徐琪 付佳 韩睿

    [摘要] 钠-葡萄糖协同转运蛋白-2(SGLT-2)在糖尿病患者中表达上调，介导近端肾小管约90%尿糖重吸收。SGLT-2抑制剂是一种新型降糖药，可减少缺氧诱导因子-1蛋白和肾损伤分子-1表达，改善肾素-血管紧张素-醛固酮系统的激活，降低氧化应激产生。还可通过降低血糖、血压、尿酸及改善血脂代谢等机制保护肾脏。此外，SGLT-2抑制剂联合血管紧张素转换酶抑制剂能够治疗2型糖尿病合并慢性肾脏病的患者。SGLT-2抑制剂在糖尿病肾病患者中安全性良好，但需关注达格列净的尿路感染风险增加，同时需警惕卡格列净、达格列净的急性肾损伤风险。本文从SGLT-2抑制剂对肾脏的作用机制及治疗糖尿病肾病的临床应用等方面进行综述，以期为糖尿病肾病提供新的治疗选择。

    [关键词] 钠-葡萄糖协同转运蛋白-2抑制剂;糖尿病肾病;机制;临床应用

    [中图分类号] R587.1? ? ? ? ? [文献标识码] A? ? ? ? ? [文章编号] 1673-7210(2020)03(b)-0021-04

    [Abstract] Sodium-glucose transporter-2 (SGLT-2) is upregulated in patients with diabetes， and it is responsible for approximately 90% of the reabsorption of urine glucose in the proximal tubules. SGLT-2 inhibitor is a new type of hypoglycemic agent which can reduce the expression of hypoxia-inducible factor-1 protein and kidney injury molecule-1， and improve the activation of the renin-angiotensin-aldosterone system， while reduce the generation of oxidative stress. It can also protect the kidneys by reducing blood sugar， blood pressure， uric acid and improving lipid metabolism. In addition， SGLT-2 inhibitors combined with angiotensin-converting enzyme inhibitor are used to treat patients with type 2 diabetes combined with chronic kidney disease. SGLT-2 inhibitors have good safety in patients with diabetic nephropathy ......