SGLT2抑制剂达格列净在心血管疾病中的应用进展

盛晓生 曹聪聪 蒋李珍 吴丽娟 王小兵

[摘要] 糖尿病与心血管疾病关系密切，治疗糖尿病的药物对心血管预后也有不同的影响。SGLT2抑制剂达格列净是治疗2型糖尿病的新药，目前有较多研究显示其能明显降低心血管风险事件的发生，特别是能明显改善糖尿病伴心力衰竭患者的临床症状、减少住院率和死亡率，还能改善心肌缺血、抑制心肌重塑、降低血压、减轻体重，对血脂、尿酸等均有不同程度的影响。达格列净对心血管系统作用是多方面的，获益也是多方面的，有望成为治疗糖尿病伴心血管疾病的理想药物。

[关键词] SGLT2抑制剂;达格列净;心血管;2型糖尿病

[中图分类号] R541.6          [文献标识码] A          [文章编号] 1673-9701（2021）24-0188-05

Progress in application of SGLT2 inhibitor Dapagliflozin in cardiovascular diseases

SHENG Xiaosheng1   CAO Congcong1   JIANG Lizhen1   WU Lijuan2   WANG Xiaobing3

1.Department of Cardiology，Jinhua People′s Hospital in Zhejiang Province， Jinhua  321000， China; 2.Xinshi Street Community Service Centre， Jinhua   321000， China; 3.Department of Medical Sciences， Jinhua Polytechnic， Jinghua   321000， China

[Abstract] Diabetes is closely related to cardiovascular disease， and the drugs for treating diabetes also have different effects on cardiovascular prognosis. SGLT2 inhibitor dapagliflozin is a new drug for the treatment of type 2 diabetes mellitus. There are many studies showing that it can significantly reduce the occurrence of cardiovascular risk events. In particular， it can significantly improve the clinical symptoms， reduce hospitalization rate and mortality of patients with diabetes and heart failure. Dapagliflozin can not only decrease myocardial ischemia and prevent myocardial remodeling but also lower blood pressure or reduce body weight.It has varying degrees influence on blood lipids and serum uric acid. Dapagliflozin has many effects and benefits on cardiovascular system. It is expected to be an ideal drug for the treatment of diabetes mellitus with cardiovascular disease.

[Key words] SGLT2 inhibitor; Dapagliflozin; Cardiovascular; Type 2 diabetes

1980年以來，全球2型糖尿病的发病率和患病率增长了3倍，并且在不断升级。糖尿病和心血管疾病关系密切，其中冠状动脉疾病（Coronary artery disease，CAD），心力衰竭（Heart failure，HF）和中风是2型糖尿病患者死亡和致残的主要原因。有报道糖尿病患者70%～80%死于心血管并发症[1]。因而联合治疗2型糖尿病和心血管疾病，合理使用对糖尿病和心血管均获益的药物治疗变得越来越重要。

达格列净是一种钠-葡萄糖协同转运蛋白 2抑制剂（sodium-glucose cotransporter 2 inhibitor，SGLT2i），通过抑制肾小管的SGLT2受体，减少肾小管对葡萄糖的重吸收，增加尿液中葡萄糖的排泄，从而降低血浆中葡萄糖的水平。虽然SGLT2i是一种治疗糖尿病药物，但近来较多研究发现，SGLT2抑制剂能降低心血管风险事件发生，在大型临床试验（EMPA-REG OUTCOME，CANVAS Program和 DECLARE-TIMI 58）中，SGLT2 抑制剂已显示可改善长期临床结果，包括T2DM（2型糖尿病，type 2 diabetes mellitus）的全因死亡率，心血管死亡和心力衰竭住院治疗[2-3]，因而本文就达格列净在心血管获益方面作一讨论。……