 導(dǎo)語 鈉-葡萄糖轉(zhuǎn)運(yùn)蛋白2抑制劑(SGLT2i)是一種新型的抗高血糖藥物(AHAs)，它能抑制腎近曲小管中葡萄糖和鈉的再吸收。 作者：沿若 來源：醫(yī)學(xué)論壇網(wǎng)心血管 鈉-葡萄糖轉(zhuǎn)運(yùn)蛋白2抑制劑(SGLT2i)是一種新型的抗高血糖藥物(AHAs)，它能抑制腎近曲小管中葡萄糖和鈉的再吸收。這些藥物導(dǎo)致葡萄糖和鈉的尿路排泄，可以使循環(huán)糖化血紅蛋白A1c降低≈0.7-1%；血壓降低≈5/2mm?Hg；體重減低≈2到3公斤；通過減少腎小球內(nèi)的壓力蛋白尿減少≈30 - 40%；和良好的代謝影響作用。
若干該類藥物用于2型糖尿病(T2DM)患者和非糖尿病患者的試驗(yàn)正在進(jìn)行，旨在觀測此類藥物對(duì)比常規(guī)用藥對(duì)于心血管(CV)臨床結(jié)果和安全性的差異。其中兩項(xiàng)針對(duì)T2DM和高CV風(fēng)險(xiǎn)因素患者的試驗(yàn)，報(bào)道顯示使用此類藥物可減少主要不良心血管事件(MACE)，特別是CV復(fù)合死亡率、非致命性心肌梗死(MI)和非致命性卒中，以及對(duì)降低心力衰竭(HHF)住院率有特別有益。
研究人員猜測HHF的獲益與MACE獲益比例不同，部分原因可能是血漿體積收縮和體重減輕的原因。同樣，在常規(guī)的臨床實(shí)踐中，使用這些藥物可以降低全因死亡率(ACM)和HHF的風(fēng)險(xiǎn)。然而，使用SGLT2i可能會(huì)導(dǎo)致潛在的傷害，報(bào)告顯示可能增加泌尿生殖系統(tǒng)感染、糖尿病酮癥酸中毒、急性腎損傷、骨折和膝關(guān)節(jié)下肢截肢(BKA)風(fēng)險(xiǎn)。
后發(fā)并發(fā)癥是一種較少見但嚴(yán)重進(jìn)展性疾病的臨床表現(xiàn)，伴有大量相關(guān)的發(fā)病率，但這一結(jié)果的可靠數(shù)據(jù)很少。鑒于試驗(yàn)可能招收可選擇的患者基數(shù)的限制和持續(xù)時(shí)間有差異，可能會(huì)影響試驗(yàn)個(gè)體臨床終點(diǎn)的收集和安全性問題。為了尋找鈉-葡萄糖轉(zhuǎn)運(yùn)蛋白2抑制劑(SGLT2i)在臨床應(yīng)用中的證據(jù)，本次隊(duì)列研究以大量人群為基礎(chǔ)，旨在評(píng)估針對(duì)T2DM和高CV風(fēng)險(xiǎn)因素患者使用SGLT2i是否與降低心血管事件風(fēng)險(xiǎn)，增加BKA風(fēng)險(xiǎn)有關(guān)。
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