钠-葡萄糖协同转运蛋白2抑制剂抗心律失常作用研究进展

The effect of sodium glucose cotransporter 2 inhibitors on arrhythmia:a review

钠-葡萄糖协同转运蛋白-2抑制剂(sodium-glucose cotransporter 2 inhibitors,SGLT2i)是一种新型的降糖药物,在临床实践中已得到广泛应用。近期多项临床研究表明,心力衰竭(简称心衰)患者在规范治疗基础上加用SGLT2i能够显著降低其心衰住院及心血管病死亡风险,且这一保护作用独立于SGLT2i的降糖作用。因此,国内外心衰诊疗指南及专家共识已将SGLT2i列为抗心衰药物治疗的I类推荐。近年来,研究者们致力于进一步探索SGLT2i在抗心律失常方面的作用。研究表明,SGLT2i具有降低心房颤动、室性心律失常和心脏性猝死发生风险的作用,其所涉及的抗心律失常作用机制包括逆转心房和心室电重构及结构重构、降低炎症反应及氧化应激、降低体重及心外膜脂肪组织体积、改善线粒体功能等。本文对SGLT2i抗心律失常作用及其相关潜在机制进行综述,期望为进一步开展深入研究及临床应用提供参考。

As a new type of antidiabetic drug,sodium-glucose cotransporter 2 inhibitors(SGLT2i)have been widely used in clinical practice.Recent studies have shown that the addition of SGLT2i to guideline-recommended therapy in patients with heart failure(HF)can significantly reduce the risk of hospitalization for HF or cardiovascular mortality,and this protective effect is independent of the glucose-lowering effect of SGLT2i.Therefore,many guidelines and expert consensus on the diagnosis and management of HF have listed SGLT2i as a Class I(A)recommendation.In recent years,researchers are committed to further exploring the role of SGLT2i in arrhythmia.Studies have shown that treatment with SGLT2i can reduce the incidence of atrial fibrillation,ventricular arrhythmias and sudden cardiac death.The possible mechanisms could include reversing the electrical or structural remodeling of atrial or ventricular structure,reducing the inflammatory reaction and oxidative stress,reducing the body weight and epicardial adipose tissue volume,and improving the function of the mitochondrion,etc.This article reviews the antiarrhythmic effects and related possible mechanisms of SGLT2i,with the hope of providing reference for further in-depth research and clinical application.