糖尿病视网膜病变(DR)是一类常见的糖尿病微血管并发症,其发病机制目前尚未完全明确。钠-葡萄糖共转运蛋白(SGLT)是一类调控葡萄糖运输的跨膜蛋白家族,既往研究在视网膜内发现其家族成员SGLT1和SGLT2的表达,提示SGLT对DR发病具有潜在影响。SGLT2介导视网膜周细胞的异常钠依赖性葡萄糖摄取,可能参与了DR早期的微血管病变过程,而SGLT抑制剂可减少高血糖引起的视网膜细胞形态及功能损伤,可能对DR有治疗作用。近期研究发现,编码SGLT2的 SLC5A2基因多态性与DR发生风险存在相关性。SGLT2抑制剂目前在临床上用于治疗2型糖尿病,其有助于预防继发的心血管和肾脏相关病变,但关于其在DR疗效方面的研究较少。现有研究结果提示,SGLT2抑制剂对DR具有治疗作用,可能是通过控制DR相关的危险因素、保护视网膜微血管系统、减轻神经相关视网膜病变等机制实现的。本文就SGLT对DR发病的影响、SGLT2抑制剂在预防和治疗DR方面的最新研究进展以及可能的保护机制进行综述。
Diabetic retinopathy (DR) is a common type of diabetic microvascular complications.Its pathogenesis has not been clarified yet.Sodium-glucose cotransporter (SGLT) is a family of transmembrane proteins that regulate glucose transport.Previous studies have found the expression of its family members SGLT1 and SGLT2 in the retina, suggesting SGLT have a potential impact on the occurrence of DR.The abnormal sodium-dependent glucose uptake of retinal pericytes mediated by SGLT2 may be involved in the early microangiopathy process of DR, while SGLT inhibitors can weaken the morphological and functional impairment of retinal cells caused by hyperglycemia and therefore potentially manage DR.A recent study has found that the polymorphism of the SLC5A2 gene encoding SGLT2 is associated with the risk of DR occurrence.SGLT2 inhibitors are currently used in the treatment of type 2 diabetes mellitus, and have been found to help prevent secondary cardiovascular and renal diseases.However, there are few studies on the efficacy of SGLT2 inhibitors in DR.Current research results suggest that SGLT2 inhibitors have a protective effect on DR, which may be achieved through mechanisms such as controlling DR-related risk factors, protecting the retinal microvascular system and alleviating nerve-related retinopathy.This review summarizes the effects of SGLT on the pathogenesis of DR, the latest research progress of SGLT2 inhibitors studies on prevention and treatment of DR as well as possible protective mechanisms.
陈姝历,邹海东. 钠-葡萄糖共转运蛋白及其抑制剂对DR的影响研究进展[J]. 中华实验眼科杂志,2024,42(08):744-749.
DOI:10.3760/cma.j.cn115989-20210325-00206版权归中华医学会所有。
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