钠-葡萄糖协同转运蛋白2抑制剂治疗糖尿病肾病的研究新进展

New progress of sodium-glucose cotransporter 2 inhibitors in the treatment of diabetic nephropathy

糖尿病肾病(DN)是糖尿病常见的微血管并发症,也是导致终末期肾病(ESRD)的主要病因之一,尽管采用了肾素-血管紧张素系统抑制剂等多种药物治疗,但DN往往持续进展,患者有很大的风险进展至ESRD。钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂是一类新型的治疗2型糖尿病(T2DM)的靶点药物,通过抑制肾小管葡萄糖的重吸收,增加尿糖排泄来降低血糖。最近一些关于T2DM患者的研究表明SGLT2抑制剂,除了降糖作用外,还具有心肾保护作用。尤其是在DN方面,可以通过多种途径减缓肾功能下降和减少尿白蛋白排泄,从而改善DN患者的预后。本文就近年来有关SGLT-2i在DN患者的肾脏保护作用及其机制的研究进展进行综述。

Diabetic nephropathy(DN)is a common and serious microvascular complication of diabetes mellitus,and it is the leading cause of end-stage renal disease(ESRD).Despite the use of various drugs such as renin-angiotensin system inhibitors,DN often continues to progress,and patients are at great risk of progressing to ESRD.Sodium-glucose cotransporter 2(SGLT2)inhibitors are a novel class of target drugs that have been extensively investigated in type 2 diabetes mellitus(T2DM).The inhibitors block sodium and glucose reabsorption in the renal proximal tubule,leading to glycosuria for the treatment of hyperglycemia.Recent large scale clinical trials in T2DM patients have shown that SGLT2 inhibitors exhibit cardiorenal protective propertiesin in addition to its hypoglycemic effects.Especially in the patients complicated with DN,SGLT2 inhibitors are found to protect renal function and reduce urinary albumin excretion through various mechanisms.Therefore,the latest studies have discovered that SGLT2 inhibitors can significantly improve the prognosis of patients with DN.This article reviews the recent progress on SGLT2 inhibitors for renal protective effects and mechanisms in DN.