钠-葡萄糖协同转运蛋白2抑制剂在非糖尿病慢性肾脏病患者中应用的研究进展

The Progress of Sodium-glucose Cotransporter 2 Inhibitors in Non-diabetic Patients with Chronic Kidney Disease

钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂是一种新型降糖药物。近年来临床研究发现SGLT2抑制剂对非糖尿病导致的慢性肾脏病(CKD)具有肾脏保护作用:在肾素-血管紧张素-醛固酮系统抑制剂基础上联合应用SGLT2抑制剂,可进一步降低IgA肾病、轻中度蛋白尿的局灶节段性肾小球硬化患者的尿蛋白水平,延缓CKD进展。根据临床试验结果,推测SGLT2抑制剂在非糖尿病CKD中应用的理论依据:促进葡萄糖排泄,促进钠和水的排泄,通过减少热量来减轻患者体重;改善肾小管-肾小球管球反馈,收缩肾小球入球小动脉,降低肾小球滤过压。现有的临床证据将有助于进一步探讨CKD的进展机制,特别是SGLT2在CKD进展中发挥的作用,将来可能成为非糖尿病CKD的一线治疗。

Sodium-glucose cotransporter 2(SGLT2)inhibitor is a new type of hypoglycemic drug.In recent years,clinical studies have found that SGLT2 inhibitors have renal protective effects on non-diabetic chronic kidney disease(CKD).For example,the combined application of SGLT2 inhibitors on the basis of renin angiotensin aldosterone system(RAAS)inhibitors can further reduce the proteinuria of IgA nephropathy and focal segmental glomerulosclerosis(FSGS)patients with mild to moderate proteinuria,and also delay the risk of CKD progression.According to the results of clinical trials,the theoretical basis for the application of SGLT2 inhibitors in non-diabetic CKD is speculated:promote glucose excretion,promote sodium and water excretion,reduce body weight by reducing calories;improve renal tubular-glomerular feedback,dilate the glomerular afferent arteriole and reduces the glomerular filtration pressure.The existing clinical evidence will help to further explore the progression mechanism of CKD,especially the role of SGLT2 in it,and will also provide new methods for the treatment of non-diabetic CKD.