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ENGLISH ABSTRACT
重视钠-葡萄糖共转运蛋白2抑制剂相关肾损伤的防范与监管
纪立伟
作者及单位信息
·
DOI： 10.3760/cma.j.cn114015-20240528-00368
Pay attention to the prevention and supervision of kidney injury related to sodium-glucose transporter 2 inhibitors
Ji Liwei
Authors Info & Affiliations
Ji Liwei
Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Drug Clinical Risk and Personalized Medication Evaluation, Beijing 100730, China
·
DOI： 10.3760/cma.j.cn114015-20240528-00368
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摘要

钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）是目前临床使用广泛的一类降糖药，因其独特的降糖机制和显著的心肾保护作用，成为2型糖尿病治疗的核心药物之一。但近年来发现SGLT2i可导致部分患者血肌酐和尿素氮增高，相关肾损伤的风险逐渐引起临床的关注。如何在充分发挥其治疗优势的同时，有效防范和监管其潜在的肾损伤风险，成为当前临床实践和药物安全管理的重要课题。临床需采取多维度防范与监管策略，如基于最新证据识别高危人群、严格筛选治疗人群、动态监测肾功能及优化联合用药方案、借助生物标志物与人工智能工具实现风险预警。

钠-葡萄糖共转运蛋白2抑制剂;急性肾损伤;糖尿病，2型;心力衰竭;慢性肾脏病;药物警戒;人工智能
ABSTRACT

Sodium-glucose transporter 2 inhibitors (SGLT2i) are currently widely used as a class of hypoglycemic drugs. Due to their unique hypoglycemic mechanism and significant cardio-renal protective effect, SGLT2i have become one of the core drugs in the treatment of type 2 diabetes mellitus. However, in recent years, it has been found that SGLT2i can lead to increased serum creatinine and urea nitrogen in some patients, and the risk of kidney injury has gradually attracted clinical attention. How to effectively prevent and supervise the potential renal injury risk while giving full play to its therapeutic advantages has become an important topic in current clinical practice and drug safety management. Multi-dimensional prevention and supervision strategies should be adopted in clinical practice such as identifying high-risk populations based on the latest evidence, strictly screening patients, dynamically monitoring renal function, optimizing combination medication regimens, and achieving risk warning using biomarkers and artificial intelligence tools.

Sodium-glucose transporter 2 inhibitors;Acute kidney injury;Dibabetes mellitus, type 2;Heart failure;Chronic kidney disease;Pharmacovigilance;Artificial intelligence
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引用本文

纪立伟. 重视钠-葡萄糖共转运蛋白2抑制剂相关肾损伤的防范与监管[J]. 药物不良反应杂志,2025,27(03)：142-146.

