钠-葡萄糖协同转运蛋白2抑制剂对射血分数保留型心力衰竭的治疗进展

Advance in sodium-glucose co-transporter 2 inhibitors in the treatment of heart failure with preserved ejection fraction

射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)的发病率高、预后差,不像射血分数降低型心力衰竭(heart failure with reduced ejection fraction,HFrEF)有明显改善预后的药物。钠-葡萄糖协同转运蛋白2抑制剂(sodium-glucose co-transporter 2 inhibitor,SGLT2i)最初被用于2型糖尿病的降糖治疗,但在心血管安全性评估中发现SGLT2i对糖尿病患者有降低心血管事件的获益。随后在无糖尿病的HFrEF患者中,数个大型随机对照研究均证实了SGLT2i降低HFrEF患者心衰再住院或心血管死亡的风险,这奠定了目前心力衰竭指南推荐SGLT2i作为治疗HFrEF的“四驾马车”之一的地位。但对于HFpEF,既往针对HFrEF改善预后的药物均未显示明显获益,直到EMPEROR-Preserved试验证实了恩格列净可显著降低HFpEF患者心血管死亡或心力衰竭住院的风险,是治疗HFpEF里程碑式的研究。近期的DELIVER也进一步证实达格列净对HFpEF有相似的获益。本文就SGLT2i在HFpEF中的治疗进展作一综述。

Heart failure with preserved ejection fraction(HFpEF)is characterized by the high incidence rate and poor prognosis.Unlike heart failure with reduced ejection fraction(HFrEF),it does not have a drug that can significantly improves the prognosis.Sodium-glucose co-transporter 2 inhibitor(SGLT2i)was initially used for the hypoglycemic treatment of type 2 diabetes,but it was found in the cardiovascular safety assessment that SGLT2i could reduce cardiovascular events in diabetes patients.Subsequently,in HFrEF patients without diabetes,several large randomized controlled studies confirmed that SGLT2i reduced the risk of readmission or cardiovascular death of HFrEF patients with heart failure,which established the status of SGLT2i as one of the“four carriages”for treating HFrEF in the current heart failure guidelines.However,for HFpEF,the drugs used to improve the prognosis of HFrEF did not show significant benefits until the EMPEROR-Preserved trial confirmed that Empagliflozin could significantly reduce the risk of cardiovascular death or hospitalization for heart failure in HFpEF patients,which is a landmark study in the treatment of HFpEF.The recent DELIVER also further confirmed that Dapagliflozin has similar benefits to HFpEF.This article reviews the treatment progress of SGLT2i in HFpEF.