SGLT2抑制剂对肾小球滤过率的影响及其机制研究进展
Progress in the Study of the Effect of SGLT2 Inhibitors on Glomerular Filtration Rate and Its Mechanism
DOI: 10.12677/acm.2025.1541104, PDF,   
作者: 李立红, 刘东方*:重庆医科大学附属第二医院内分泌与代谢病科,重庆
关键词: SGLT2抑制剂肾小球滤过率急性肾损伤SGLT2 Inhibitor Glomerular Filtration Rate Acute Kidney Injury
摘要: 钠–葡萄糖共转运蛋白2 (Sodium-Glucose Cotransporter, SGLT) 2抑制剂是一类作用机制独特的新型口服降糖药,在降低跨肾小球压的同时可能导致用药早期肾小球滤过率下降。本文综述了近年来各种钠–葡萄糖转运蛋白2抑制剂对2型糖尿病患者肾小球滤过率影响的相关研究及其作用机制,从而为SGLT2抑制剂在T2DM治疗安全性方面提供新的理念和依据。
Abstract: Sodium-glucose cotransporter (SGLT) 2 inhibitors are a new class of oral hypoglycemic agents with a unique mechanism, which may lead to a decrease in glomerular filtration rate in the early phase of drug administration while lowering transglomerular pressure. In this paper, we review the recent studies on the effects of various sodium-glucose cotransporter 2 inhibitors on glomerular filtration rate in type 2 diabetes mellitus patients and their mechanisms of action, so as to provide new concepts and rationale for the safety of SGLT2 inhibitors in the treatment of T2DM.
文章引用:李立红, 刘东方. SGLT2抑制剂对肾小球滤过率的影响及其机制研究进展[J]. 临床医学进展, 2025, 15(4): 1654-1660. https://doi.org/10.12677/acm.2025.1541104

参考文献

[1] Malik, A.S., Boyko, O., Aktar, N. and Young, W.F. (2001) A Comparative Study of MR Imaging Profile of Titanium Pedicle Screws. Acta Radiologica, 42, 291-293. [Google Scholar] [CrossRef] [PubMed]
[2] Hahn, K., Ejaz, A.A., Kanbay, M., Lanaspa, M.A. and Johnson, R.J. (2016) Acute Kidney Injury from SGLT2 Inhibitors: Potential Mechanisms. Nature Reviews Nephrology, 12, 711-712. [Google Scholar] [CrossRef] [PubMed]
[3] Schork, A., Saynisch, J., Vosseler, A., Jaghutriz, B.A., Heyne, N., Peter, A., et al. (2019) Effect of SGLT2 Inhibitors on Body Composition, Fluid Status and Renin-Angiotensin-Aldosterone System in Type 2 Diabetes: A Prospective Study Using Bioimpedance Spectroscopy. Cardiovascular Diabetology, 18, Article No. 46. [Google Scholar] [CrossRef] [PubMed]
[4] Ohara, K., Masuda, T., Murakami, T., Imai, T., Yoshizawa, H., Nakagawa, S., et al. (2019) Effects of the Sodium-Glucose Cotransporter 2 Inhibitor Dapagliflozin on Fluid Distribution: A Comparison Study with Furosemide and Tolvaptan. Nephrology, 24, 904-911. [Google Scholar] [CrossRef] [PubMed]
[5] Masuda, T., Muto, S., Fukuda, K., Watanabe, M., Ohara, K., Koepsell, H., et al. (2020) Osmotic Diuresis by SGLT2 Inhibition Stimulates Vasopressin‐Induced Water Reabsorption to Maintain Body Fluid Volume. Physiological Reports, 8, e14360. [Google Scholar] [CrossRef] [PubMed]
[6] Škrtić, M., Yang, G.K., Perkins, B.A., Soleymanlou, N., Lytvyn, Y., von Eynatten, M., et al. (2014) Characterisation of Glomerular Haemodynamic Responses to SGLT2 Inhibition in Patients with Type 1 Diabetes and Renal Hyperfiltration. Diabetologia, 57, 2599-2602. [Google Scholar] [CrossRef] [PubMed]
[7] Anders, H., Davis, J.M. and Thurau, K. (2016) Nephron Protection in Diabetic Kidney Disease. New England Journal of Medicine, 375, 2096-2098. [Google Scholar] [CrossRef] [PubMed]
[8] Kagami, S., Border, W.A., Miller, D.E., et al. (1994) Angiotensin Ⅱ Stimulates Extracellular Matrix Protein Synthesis through Induction of Transforming Growth Factor-β Expression in Rat Glomerular Mesangial Cells. Journal of Clinical Investigation, 93, 2431-2437.