DOI:10.3760/cma.j.cn114015-20240528-00368

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钠-葡萄糖共转运蛋白2抑制剂（sodium-glucose transporter 2 inhibitors，SGLT2i）作为一类新型的口服降糖药，通过抑制位于肾脏近曲小管的钠-葡萄糖共转运蛋白2的表达而抑制近曲小管对葡萄糖的重吸收，增加尿糖排泄，从而降低血糖。SGLT2i的心血管与肾脏保护作用已获多项临床研究证实 [ 1 , 2 , 3 ]。然而，随着SGLT2i在临床应用日益广泛，适应证扩展至非糖尿病患者群，如用于对慢性肾脏病（chronic kidney disease，CKD）及心力衰竭患者的治疗，其肾损伤风险引发关注。自美国食品药品管理局（Food and Drug Administration，FDA）2016年发布卡格列净/达格列净相关急性肾损伤（acute kidney injury，AKI）的警示后，SGLT2i相关肾损伤的临床研究和病例报告增多 [ 4 , 5 , 6 , 7 , 8 ]。如何在充分发挥其治疗优势的同时，有效防范和监管潜在的肾损伤风险，成为当前SGLT2i临床实践和药物安全管理的重要课题。
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参考文献
[1]
Wanner C , Inzucchi SE , Lachin JM ,et al. Empagliflozin and progression of kidney disease in type 2 diabetes[J]. N Engl J Med, 2016,375(4):323-334. DOI: 10.1056/NEJMoa1515920 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Neal B , Perkovic V , Mahaffey KW ,et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes[J]. N Engl J Med, 2017,377(7):644-657. DOI: 10.1056/NEJMoa1611925 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Heerspink H , Stefansson BV , Correa-Rotter R ,et al. Dapagliflozin in patients with chronic kidney disease[J]. N Engl J Med, 2020,383(15):1436-1446. DOI: 10.1056/NEJMoa2024816 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Katsuhara Y , Ogawa T . Acute renal failure, ketoacidosis, and urogenital tract infections with SGLT2 inhibitors: signal detection using a Japanese Spontaneous Reporting Database[J]. Clin Drug Investig, 2020,40(7):645-652. DOI: 10.1007/s40261-020-00925-3 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Rampersad C , Kraut E , Whitlock RH ,et al. Acute kidney injury events in patients with type 2 diabetes using SGLT2 inhibitors versus other glucose-lowering drugs: a retrospective cohort study[J]. Am J Kidney Dis, 2020,76(4):471-479. DOI: 10.1053/j.ajkd.2020.03.019 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Iskander C , Cherney D , Clemens KK ,et al. Use of sodium-glucose cotransporter-2 inhibitors and risk of acute kidney injury in older adults with diabetes: a population-based cohort study[J]. CMAJ, 2020,192(14):E351-E360. DOI: 10.1503/cmaj.191283 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
卢珊,李立,王声祥,等. 达格列净致急性肾损伤1例[J]. 中南药学, 2022,20(3):712-714. DOI: 10.7539/j.issn.1672-2981.2022.03.043 .
返回引文位置Google Scholar
百度学术
万方数据
Lu S , Li L , Wang SX ,et al. Daglizin induced acute kidney injury: a case report[J]. Central South Pharmacy, 2022,20(3):712-714. DOI: 10.7539/j.issn.1672-2981.2022.03.043 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[8]
邓翠雯,孙俊生. 达格列净致急性肾损伤合并大肠埃希菌尿路感染1例[J]. 中华全科医师杂志, 2022,21(12):1187-1188. DOI: 10.3760/cma.j.cn114798-20220515-00484 .
返回引文位置Google Scholar
百度学术
万方数据
Deng CW , Sun JS . A case of dapagliflozin-induce d acute kidney injury complicated with Escherichia coli urinary tract infection [J]. Chin J Gen Pract, 2022,21(12):1187-1188. DOI: 10.3760/cma.j.cn114798-20220515-00484 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[9]
中华医学会糖尿病学分会. 中国2型糖尿病防治指南（2020年版）[J]. 中华糖尿病杂志, 2021,13(4):315-409. DOI: 10.3760/cma.j.cn115791-20210221-00095 .
返回引文位置Google Scholar
百度学术
万方数据
Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)[J]. Chin J Diabetes Mellitus, 2021,13(4):315-409. DOI: 10.3760/cma.j.cn115791-20210221-00095 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[10]
Heidenreich PA , Bozkurt B , Aguilar D ,et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. J Am Coll Cardiol, 2022,79(17):1757-1780. DOI: 10.1016/j.jacc.2021.12.011 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
中华医学会心血管病学分会,中国医师协会心血管内科医师分会,中国医师协会心力衰竭专业委员会,等. 中国心力衰竭诊断和治疗指南2024[J]. 中华心血管病杂志, 2024,52(3):235-275. DOI: 10.3760/cma.j.cn112148-20231101-00405 .
返回引文位置Google Scholar
百度学术
万方数据
Chinese Society of Cardiology,Chinese Medical Association Chinese College of Cardiovascular Physician,Chinese Heart Failure Association of Chinese Medical Doctor Association,et al. Chinese guidelines for the diagnosis and treatment of heart failure 2024[J]. Chin J Cardiol, 2024,52(3):235-275. DOI: 10.3760/cma.j.cn112148-20231101-00405 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[12]
