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胰高血糖素样肽-1受体激动剂相关心率加快的研究进展
王丽
张旭升
任秀丽
沈承武
卢翠翠
作者及单位信息
·
DOI： 10.3760/cma.j.cn114015-20240508-00315
Research progress of increased heart rate related to glucagon-like peptide-1 receptor agonists
Wang Li
Zhang Xusheng
Ren Xiuli
Shen Chengwu
Lu Cuicui
Authors Info & Affiliations
Wang Li
Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji′nan 250021, China
Zhang Xusheng
Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji′nan 250021, China
Ren Xiuli
Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji′nan 250021, China
Shen Chengwu
Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji′nan 250021, China
Lu Cuicui
Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji′nan 250021, China
·
DOI： 10.3760/cma.j.cn114015-20240508-00315
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摘要

胰高血糖素样肽-1受体激动剂（GLP-1RA）广泛用于2型糖尿病（T2DM）的治疗，其导致的心率加快不容忽视。在一般人群和糖尿病患者中，心率加快与心血管疾病的患病率及病死率具有独立相关性。一般来说，长效GLP-1RA对心率的影响更大，心率的增加呈剂量依赖性且与基线水平心率呈负相关。GLP-1RA导致的心率增加可能与增强交感神经活动、诱发血管舒张引起的反射性心动过速等有关。临床使用GLP-1RA时，应注意该药可致的心率加快，尤其对于有心血管疾病高危因素的患者。若患者出现明显心率加快，需尽快停用GLP-1RA，必要时给予对症治疗。

胰高血糖素样肽-1;糖尿病，2型;心率;药物相关性副作用和不良反应;胰高血糖素样肽-1受体激动剂
ABSTRACT

Glucagon-like peptide-1 receptor agonists (GLP-1RA) have been widely used in the treatment of type 2 diabetes mellitus (T2DM). However, the acceleration of heart rate caused by GLP-1RA should not be ignored. In the general population and patients with diabetes, increased heart rate has an independent correlation with the incidence and mortality of cardiovascular diseases. In general, the long-acting GLP-1RA seem to exert a greater effect in increasing heart rate, and the effect is dose-dependent and negatively correlated with baseline heart rate. The increase in heart rate caused by GLP-1RA may be related to enhanced sympathetic nervous activity, reflex tachycardia as a response to vasodilation, etc. It is advisable to closely monitor the increased heart rate induced by GLP-1RA in clinical practice, especially in patients with high-risk factors for cardiovascular disease. In case of elevated heart rate, the management begins with immediate discontinuation of the GLP-1RA and symptomatic intervention should be given if necessary.

Glucagon-like peptide-1;Diabetes mellitus, type 2;Heart rate;Drug-related side effects and adverse reactions;Glucagon-like peptide-1 receptor agonists
Lu Cuicui, Email: mocdef.3ab611202ecec
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引用本文

王丽,张旭升,任秀丽,等. 胰高血糖素样肽-1受体激动剂相关心率加快的研究进展[J]. 药物不良反应杂志,2025,27(03)：182-187.

