钠-葡萄糖共转运体2抑制剂改善心力衰竭的研究进展

Progress in study on alleviation of heart failure with sodium-glucose cotransporter 2 inhibitors

当前诸多临床试验证明降糖新药钠葡萄糖共转运体2抑制剂(sodium-glucose cotransporter 2 inhibitors,SGLT-2i)具有改善2型糖尿病患者心力衰竭结局的作用,其改善心力衰竭除了抑制肾脏重吸收葡萄糖而改善代谢、降低体重外,还参与心血管系统活动调节,但这种作用包含的中枢机制目前还不完全明了。有研究提出SGLT-2i可能通过影响能量代谢和心血管中枢活动而调节心血管活动,是除了减少血容量外的一个重要机制。因此本文将进一步对心血管中枢的神经内分泌调节、SGLT-2i对该系统影响的相关机制进行以下方面的综述:(1)心血管机能的中枢神经系统调节;(2)中枢钠葡萄糖转运体(sodium glucose cotransporter,SGLT)的分布及作用;(3)SGLT-2i心血管获益的外周机制研究进展;(4)SGLT-2i对中枢的影响作用及机制研究进展。

Currently,clinical studies have revealed that the novel antidiabetic agent sodium-glucose cotranspotor 2 inhibitor(SGLT-2i)can improve the outcome of heart failure in patients with type 2 diabetes mellitus(T2DM).This drug have hypoglycemic effect mediated by inhibition of glucose reabsorption by kidney,which not only improves metabolism,reduces body weight,but also regulates activity of cardiovascular system.However,the pertinent central mechanism remains unclear.In recent years,some studies have proposed that SGLT-2i probably influences the neural energy metabolism and cardiovascular control beside blood volume depletion.This article reviews the neuroendocrine mechanisms of central cardiovascular control of SGLT-2i from the following aspects:(1)the central regulation of cardiovascular activity;(2)the central distribution and associated role of SGLT;(3)the peripheral mechanism of cardiovascular benefits of SGLT-2i;and(4)the central implication and mechanism of SGLT-2i.