Agarwal A , Zeng X , Li S ,et al. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors for adults with chronic kidney disease: a clinical practice guideline[J]. BMJ, 2024,387:e080257. DOI: 10.1136/bmj.q2605 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA strengthens kidney warnings for diabetes medicines canaglifozin (Invokana, Invokamet) and dapaglifozin (Farxiga, Xigduo XR)[EB/OL]. ( 2016-06-14) [2024-05-03]. https://www.fda.gov/drugs/drugsafety/ucm505860.htm.
返回引文位置Google Scholar
百度学术
万方数据
[14]
国家药品监督管理局. 欧盟拟采取措施降低SGLT2抑制剂的 酮症酸中毒风险 [EB/OL].( 2016-06-14)[2024-05-03]. https://www.nmpa.gov.cn/xxgk/yjjsh/ywjjkx/20160420163801199.html.
返回引文位置Google Scholar
百度学术
万方数据
National Medical Products Administration. The EU proposes measures to reduce the risk of ketoacidosis from SGLT2 inhibitors[EB/OL]. ( 2016-06-14) [2024-05-03]. https://www.nmpa.gov.cn/xxgk/yjjsh/ywjjkx/20160420163801199.html.
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[15]
Health Canada. Sodium-glucose cotransporter-2 (SGLT2) inhibitors: Invokana (canagliflozin), Invokamet (canagliflozin/metformin), Forxiga (dapagliflozin), Xigduo (dapagliflozin/metformin), Jardiance (empagliflozin) and Synjardy (empagliflozin/metformin)[EB/OL]. ( 2024-08-21) [2025-02-03]. https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/health-product-infowatch/august-2024.html#a2_b3.
返回引文位置Google Scholar
百度学术
万方数据
[16]
方振威,石佳,石秀锦,等. 钠-葡萄糖共转运蛋白2抑制剂致急性肾损伤风险：基于美国FDA不良事件报告系统相关数据的研究[J]. 药物不良反应杂志, 2019,21(3):190-197. DOI: 10.3760/cma.j.issn.1008-5734.2019.03.006 .
返回引文位置Google Scholar
百度学术
万方数据
Fang ZW , Shi J , Shi XJ ,et al. Risks of acute kidney injury due to sodium glucose co-transporter 2 inhibitors: a study based on the related data in the US Food and Drug Administration Adverse Event Reporting System[J]. ADRJ, 2019,21(3):190-197. DOI: 10.3760/cma.j.issn.1008-5734.2019.03.006 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[17]
Frent I , Leucuta D , Bucsa C ,et al. A description of acute renal failure and nephrolithiasis associated with sodium-glucose co-transporter 2 inhibitor use: a VigiBase study[J]. Front Pharmacol, 2022,13(8):925805. DOI: 10.3389/fphar.2022.925805 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Horii T , Oikawa Y , Kunisada N ,et al. Acute kidney injury in Japanese type 2 diabetes patients receiving sodium-glucose cotransporter 2 inhibitors: a nationwide cohort study[J]. J Diabetes Investig, 2022,13(1):42-46. DOI: 10.1111/jdi.13630 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Bjornstad P , Nelson RG , Pavkov ME . Do sodium-glucose cotransporter-2 inhibitors affect renal hemodynamics by different mechanisms in type 1 and type 2 diabetes?[J]. Kidney Int, 2020,97(1):31-33. DOI: 10.1016/j.kint.2019.09.023 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Perlman A , Heyman SN , Stokar J ,et al. Clinical spectrum and mechanism of acute kidney injury in patients with diabetes mellitus on SGLT-2 inhibitors[J]. Isr Med Assoc J, 2018,20(8):513-516.
返回引文位置Google Scholar
百度学术
万方数据
[21]
Palmer BF , Clegg DJ . Kidney-protective effects of SGLT2 inhibitors[J]. Clin J Am Soc Nephrol, 2023,18(2):279-289. DOI: 10.2215/CJN.09380822 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
巩艳,贺巧艳,杨小娟. SGLT-2抑制剂引起糖尿病患者急性肾损伤的机制[J]. 临床肾脏病杂, 2021,21(12):1044-1048. DOI: 10.3969/j.issn.1671-2390.2021.12.014 .
返回引文位置Google Scholar
百度学术
万方数据
Gong Y , He QY , Yang XJ . Mechanisms of acute renal injury caused by SGLT-2 inhibitor in patients with diabetes mellitus[J]. J Clin Nephrol, 2021,21(12):1044-1048. DOI: 10.3969/j.issn.1671-2390.2021.12.014 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[23]
邢蓓,王新玲. SGLT-2抑制剂的肾脏效应及其分子机制研究进展[J]. 临床肾脏病杂志, 2020,20(8):684-687. DOI: 10.3969/j.issn.1671-2390.2020.08.014 .
返回引文位置Google Scholar
百度学术
万方数据
Xing B , Wang XL . Progress in studies on renal effects and molecular mechanism of SGLT-2 inhibitors[J]. J Clin Nephrol, 2020,20(8):684-687. DOI: 10.3969/j.issn.1671-2390.2020.08.014 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[24]
