住院期尽早启动SGLT2抑制剂在心力衰竭 治疗中的最新证据与临床应用进展
Recent Evidence and Clinical Progress of Early In-Hospital Initiation of SGLT2 Inhibitors in Heart Failure Management
摘要: 钠–葡萄糖协同转运蛋白2抑制剂(SGLT2i)已从最初的二线降糖药物演变为覆盖心力衰竭(HF)全病程及全射血分数谱系的基石药物。随着EMPULSE、SOLOIST-WHF等研究及2025~2026年最新循证证据的公布，治疗范式正经历从“出院后启动”向“住院期尽早启动”的深刻变革。本文系统综述了SGLT2i在急性期启动的多重保护机制，详尽剖析了其在不同射血分数背景下的循证获益，并针对安全性管理、启动时机及中国实践进行了深度探讨，旨在为降低急性心衰(AHF)患者出院后“脆弱期”风险提供参考。
Abstract: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have transitioned from ancillary glucose-lowering agents to cornerstone therapies encompassing the entire clinical course and the full spectrum of heart failure (HF) ejection fractions. Driven by the landmark EMPULSE and SOLOIST-WHF trials, alongside emerging evidence from 2025~2026, the treatment paradigm is shifting decisively from post-discharge initiation to early in-hospital intervention. This review systematically delineates the pleiotropic protective mechanisms of SGLT2i during the acute phase and analyzes its clinical efficacy across diverse ejection fraction profiles. Furthermore, it addresses safety management, optimal initiation timing, and clinical implementation within China’s healthcare landscape, providing a critical framework for mitigating risks during the post-discharge “vulnerable period” for patients with acute heart failure (AHF).
文章引用：盘心宇. 住院期尽早启动SGLT2抑制剂在心力衰竭 治疗中的最新证据与临床应用进展[J]. 临床医学进展, 2026, 16(4): 3591-3598. https://doi.org/10.12677/acm.2026.1641623

参考文献

[1] 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, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2024 (上) [J]. 中华心血管病杂志, 2024, 52(3): 235-275.
[2] 王华, 刘宇佳, 杨杰孚. 心力衰竭流行病学[J]. 临床心血管病杂志, 2023, 39(4): 243-247.
[3] McMurray, J.J.V., Solomon, S.D., Inzucchi, S.E., Køber, L., Kosiborod, M.N., Martinez, F.A., et al. (2019) Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. New England Journal of Medicine, 381, 1995-2008. [Google Scholar] [CrossRef] [PubMed]
[4] McDonagh, T.A., Metra, M., Adamo, M., Gardner, R.S., Baumbach, A., Böhm, M., et al. (2021) 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. European Heart Journal, 42, 3599-3726. [Google Scholar] [CrossRef] [PubMed]
[5] Anker, S.D., Butler, J., Filippatos, G., Ferreira, J.P., Bocchi, E., Böhm, M., et al. (2021) Empagliflozin in Heart Failure with a Preserved Ejection Fraction. New England Journal of Medicine, 385, 1451-1461. [Google Scholar] [CrossRef] [PubMed]
[6] Berg, D.D., Patel, S.M., Haller, P.M., Cange, A.L., Palazzolo, M.G., Bellavia, A., et al. (2025) Dapagliflozin in Patients Hospitalized for Heart Failure: Primary Results of the DAPA ACT HF-TIMI 68 Randomized Clinical Trial and Meta-Analysis of Sodium-Glucose Cotransporter-2 Inhibitors in Patients Hospitalized for Heart Failure. Circulation, 152, 1411-1422. [Google Scholar] [CrossRef] 
[7] Cherbi, M., Lairez, O., Baudry, G., Gautier, P., Roubille, F. and Delmas, C. (2025) Early Initiation of Sodium-Glucose Cotransporter 2 Inhibitors in Acute Heart Failure: A Systematic Review and Meta‐Analysis. Journal of the American Heart Association, 14, e039105. [Google Scholar] [CrossRef] [PubMed]
[8] Zelniker, T.A., Wiviott, S.D., Raz, I., Im, K., Goodrich, E.L., Bonaca, M.P., et al. (2019) SGLT2 Inhibitors for Primary and Secondary Prevention of Cardiovascular and Renal Outcomes in Type 2 Diabetes: A Systematic Review and Meta-Analysis of Cardiovascular Outcome Trials. The Lancet, 393, 31-39. [Google Scholar] [CrossRef] [PubMed]
[9] Packer, M., Anker, S.D., Butler, J., Filippatos, G., Pocock, S.J., Carson, P., et al. (2020) Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. New England Journal of Medicine, 383, 1413-1424. [Google Scholar] [CrossRef] [PubMed]