DOI:10.3760/cma.j.cn114015-20240508-00315

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胰高血糖素样肽-1（glucagon-like peptide-1，GLP-1）是主要由肠道L细胞分泌的一种激素，属于肠促胰素。GLP-1受体激动剂（GLP-1 receptor agonists，GLP-1RA）是一类新型降糖药，通过激活GLP-1受体，以葡萄糖浓度依赖的方式增加胰岛素分泌、抑制胰高血糖素分泌、延缓胃排空和增加饱腹感而发挥降低血糖的作用。目前国内批准上市的此类药物包括短效GLP-1RA（艾塞那肽、贝那鲁肽、利司那肽），每日1~3次皮下注射；长效GLP-1RA（利拉鲁肽），每日1次皮下注射；超长效GLP-1RA（度拉糖肽、司美格鲁肽、聚乙二醇洛塞那肽、艾塞那肽微球），每周1次皮下注射。
GLP-1RA不仅降糖效果显著，同时兼具调脂、降压、改善心肾功能等作用。近年来，随着循证医学证据的增加，GLP-1RA在国内外临床应用十分广泛。此外，GLP-1RA因具有减重效果受到了很多非糖尿病人群，尤其是年轻女性的青睐。GLP-1RA在广泛用于糖尿病患者以及减重人群的同时，其引起的心率加快不容忽视。短效GLP-1RA可引起平均心率加快1~3次/min，而长效GLP-1RA可引起平均心率加快6~10次/min [ 1 ]。在一般人群和糖尿病患者中，心率增快与心血管疾病患病率及病死率有独立相关性 [ 2 ]。虽然LEADER、ELIXA试验表明GLP-1RA可以降低主要不良心血管事件的风险 [ 3 , 4 ]，但美国一项对心力衰竭患者的研究显示，利拉鲁肽组患者较安慰剂组患者发生了更严重的心脏不良事件 [ 5 ]。为此，本文对不同GLP-1RA相关心率加快的临床特点和发生机制进行综述，以期为临床安全合理使用GLP-1RA提供参考。
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参考文献
[1]
Mikhail N . Cardiovascular effects of liraglutide[J]. Curr Hypertens Rev, 2019,15(1):64-69. DOI: 10.2174/1573402114666180507152620 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Hillis GS , Hata J , Woodward M ,et al. Resting heart rate and the risk of microvascular complications in patients with type 2 diabetes mellitus[J]. Am Heart Assoc, 2012,1(5):e002832. DOI: 10.1161/JAHA.112.002832 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Marso SP , Daniels GH , Brown-Frandsen K ,et al. Liraglutide and cardiovascular outcomes in type 2 diabetes[J]. N Eng J Med, 2016,375(4):311-322. DOI: 10.1056/NEJMoa1603827 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Gerstein HC , Wolsk E , Claggett B ,et al. Effect of lixisenatide on natriuretic peptides in people with type 2 diabetes and recent acute coronary syndrome: the ELIXA trial[J]. Diabetes Obes Metab, 2023,25(4):1125-1129. DOI: 10.1111/dom.14954 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Margulies KB , Hernandez AF , Redfield MM ,et al. Effects of liraglutide on clinical stability among patients with advanced heart failure and reduced ejection fraction: a randomized clinical trial[J]. JAMA, 2016,316(5):500-508. DOI: 10.1001/jama.2016.10260 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Linnebjerg H , Seger M , Kothare PA ,et al. A thorough QT study to evaluate the effects of single dose exenatide 10 μg on cardiac repolarization in healthy subjects[J]. Int J Clin Phar macol Ther, 2011,49(10):594-604. DOI: 10.5414/cp201462 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Gill A , Hoogwerf BJ , Burger J ,et al. Effect of exenatide on heart rate and blood pressure in subjects with type 2 diabetes mellitus: a double-blind, placebo-controlled, randomized pilot study[J]. Cardiovasc Diabetol, 2010,9:6. DOI: 10.1186/1475-2840-9-6 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
Pfeffer MA , Claggett B , Diaz R ,et al. Lixisenatide in patients with type 2 diabetes and acute coronary syndrome[J]. N Engl J Med, 2015,373(23):2247-2257. DOI: 10.1056/NEJMoa1509225 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
Nakatani Y , Kawabe A , Matsumura M ,et al. Effects of GLP-1 receptor agonists on heart rate and the autonomic nervous system using Holter electrocardiography and power spectrum analysis of heart rate variability[J]. Diabetes Care, 2016,39(2):e22-e23. DOI: 10.2337/dc15-1437 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Meier JJ , Rosenstock J , Hincelin-Méry A ,et al. Contrasting effects of lixisenatide and liraglutide on postprandial glycemic control, gastric emptying, and safety paramete rs in patients with type 2 diabetes on optimized insulin glargine with or without metformin: a randomized, open-label trial [J]. Diabetes Care, 2015,38(7):1263-1273. DOI: 10.2337/dc14-1984 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Chen K , Chen L , Shan Z ,et al. Beinaglutide for weight management in Chinese individuals with overweight or obesity: a phase 3 randomized controlled clinical study[J]. Diabetes Obes Metab, 2024,26(2):690-698. DOI: 10.1111/dom.15360 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Zhang YL , Zhou C , Li XF ,et al. Beinaglutide showed significant weight-loss benefit and effective glycaemic control for the treatment of type 2 diabetes in a real-world setting: a 3-month, multicentre, obse rvational, retrospective, open-label study [J]. Obes Sci Pract, 2019,5(4):366-375. DOI: 10.1002/osp4.342 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