Luna-Marco C , Iannantuoni F , Hermo-Argibay A ,et al. Cardiovascular benefits of SGLT2 inhibitors and GLP-1 receptor agonists through effects on mitochondrial function and oxidative stress[J]. Free Radic Biol Med, 2024,213:19-35. DOI: 10.1016/j.freeradbiomed.2024.01.015 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Liu J , Livingston MJ , Dong G ,et al. HIF-1 contributes to autophagy activation via BNIP3 to facil itate renal fibrosis in hypoxia in vitro and UUO in vivo [J]. Am J Physiol Cell Physiol, 2024,326(3):C935-C947. DOI: 10.1152/ajpcell.00458.2023 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Zhao XY , Li SS , He YX ,et al. SGLT2 inhibitors alleviated podocyte damage in lupus nephritis by decreasing inflammation and enhancing autophagy[J]. Ann Rheum Dis, 2023,82(10):1328-1340. DOI: 10.1136/ard-2023-224242 .
返回引文位置Google Scholar
百度学术
万方数据
[27]
《钠-葡萄糖转运体2抑制剂在慢性肾脏病患者临床应用的中国专家共识（2023年版）》专家组. 钠-葡萄糖转运体2抑制剂在慢性肾脏病患者临床应用的中国专家共识（2023年版）[J]. 中华肾脏病杂志, 2023,39(11):879-888. DOI: 10.3760/cma.j.cn441217-20230625-00633 .
返回引文位置Google Scholar
百度学术
万方数据
Expert Group of Chinese Expert Consensus on the Clinical Application of Sodium-glucose Transporter 2 Inhibitors in Patients with Chronic Kidney Disease (2023 edition). Chinese expert consensus on the clinical application of sodium-glucose transporter 2 inhibitors in patients with chronic kidney disease (2023 edition)[J]. Chin J Nephrol, 2023,39(11):879-888. DOI: 10.3760/cma.j.cn441217-20230625-00633 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[28]
Chen C , Wu B , Zhang CY ,et al. Angiotensin receptor-neprilysin inhibitor and sodium-dependent glucose cotransporter-2 inhibitor-associated renal injury: a pharmacovigilance study[J]. Expert Opin Drug Saf, 2023,22(3):259-266. DOI: 10.1080/14740338.2022.2120609 .
返回引文位置Google Scholar
百度学术
万方数据
[29]
赵瑞,周增慧,杭永付,等. 22例钠-葡萄糖协调转运蛋白2抑制剂致急性肾损伤的文献病例分析[J]. 中国医院药学杂志, 2023,43(16):1846-1850. DOI: 10.13286/j.1001-5213.2023.16.13 .
返回引文位置Google Scholar
百度学术
万方数据
Zhao R , Zhou ZH , Hang YF ,et al. Literature case analysis of 22 cases of acute kidney injury caused by sodium-glucose cotransporter 2 inhibitors[J]. Chin J Hosp Pharm, 2023,43(16):1846-1850. DOI: 10.13286/j.1001-5213.2023.16.13 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[30]
杨柳,张之,马海林. SGLT-2抑制剂致成人2型糖尿病患者糖尿病酮症酸中毒风险的Meta分析[J]. 疑难病杂志, 2024, (10):1252-1257.
返回引文位置Google Scholar
百度学术
万方数据
Yang L , Zhang YZ , Ma HL . Meta-analysis of the risk of diabetic ketoacidosis in adults with type 2 diabetes induced by SGLT-2 inhibitors[J]. Chin J Diffic and Compl Cas, 2024, (10):1252-1257.
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[31]
Kidney Disease: Improving Global Outcomes (KDIGO) CKD work group. KDIGO 2024 clinical practice guideline for the evaluationand, management of chronic kidney disease[J]. Kidney Int, 2024,105(4s):s117-s314. DOI: 10.1016/j.kint.2023.10.018 .
返回引文位置Google Scholar
百度学术
万方数据
[32]
Liu C , Debnath N , Mosoyan G ,et al. Systematic review and meta-analysis of plasma and urine biomarkers for CKD outcomes[J]. J Am Soc Nephrol, 2022,33(9):1657-1672. DOI: 10.1681/ASN.2022010098 .
返回引文位置Google Scholar
百度学术
万方数据
[33]
McCoy IE , Hsu JY , Bonventre JV ,et al. Chronic Renal Insufficiency Cohort (CRIC) Study Investigators. Acute kidney injury associates with long-term increases in plasma TNFR1, TNFR2, and KIM-1: findings from the CRIC study[J]. J Am Soc Nephrol, 2022,33(6):1173-1181. DOI: 10.1681/ASN.2021111453 .
返回引文位置Google Scholar
百度学术
万方数据
[34]
Anders HJ , Davis JM , Thurau K . Nephron protection in diabetic kidney disease[J]. N Engl J Med, 2016,375(21):2096-2098. DOI: 10.1056/NEJMcibr1608564 .
返回引文位置Google Scholar
百度学术
万方数据
[35]
Sen T , Heerspink HJL . A kidney perspective on the mechanism of action of sodium glucose co-transporter 2 inhibitors[J]. Cell Metab, 2021,33(4):732-739. DOI: 10.1016/j.cmet.2021.02.016 .
返回引文位置Google Scholar
百度学术
万方数据
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