2 型糖尿病和慢性肾病患者的新型心脏保护和肾脏保护联合疗法:应用前景

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Diabetes Mellitus Pub Date : 2024-03-19 DOI:10.14341/dm13113
Y. Khalimov, G. V. Semikova, Yu. A. Shutova
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引用次数: 0

摘要

慢性肾病(CKD)是糖尿病的常见并发症。它大大增加了心血管风险,降低了生活质量。慢性肾脏病需要治疗,而 2 型糖尿病的治疗模式已从以血糖为中心的方法转向疾病调节疗法。保护心脏和肾脏的作用正受到重视。在 2 型糖尿病和慢性肾脏病患者中,影响肾素-血管紧张素-醛固酮系统的药物以及钠-葡萄糖共转运体 2 型抑制剂(iSGLT2)被广泛使用。尽管这些药物在保护肾功能方面的积极作用已得到证实,但慢性肾功能衰竭的发病机制中仍有一些尚未涉及的环节。特别是,由于矿皮质激素受体的高表达,CKD 患者肾实质纤维化过程的活性增加。这可能是肾脏保护药物的潜在靶点。因此,矿皮质激素受体拮抗剂(MCRA)可能会影响 CKD 进展的残余风险。特别是非类固醇选择性 AMCR 非格列酮(fineerenone)的有效性已在多项大型临床研究中得到证实,这些研究证实了其肾脏保护潜力。在这方面,亟需研究已知肾脏保护药物的联合作用,以及它们对心血管风险的联合作用。本综述介绍了 iSGLT2 和非奈酮联合作用的主要机制。本综述介绍了 iSGLT2 和非格列酮联合作用的主要机制,并讨论了联合使用标准肾保护疗法、SGLT2 和非格列酮的主要临床研究结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Novel cardioprotective and nephroprotective combination in patients with type 2 diabetes and chronic kidney disease: perspectives of use
Chronic kidney disease (CKD) is a common complication of diabetes mellitus. It increases significantly cardiovascular risk and decreases the quality of life. CKD requires treatment, and the treatment paradigm for type 2 diabetes has shifted from a glucose-centric approach towards disease-modifying therapy. Attention is being paid to cardioprotective and nephroprotective effects. In patients with type 2 diabetes and CKD, drugs that affect the renin-angiotensin-aldosterone system, as well as sodium-glucose cotransporter type 2 inhibitors (iSGLT2) are widely used. Despite the proven positive effect of these drugs in preservation of renal functions, the pathogenesis of CKD contains links that have not yet been covered. In particular, the activity of fibrosis processes in the renal parenchyma is increased in patients with CKD due to high expression of mineracorticoid receptors. It may be a potential target for nephroprotective drugs. Thus, mineralocorticoid receptor antagonists (MCRA) may influence the residual risk of CKD progression. In particular, the effectiveness of the non-steroid selective AMCR finerenone has been proven in a number of large clinical studies, which confirmed its nephroprotective potential. In this regard, studies aimed at studying the joint effect of known nephroprotective drugs, as well as their combined effect on cardiovascular risk, are highly needed.This review marks the main mechanisms of the combined action of iSGLT2 and finerenone. Discussion of the results of main clinical studies with combined use of standard nephroprotective therapy, SGLT2 and finerenone is also presented.
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来源期刊
Diabetes Mellitus
Diabetes Mellitus ENDOCRINOLOGY & METABOLISM-
CiteScore
1.90
自引率
40.00%
发文量
61
审稿时长
7 weeks
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