钠-葡萄糖共转运蛋白2抑制剂治疗心力衰竭的研究进展

Research progress on the treatment of heart failure with sodium-glucose cotransporter 2 inhibitors

心力衰竭(heart failure,HF)是心血管疾病的晚期表现和终末期阶段,具有较高的患病率、病死率,患者因反复住院、活动耐力下降而严重影响生活质量。钠-葡萄糖共转运蛋白2(sodium-glucose cotransporter 2,SGLT2)抑制剂是一种通过抑制肾小管上皮细胞SGLT2的降血糖药物,其通过降低血容量、减轻心脏负荷,改善心脏能量代谢、抑制心室重塑,改善心脏微血管、保护血管内皮功能,抑制心脏钠转运蛋白,增加红细胞压积和血红蛋白,维持线粒体自噬平衡等机制改善HF患者的症状,降低心血管死亡风险和再住院率。SGLT2抑制剂在治疗HF时有良好的心血管获益及安全性,但因SGLT2抑制剂的长期使用时安全性不明,所以临床医师在使用过程中应需密切观察,及时发现一些隐匿的不良反应,避免不良事件发生。

Heart failure(HF)is a late manifestation and end-stage phase of cardiovascular disease,characterized by high prevalence and mortality rates.Patients with HF experience repeated hospitalizations and a decline in activity tolerance,severely affecting their quality of life.Sodium-glucose cotransporter 2(SGLT2)inhibitors are a class of antidiabetic drugs that lower blood glucose levels by inhibiting SGLT2 in the renal tubular epithelial cells.These inhibitors have shown promising cardiovascular benefits and safety in the treatment of HF.They achieve this by reducing blood volume,alleviating cardiac workload,improving cardiac energy metabolism,inhibiting ventricular remodelling,enhancing cardiac microvascular function,protecting vascular endothelial function,inhibiting cardiac sodium transport proteins,increasing haematocrit and haemoglobin,and maintaining mitochondrial autophagy homeostasis.SGLT2 inhibitors improve symptoms in HF patients,reduce the risk of cardiovascular death,and decrease the rate of rehospitalization.While SGLT2 inhibitors have good cardiovascular benefits and safety in the treatment of HF,their longterm safety profile remains unclear.Therefore,clinicians should closely monitor patients during SGLT2 inhibitor use to promptly detect potential adverse reactions and avoid adverse events.