Liu X , Yang W , Liu J ,et al. The efficacy and safety of beinaglutide alone or in combination with insulin glargine in Chinese patients with type 2 diabetes mellitus who are inadequately controlled with oral antihyperglycemic therapy: a multicenter, open-label, randomized trial[J]. J Diabetes, 2023,16(2):e13483. DOI: 10.1111/1753-0407.13483 .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Wang G , Wu P , Qiu Y ,et al. Effect of beinaglutide treatment on weight loss in Chinese patients with type 2 diabetes mellitus and overweight/obesity[J]. Arch Endocrin ol Metab , 2021,65(4):421-427. DOI: 10.20945/2359-3997000000388 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Ladenheim EE . Liraglutide and obesity: a review of the data so far[J]. Drug Des Devel Ther, 2015,9:1867-1875. DOI: 10.2147/DDDT.S58459 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Lorenz M , Lawson F , Owens D ,et al. Differential effects of glucagon-like peptide-1 receptor agonists on heart rate[J]. Cardiovasc Diabetol, 2017,16(1):6. DOI: 10.1186/s12933-016-0490-6 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Kumarathurai P , Anholm C , Larsen BS ,et al. Effects of liraglutide on heart rate and heart rate variability: a randomized, double-blind, placebo-controlled crossover study[J]. Diabetes Care, 2017,40(1):117-124. DOI: 10.2337/dc16-1580 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Van Can J , Sloth B , Jensen CB ,et al. Effects of the once-daily GLP-1 analog liraglutide on gastric emptying, glycemic parameters, appetite and energy metabolism in obese, non-diabetic adults[J]. Int J Obes (Lond), 2014,38:784-793. DOI: 10.1038/ijo.2013.162 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Lovshin JA , Barnie A , DeAlmeida A ,et al. Liraglutide promotes natriuresis but does not increase circulating levels of atrial natriuretic peptide in hypertensive subjects with type 2 diabetes[J]. Diabetes Care, 2015,38:132-139. DOI: 10.2337/dc14-1958 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Lorenz M , Evers A , Wagner M . Recent progress and future options in the development of GLP-1 receptor agonists for the treatment of diabesity[J]. Bioorg Med Chem Lett, 2013,23:4011-4018. DOI: 10.1016/j.bmcl.2013.05.022 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Gerstein HC , Colhoun HM , Dagenais GR ,et al. Dulaglutide and cardiova scular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial [J]. Lancet, 2019,394(10193):121-130. DOI: 10.1016/S0140-6736(19)31149-3 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Ferdinand KC , White WB , Calhoun DA ,et al. Effects of the once weekly glucagon-like peptide-1 receptor agonist dulaglutide on ambulatory blood pressure and heart rate in patients with type 2 diabetes mellitus[J]. Hypertension, 2014,64(4):731-737. DOI: 10.1161/HYPERTENSIONAHA.114.03062 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Andreadis P , Karagiannis T , Malandris K ,et al. Semaglutide for type 2 diabetes mellitus: a systematic review and meta-analysis[J]. Diabetes Obes Metab, 2018,20(9):2255-2263. DOI: 10.1111/dom.13361 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
Aroda VR , Erhan U , Jelnes P ,et al. Safety and tolerability of semaglutide across the SUSTAIN and PIONEER phase Ⅲ a clinical trial programmes[J]. Diabetes Obes Metab, 2023,25(5):1385-1397. DOI: 10.1111/dom.14990 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Li XY , Li CP , Zhang CY ,et al. Effect of polyethylene glycol loxenatide (long-acting GLP-1RA) on lipid, glucose levels and weight in type 2 diabetes mellitus patients with obesity[J]. Eur Rev Med Pharmacol Sci, 2022,26(21):7996-8003. DOI: 10.26355/eurrev_202211_30153 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Cai H , Chen Q , Duan Y ,et al. Short-term effect of polyethylene glycol loxenatide on weight loss in overweight or obese patients with type 2 diabetes: an open-label, parallel-arm, randomized, metformin-controlled trial[J]. Front Endocrinol (Lausanne), 2023,14:1106868. DOI: 10.3389/fendo.2023.1106868 .
返回引文位置Google Scholar
百度学术
万方数据
[27]
