PDF(Pubmed)
Abstract：
Sodium-glucose transporter-2 (SGLT-2) inhibitors have emerged as novel oral glucose-lowering agents for type 2 diabetes. SGLT-2 inhibitors improve glycemic control by blocking sodium-glucose cotransport in the renal proximal tubules, thereby promoting glycosuria. In this review, it is discussed mechanistically how SGLT-2 inhibitors might be particularly relevant to use in patients with or at high risk for heart failure. On a daily base, SGLT-2 inhibitors block ~330-495 mEq sodium reabsorbed in the proximal tubules, although substantial amounts can be reabsorbed more distally in the nephron. Increased sodium offering to the distal nephron is sensed at the macula densa and may attenuate neurohumoral activation, thereby improving salt sensitivity, augmenting diuretic efficacy of loop and thiazide diuretics, and potentiating the native natriuretic peptide system. Whether the favorable profile offered by SGLT-2 inhibitors is renoprotective and whether SGLT-2 inhibition can relieve and/or prevent congestion beyond traditional diuretic drugs warrants further investigation.
摘要：
钠-葡萄糖转运蛋白-2（SGLT-2）抑制剂已成为2型糖尿病的新型口服降糖药。SGLT-2抑制剂通过阻断肾近端小管中的钠-葡萄糖共转运改善血糖控制,从而促进糖尿。在这次审查中,从机制上讨论了SGLT-2抑制剂如何与心力衰竭或心力衰竭高危患者的使用特别相关.在每天的基础上，SGLT-2抑制剂阻断~330-495mEq钠在近端小管重吸收，尽管大量的可以在肾单位更远端重新吸收。在黄斑处感觉到远端肾单位的钠供应增加，并可能减弱神经体液激活，从而提高盐的敏感性，增强loop和噻嗪类利尿剂的利尿功效，并增强天然利钠肽系统。SGLT-2抑制剂提供的有利概况是否具有肾脏保护作用，以及SGLT-2抑制剂是否可以缓解和/或预防传统利尿药以外的充血，值得进一步研究。
