白2(SGLT-2)而降低肾糖阈,促进尿葡萄糖排泄,进而达到降低血液循环中葡萄糖水平的作用。目前美国食品药品监督管理局(FDA)批准的用于治疗2型糖尿病的SGLT2i有卡格列净、恩格列净、达格列净等。在最近结束的大型临床试验中,SGLT2i除具有降低血糖作用外,均显示出明显的心脏和肾脏保护作用。这些临床试验的亚组分析显示,SGLT2i可以显著延缓肾脏病的进展及降低心力衰竭的再住院率。本文总结了SGLT2i心血管方面最新的临床试验及动物实验,旨在对SGLT2i的心血管获益机制进行探讨,以期指导SGLT2i在心血管疾病尤其是心力衰竭患者中的进一步应用,改善患者的临床预后。

Sodium-glucose co-transporter 2 inhibitors(SGLT2i),a new class of drugs approved for the treatment of diabetes,which lower the renal glucose threshold via inhibiting SGLT-2,and promote urinary glucose excretion,thus reducing the level of glucose in the plasma.Currently,FDA-approved SGLT2i for diabetes include canagliflozin,empagliflozin,dapagliflozin and so on.Several recently completed large clinical trials have demonstrated that SGLT2i have cardioprotective and renoprotective effects besides hypoglycemic effect.Subgroup analysis from these trials indicated a significant reduction in the progression of nephropathy and the readmission rate of heart failure with SGLT2i.This article explores the mechanism of cardiovascular befits of SGLT2i by reviewing the latest relevant human clinical trials and animal experiments,aiming to provide guidance for further application of SGLT2i in treating cardiovascular disease,especially heart failure,to improve the prognosis of such patients.