SGLT2抑制剂在心血管疾病的研究进展

Advances in SGLT2 Inhibitors for Cardiovascular Diseases

摘要: 本文综述钠–葡萄糖协同转运蛋白2抑制剂(SGLT2i)在心血管疾病领域的研究进展。通过调节心脏负荷、改善能量代谢及抑制纤维化多靶点作用机制，SGLT2i显著降低心力衰竭患者心血管死亡及住院风险，且在射血分数保留型与降低型心衰中均证实获益。关键临床研究证实其心肾保护作用独立于降糖效应：可降低心衰患者主要复合终点风险18%~26%，延缓慢性肾脏病患者肾功能恶化进展28%~39%。基于循证证据，国际指南已将SGLT2i列为心力衰竭标准治疗的基石。当前临床应用仍面临特殊人群安全性、机制争议及药物可及性等挑战。未来研究应着眼于心血管事件早期干预、联合治疗策略完善及精准医疗实践，以进一步降低残余心血管风险。

Abstract: This review examines advances in sodium-glucose cotransporter-2 inhibitors (SGLT2i) for cardiovascular diseases. Through multitarget mechanisms—including cardiac load modulation, energy metabolism optimization, and fibrosis suppression—SGLT2i significantly reduce cardiovascular mortality and hospitalization risks in heart failure (HF) patients, demonstrating consistent benefits in both heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). Pivotal clinical trials confirm cardiorenal protection independent of glucose-lowering effects: an 18%~26% reduction in primary composite endpoints for HF, and 28%~39% attenuation of renal function deterioration in chronic kidney disease (CKD) patients. Evidence-based guidelines now designate SGLT2i as foundational therapy for HF. Current clinical implementation faces challenges regarding special population safety, mechanistic controversies, and global accessibility. Future research should prioritize early cardiovascular event intervention, refined combination strategies, and precision medicine approaches to further mitigate residual cardiovascular risk.