[10] Lopaschuk, G.D. and Verma, S. (2020) Mechanisms of Cardiovascular Benefits of Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors. JACC: Basic to Translational Science, 5, 632-644. [Google Scholar] [CrossRef] [PubMed]
[11] Byrne, N.J., Matsumura, N., Maayah, Z.H., Ferdaoussi, M., Takahara, S., Darwesh, A.M., et al. (2020) Empagliflozin Blunts Worsening Cardiac Dysfunction Associated with Reduced NLRP3 (Nucleotide-Binding Domain-Like Receptor Protein 3) Inflammasome Activation in Heart Failure. Circulation: Heart Failure, 13, e006277. [Google Scholar] [CrossRef] [PubMed]
[12] Requena-Ibáñez, J.A., Santos-Gallego, C.G., Rodriguez-Cordero, A., Vargas-Delgado, A.P., Mancini, D., Sartori, S., et al. (2021) Mechanistic Insights of Empagliflozin in Nondiabetic Patients with HFrEF: From the EMPA-TROPISM Study. JACC: Heart Failure, 9, 578-589. [Google Scholar] [CrossRef] [PubMed]
[13] Wan, N., Rahman, A., Hitomi, H. and Nishiyama, A. (2018) The Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Sympathetic Nervous Activity. Frontiers in Endocrinology, 9, Article No. 421. [Google Scholar] [CrossRef] [PubMed]
[14] Uthman, L., Baartscheer, A., Bleijlevens, B., Schumacher, C.A., Fiolet, J.W.T., Koeman, A., et al. (2018) Class Effects of SGLT2 Inhibitors in Mouse Cardiomyocytes and Hearts: Inhibition of Na+/H+ Exchanger, Lowering of Cytosolic Na+ and Vasodilation. Diabetologia, 61, 722-726. [Google Scholar] [CrossRef] [PubMed]
[15] Biegus, J., Voors, A.A., Collins, S.P., Kosiborod, M.N., Teerlink, J.R., Angermann, C.E., et al. (2023) Impact of Empagliflozin on Decongestion in Acute Heart Failure: The EMPULSE Trial. European Heart Journal, 44, 41-50. [Google Scholar] [CrossRef] [PubMed]
[16] Voors, A.A., Angermann, C.E., Teerlink, J.R., Collins, S.P., Kosiborod, M., Biegus, J., et al. (2022) The SGLT2 Inhibitor Empagliflozin in Patients Hospitalized for Acute Heart Failure: A Multinational Randomized Trial. Nature Medicine, 28, 568-574. [Google Scholar] [CrossRef] [PubMed]
[17] Bhatt, D.L., Szarek, M., Steg, P.G., Cannon, C.P., Leiter, L.A., McGuire, D.K., et al. (2021) Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure. New England Journal of Medicine, 384, 117-128. [Google Scholar] [CrossRef] [PubMed]
[18] Cox, Z.L., Collins, S.P., Hernandez, G.A., McRae, A.T., Davidson, B.T., Adams, K., et al. (2024) Efficacy and Safety of Dapagliflozin in Patients with Acute Heart Failure. Journal of the American College of Cardiology, 83, 1295-1306. [Google Scholar] [CrossRef] [PubMed]
[19] Laborante, R., Paglianiti, D.A., Bianchini, E., Galli, M., Borovac, J.A., Savarese, G., et al. (2025) Safety and Efficacy of Early Initiation of Sodium-Glucose Co-Transporter Inhibitors 2 in Patients Hospitalized for Acute Heart Failure: A Meta-Analysis of Randomized Controlled Trials. European Journal of Internal Medicine, 135, 55-63. [Google Scholar] [CrossRef] [PubMed]
[20] Kosiborod, M.N., Angermann, C.E., Collins, S.P., Teerlink, J.R., Ponikowski, P., Biegus, J., et al. (2022) Effects of Empagliflozin on Symptoms, Physical Limitations, and Quality of Life in Patients Hospitalized for Acute Heart Failure: Results from the EMPULSE Trial. Circulation, 146, 279-288. [Google Scholar] [CrossRef] [PubMed]
[21] Arshad, M.S., Jamil, A., Greene, S.J., Van Spall, H.G.C., Fonarow, G.C., Butler, J., et al. (2025) In-Hospital Initiation of Sodium-Glucose Co-Transporter-2 Inhibitors in Patients with Acute Heart Failure. Heart Failure Reviews, 30, 89-101. [Google Scholar] [CrossRef] [PubMed]