[9] Roscioni, S.S., Heerspink, H.J.L. and de Zeeuw, D. (2014) The Effect of RAAS Blockade on the Progression of Diabetic Nephropathy. Nature Reviews Nephrology, 10, 77-87.
[10] Scholtes, R.A., Muskiet, M.H.A., van Baar, M.J.B., Hesp, A.C., Greasley, P.J., Hammarstedt, A., et al. (2022) The Adaptive Renal Response for Volume Homeostasis during 2 Weeks of Dapagliflozin Treatment in People with Type 2 Diabetes and Preserved Renal Function on a Sodium-Controlled Diet. Kidney International Reports, 7, 1084-1092. [Google Scholar] [CrossRef] [PubMed]
[11] Li, Y.C., Kong, J., Wei, M., Chen, Z., Liu, S.Q. and Cao, L. (2002) 1,25-Dihydroxyvitamin D3 Is a Negative Endocrine Regulator of the Renin-Angiotensin System. Journal of Clinical Investigation, 110, 229-238. [Google Scholar] [CrossRef] [PubMed]
[12] Blau, J.E., Bauman, V., Conway, E.M., Piaggi, P., Walter, M.F., Wright, E.C., et al. (2018) Canagliflozin Triggers the FGF23/1,25-Dihydroxyvitamin D/PTH Axis in Healthy Volunteers in a Randomized Crossover Study. JCI Insight, 3, e99123. [Google Scholar] [CrossRef] [PubMed]
[13] Hawley, S.A., Ford, R.J., Smith, B.K., Gowans, G.J., Mancini, S.J., Pitt, R.D., et al. (2016) The Na+/Glucose Cotransporter Inhibitor Canagliflozin Activates AMPK by Inhibiting Mitochondrial Function and Increasing Cellular AMP Levels. Diabetes, 65, 2784-2794. [Google Scholar] [CrossRef] [PubMed]
[14] O’Neill, J., Fasching, A., Pihl, L., et al. (2015) Acute SGLT Inhibition Normalizes O2 Tension in the Renal Cortex but Causes Hypoxia in the Renal Medulla in Anaesthetized Control and Diabetic Rats. American Journal of Physiology-Renal Physiology, 309, F227-F234.
[15] Layton, A.T., Vallon, V. and Edwards, A. (2015) Modeling Oxygen Consumption in the Proximal Tubule: Effects of NHE and SGLT2 Inhibition. American Journal of Physiology-Renal Physiology, 308, F1343-F1357. [Google Scholar] [CrossRef] [PubMed]
[16] Lambers Heerspink, H.J., de Zeeuw, D., Wie, L., Leslie, B. and List, J. (2013) Dapagliflozin a Glucose‐Regulating Drug with Diuretic Properties in Subjects with Type 2 Diabetes. Diabetes, Obesity and Metabolism, 15, 853-862. [Google Scholar] [CrossRef] [PubMed]
[17] Paliege, A., Rosenberger, C., Bondke, A., Sciesielski, L., Shina, A., Heyman, S.N., et al. (2010) Hypoxia-Inducible Factor-2α-Expressing Interstitial Fibroblasts Are the Only Renal Cells that Express Erythropoietin under Hypoxia-Inducible Factor Stabilization. Kidney International, 77, 312-318. [Google Scholar] [CrossRef] [PubMed]
[18] Hahn, K., Kanbay, M., Lanaspa, M.A., Johnson, R.J. and Ejaz, A.A. (2017) Serum Uric Acid and Acute Kidney Injury: A Mini Review. Journal of Advanced Research, 8, 529-536. [Google Scholar] [CrossRef] [PubMed]
[19] Roncal Jimenez, C.A., Ishimoto, T., Lanaspa, M.A., Rivard, C.J., Nakagawa, T., Ejaz, A.A., et al. (2014) Fructokinase Activity Mediates Dehydration-Induced Renal Injury. Kidney International, 86, 294-302. [Google Scholar] [CrossRef] [PubMed]
