钠-葡萄糖共转运蛋白2抑制剂心脏保护研究进展及指南推荐

Advances in cardioprotection research and guideline recommendations for sodium-glucose cotransporter 2 inhibitors

心力衰竭(HF)是所有心血管疾病的晚期阶段。目前的“金三角”治疗方案,虽然很大程度上降低了HF患者的住院率并提高了其生存率,但患者的整体预后仍较差。HF患者通常合并2型糖尿病(T2DM)、慢性肾脏病(CKD)等其他疾病,理想的HF治疗方案应该能兼顾改善原发、并发疾病。近年来的多项研究表明新型降糖药物钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)具有独立于降糖以外的心血管保护作用,可显著降低HF患者不良事件的发生风险。欧洲心脏病学会(ESC)发布的2021新版心HF治疗指南,把“金三角”方案,改为“新四联”方案,将SGLT2i正式纳入HF治疗基础药物。笔者就SGLT2i对心脏保护的相关研究及临床指南推荐等进行综述。

Heart failure(HF)is an advanced stage of all cardiovascular diseases.The current"Golden Triangle"treatment protocol has largely reduced hospitalization rates and improved survival in patients with HF,but the overall prognosis for patients remains poor.Patients with HF usually have a combination of other diseases such as type 2 diabetes mellitus(T2DM)and chronic kidney disease(CKD),and an ideal HF treatment plan should improve both primary and concurrent diseases.In recent years,several studies have shown that the new glucose-lowering drug sodium-glucose cotransporter 2 inhibitor(SGLT2i)has cardiovascular protective effects independent of glucose-lowering and can significantly reduce the risk of adverse events in patients with HF.The new 2021 edition of the European Society of Cardiology(ESC)guidelines for the treatment of cardiac HF has changed the"Golden Triangle"regimen to the"New Quadruple"regimen,and SGLT2i has been formally included as a basic drug for the treatment of HF.The author reviews the research and clinical guideline recommendations related to the cardiovascular benefits of SGLT2i.