[22] Heerspink, H.J.L., Stefánsson, B.V., Correa-Rotter, R., Chertow, G.M., Greene, T., Hou, F., et al. (2020) Dapagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine, 383, 1436-1446. [Google Scholar] [CrossRef] [PubMed]
[23] Li, F., Baheti, R., Jin, M., Xiong, W., Duan, J., Fang, P., et al. (2024) Impact of SGLT2 Inhibitors on Cardiovascular Outcomes and Metabolic Events in Chinese Han Patients with Chronic Heart Failure. Diabetology & Metabolic Syndrome, 16, Article No. 299. [Google Scholar] [CrossRef] [PubMed]
[24] Heidenreich, P.A., Bozkurt, B., Aguilar, D., Allen, L.A., Byun, J.J., Colvin, M.M., et al. (2022) 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145, e895-e1032. [Google Scholar] [CrossRef] [PubMed]
[25] Rao, V.N., Murray, E., Butler, J., Cooper, L.B., Cox, Z.L., Fiuzat, M., et al. (2021) In-Hospital Initiation of Sodium-Glucose Cotransporter-2 Inhibitors for Heart Failure with Reduced Ejection Fraction. Journal of the American College of Cardiology, 78, 2004-2012. [Google Scholar] [CrossRef] [PubMed]
[26] Mazzotta, R., Garofalo, M., Salvi, S., Orlandi, M., Marcaccini, G., Susini, P., et al. (2025) Early Administration of SGLT2 Inhibitors in Hospitalized Patients: A Practical Guidance from the Current Evidence. ESC Heart Failure, 12, 2631-2642. [Google Scholar] [CrossRef] [PubMed]
[27] Rahil, A.I., Bhavsar, T., Fatima, R., Rajkumar, A., Kumar, J., Majidan, H.A., et al. (2025) Efficacy and Safety of SGLT2 Inhibitors in Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Frontiers in Cardiovascular Medicine, 12, Article ID: 1543153. [Google Scholar] [CrossRef] [PubMed]
[28] Angermann, C.E., Gerhardt, T., Blatchford, J.P., Biegus, J., Collins, S.P., Kosiborod, M., et al. (2026) Empagliflozin in De Novo vs Acute Decompensated Chronic Heart Failure: A Prespecified Analysis from EMPULSE. JACC: Heart Failure, 2026, 102999. [Google Scholar] [CrossRef] 
[29] Vaduganathan, M., Docherty, K.F., Claggett, B.L., Jhund, P.S., de Boer, R.A., Hernandez, A.F., et al. (2022) SGLT2 Inhibitors in Patients with Heart Failure: A Comprehensive Meta-Analysis of Five Randomised Controlled Trials. The Lancet, 400, 757-767. [Google Scholar] [CrossRef] [PubMed]
[30] Kosiborod, M.N., Bhatt, A.S., Claggett, B.L., Vaduganathan, M., Kulac, I.J., Lam, C.S.P., et al. (2023) Effect of Dapagliflozin on Health Status in Patients with Preserved or Mildly Reduced Ejection Fraction. Journal of the American College of Cardiology, 81, 460-473. [Google Scholar] [CrossRef] [PubMed]
[31] Greene, S.J., Butler, J., Albert, N.M., DeVore, A.D., Sharma, P.P., Duffy, C.I., et al. (2018) Medical Therapy for Heart Failure with Reduced Ejection Fraction. Journal of the American College of Cardiology, 72, 351-366. [Google Scholar] [CrossRef] [PubMed]
[32] Zannad, F., Ferreira, J.P., Gregson, J., Kraus, B.J., Mattheus, M., Hauske, S.J., et al. (2022) Early Changes in Estimated Glomerular Filtration Rate Post‐Initiation of Empagliflozin in Emperor-Reduced. European Journal of Heart Failure, 24, 1829-1839. [Google Scholar] [CrossRef] [PubMed]
[33] Vaduganathan, M., Claggett, B.L., Jhund, P.S., Cunningham, J.W., Pedro Ferreira, J., Zannad, F., et al. (2020) Estimating Lifetime Benefits of Comprehensive Disease-Modifying Pharmacological Therapies in Patients with Heart Failure with Reduced Ejection Fraction: A Comparative Analysis of Three Randomised Controlled Trials. The Lancet, 396, 121-128. [Google Scholar] [CrossRef] [PubMed]

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