[20] Lanaspa, M.A., Ishimoto, T., Cicerchi, C., Tamura, Y., Roncal-Jimenez, C.A., Chen, W., et al. (2014) Endogenous Fructose Production and Fructokinase Activation Mediate Renal Injury in Diabetic Nephropathy. Journal of the American Society of Nephrology, 25, 2526-2538. [Google Scholar] [CrossRef] [PubMed]
[21] Cirillo, P., Gersch, M.S., Mu, W., Scherer, P.M., Kim, K.M., Gesualdo, L., et al. (2009) Ketohexokinase-Dependent Metabolism of Fructose Induces Proinflammatory Mediators in Proximal Tubular Cells. Journal of the American Society of Nephrology, 20, 545-553. [Google Scholar] [CrossRef] [PubMed]
[22] Nakayama, T., Kosugi, T., Gersch, M., Connor, T., Sanchez-Lozada, L.G., Lanaspa, M.A., et al. (2010) Dietary Fructose Causes Tubulointerstitial Injury in the Normal Rat Kidney. American Journal of Physiology-Renal Physiology, 298, F712-F720. [Google Scholar] [CrossRef] [PubMed]
[23] 花慧, 祝超瑜, 魏丽. 钠-葡萄糖转运蛋白2抑制剂对2型糖尿病患者血尿酸影响的研究进展[J]. 解放军药学学报, 2023, 36(6): 551-556.
[24] Vasilakou, D., Karagiannis, T., Athanasiadou, E., Mainou, M., Liakos, A., Bekiari, E., et al. (2013) Sodium-Glucose Cotransporter 2 Inhibitors for Type 2 Diabetes: A Systematic Review and Meta-Analysis. Annals of Internal Medicine, 159, 262-274. [Google Scholar] [CrossRef] [PubMed]
[25] Perlman, A., Heyman, S.N., Matok, I., Stokar, J., Muszkat, M. and Szalat, A. (2017) Acute Renal Failure with Sodium-Glucose-Cotransporter-2 Inhibitors: Analysis of the FDA Adverse Event Report System Database. Nutrition, Metabolism and Cardiovascular Diseases, 27, 1108-1113. [Google Scholar] [CrossRef] [PubMed]
[26] Pleros, C., Stamataki, E., Papadaki, A., Damianakis, N., Poulidaki, R., Gakiopoulou, C., et al. (2018) Dapagliflozin as a Cause of Acute Tubular Necrosis with Heavy Consequences: A Case Report. CEN Case Reports, 7, 17-20. [Google Scholar] [CrossRef] [PubMed]
[27] Hassani-Ardakania, K., Lipman, M.L., Laporta, D. and Yu, O.H.Y. (2019) A Case of Severe Acute Kidney Injury Exacerbated by Canagliflozin in a Patient with Type 2 Diabetes. Case Reports in Endocrinology, 2019, Article 8639629. [Google Scholar] [CrossRef] [PubMed]
[28] Bnaya, A., Itzkowitz, E., Atrash, J., Abu-Alfeilat, M. and Shavit, L. (2022) Acute Interstitial Nephritis Related to SGLT-2 Inhibitor. Postgraduate Medical Journal, 98, 740-741. [Google Scholar] [CrossRef] [PubMed]
[29] Phadke, G., Kaushal, A., Tolan, D.R., Hahn, K., Jensen, T., Bjornstad, P., et al. (2020) Osmotic Nephrosis and Acute Kidney Injury Associated with SGLT2 Inhibitor Use: A Case Report. American Journal of Kidney Diseases, 76, 144-147. [Google Scholar] [CrossRef] [PubMed]
[30] Jain, R., Bhavatharini, N., Saravanan, T., Seshiah, V. and Jain, N. (2022) Use of Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitor Remogliflozin and Possibility of Acute Kidney Injury in Type-2 Diabetes. Cureus, 14, e32573. [Google Scholar] [CrossRef] [PubMed]
[31] 《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.