Cacciatori V , Zoppini G , Bellavere F ,et al. Long-acting GLP-1 receptor agonist exenatide influence on the autonomic cardiac sympatho-vagal balance[J]. Endocr Soc, 2017,2(1):53-62. DOI: 10.1210/js.2017-00300 .
返回引文位置Google Scholar
百度学术
万方数据
[28]
Marso SP , Hardy E , Han J ,et al. Changes in heart rate associated with exenatide once weekly: pooled analysis of clinical data in patients with type 2 diabetes[J]. Diabetes Ther, 2018,9(2):551-564. DOI: 10.1007/s13300-018-0370-z .
返回引文位置Google Scholar
百度学术
万方数据
[29]
Forzano I , Varzideh F , Avvisato R ,et al. Tirzepatide: a systematic update[J]. Int J Mol Sci, 2022,23(23):14631. DOI: 10.3390/ijms232314631 .
返回引文位置Google Scholar
百度学术
万方数据
[30]
Yang Y , He L , Liu P ,et al. Impact of a dual glucose-dependent insulinotropic peptide/glucagon-like peptide-1 receptor agonist tirzepatide on heart rate among patients with type 2 diabetes: a systematic review and pairwise and network meta-analysis[J]. Diabetes Obes Metab, 2024,26(2):548-556. DOI: 10.1111/dom.15342 .
返回引文位置Google Scholar
百度学术
万方数据
[31]
Inagaki N , Takeuchi M , Oura T ,et al. Efficacy and safety of tirzepatide monotherapy compared with dulaglutide in Japanese patients with type 2 diabetes (SURPASS J-mono): a double-blind, multicentre, randomised, phase 3 trial[J]. Lancet Diabetes Endocrinol, 2022,10(9):623-633. DOI: 10.1016/S2213-8587(22)00188-7 .
返回引文位置Google Scholar
百度学术
万方数据
[32]
Smits MM , Tonneijck L , Muskiet MH ,et al. Heart rate acceleration with GLP-1 receptor agonists in type 2 diabetes patients: an acute and 12-week randomised, double-blind, placebo-controlled trial[J]. Eur J Endocrinol, 2017,176(1):77-86. DOI: 10.1530/EJE-16-0507 .
返回引文位置Google Scholar
百度学术
万方数据
[33]
Smits MM , Muskiet MH , Tonneijck L ,et al. Exenatide acutely increases heart rate in parallel with augmented sympathetic nervous system activation in healthy overweight males[J]. Br J Clin Pharmacol, 2016,81(4):613-620. DOI: 10.1111/bcp.12843 .
返回引文位置Google Scholar
百度学术
万方数据
[34]
Mendis B , Simpson E , MacDonald I ,et al. Investigation of the haemodynamic effects of exenatide in healthy male subjects[J]. Br J Clin Pharmacol, 2012,74(3):437-444. DOI: 10.1111/j.1365-2125.2012.04214.x .
返回引文位置Google Scholar
百度学术
万方数据
[35]
Pyke C , Heller RS , Kirk RK ,et al. GLP-1 receptor localization in monkey and human tissue: novel distribution revealed with extensively validated monoclonal antibody[J]. Endocrinology, 2014,155(4):1280-1290. DOI: 10.1210/en.2013-1934 .
返回引文位置Google Scholar
百度学术
万方数据
[36]
Sun F , Wu S , Guo S ,et al. Impac t of GLP-1 receptor agonists on blood pressure, heart rate and hypertension among patients with type 2 diabetes: a systematic review and network meta-analysis [J]. Diabetes Res Clin Pract, 2015,110(1):26-37. DOI: 10.1016/j.diabres.2015.07.015 .
返回引文位置Google Scholar
百度学术
万方数据
[37]
Dalsgaard NB , Vilsbøll T , Knop FK . Effects of glucagon-like peptide-1 receptor agonists on cardiovascular risk factors: a narrative review of head-to-head comparisons[J]. Diabetes Obes Metab, 2018,20(3):508-519. DOI: 10.1111/dom.13128 .
返回引文位置Google Scholar
百度学术
万方数据
[38]
Ferdinand KC , White WB , Calhoun DA ,et al. Effects of the once-weekly glucagon-like peptide-1 receptor agonist dulaglutide on ambulatory blood pressur e and heart rate in patients with type 2 diabetes mellitus [J]. Hypertension, 2014,64(4):731-737. DOI: 10.1161/HYPERTENSIONAHA.114.03062 .
返回引文位置Google Scholar
百度学术
万方数据
[39]
Gentilella R , Pechtner V , Corcos A ,et al. Glucagon-like peptide-1 receptor agonists for the treatment of type 2 diabetes: differences and similarities[J]. Diabetes Metab Res Rev, 2019,35(1):e3070. DOI: 10.1002/dmrr.3070 .
返回引文位置Google Scholar
百度学术
万方数据
[40]
Swedberg K , Komajda M , Böhm M ,et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study[J]. Lancet, 2010,376(9744):875-885. DOI: 10.1016/S0140-6736(10)61198-1 .
返回引文位置Google Scholar
百度学术
万方数据
[41]
Jøns C , Porta-Sánchez A , Lai PFH ,et al. Mechanism of and strategy to mitigate liraglutide-mediated positive chronotropy[J]. Life Sci, 2021,282:119815. DOI: 10.1016/j.lfs.2021.119815 .
返回引文位置Google Scholar
百度学术
万方数据
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卢翠翠，Email： mocdef.3ab611202ecec
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所有作者声明不存在利益冲突
C
山东省药品化妆品不良反应监测哨点课题 (2022SDADRKY01)
山东省医学会临床药学科研专项 (YXH2022ZX001)
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