SGLT2抑制剂对糖尿病心肌病心肌组织的直接作用机制研究进展

Direct mechanism of SGLT2 inhibitor on myocardial tissue in diabetic cardiomyopathy

自从糖尿病药物问世以来,少有药物对糖尿病心脏病(DCM)有明确的直接治疗的作用,其中大多数药物都是通过降低血糖来间接治疗DCM。钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)的上市改变了这一现状,是对糖尿病心肌病治疗空缺的极大补充。SGLT2i是一类新型的肾靶向药物,通过抑制SGLT2受体,减少原尿中葡萄糖的吸收,增加尿糖排泄,以非胰岛素依赖的方式降低血糖。大量实验证明SGLT2i同样具有明确的心血管益处,而且这些益处已经证明不能单一用一般心血管危险因素(血糖、血压或血管硬化)的减少和降低来解释,说明其在高糖环境中对心脏组织(包括心房肌、心室肌、心血管)应该具有直接靶向作用。本文将围绕SGLT2抑制剂对DCM心肌组织的直接作用机制进行综述。

Since the advent of diabetes drugs,few drugs have a clear direct treatment effect of diabetic cardio-myopathy(DCM),most of which are indirect treatment of DC by lowering blood glucose.The introduction of a sodi-umglucose cotransporter 2 inhibitor(SGLT2i)has changed this situation and is a significant complement to the treat-ment gap in diabetic cardiomyopathy.SGLT2i is a novel class of renal targeting drugs that reduces glucose uptake in pri-mary urine and increases urinary glucose excretion by inhibiting SGLT2 receptors,lowering blood glucose in a non-insu-lindependent manner.Numerous experiments have demonstrated that SGLT2i also has clear cardiovascular benefits,and that benefits have been shown not to be explained by a single reduction and lowering of general cardiovascular risk fac-tors(blood glucose,blood pressure or vascular sclerosis),suggesting that it should have direct targeting effects on cardi-ac tissue(including atrial muscle,ventricular muscle,and cardiovascular)in a high-glucose environment.This review will focus on the direct mechanism of SGLT2 inhibitors on myocardial tissue in diabetic cardiomyopathy.