Pop Laurentiu M, Lingvay Ildiko
Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, TX, USA.
Department of Clinical Science, UT Southwestern Medical Center, 5323 Harry Hines Blvd, U9.134C, Dallas, TX, 75390-9302, USA.
Curr Diab Rep. 2017 Oct 23;17(12):124. doi: 10.1007/s11892-017-0954-4.
Sulfonylureas (SUs) are one of the most commonly used glucose-lowering agents worldwide. While their efficacy is undisputed, their cardiovascular safety has been debated since the 1970's.
With no dedicated cardiovascular studies to definitively answer this question, observational studies and meta-analyses abound and have reported divergent results, fueling the controversy. Studies that compared SUs to metformin or newer agents, like GLP-1 agonists and SGLT2 inhibitors, suggest a difference in cardiovascular events, yet this is likely the result of beneficial effects of the latter. Studies comparing SUs to other agents have been reassuring. SUs remain a common choice of treatment for patients with type 2 diabetes due to their exceptional value. They are effective at lowering glucose and thus contributing to the prevention of microvascular complications. Weight gain and hypoglycemia are their main side effects, although less severe when compared to insulin treatment. Their cardiovascular safety will remain a controversial topic due to lack of conclusive data, but there is no definitive evidence of harm with the second-generation agents.
磺脲类药物（SUs）是全球最常用的降糖药物之一。虽然其疗效无可争议，但自20世纪70年代以来，其心血管安全性一直存在争议。
由于缺乏专门的心血管研究来明确回答这个问题，观察性研究和荟萃分析大量涌现，且报告结果不一，加剧了争议。将磺脲类药物与二甲双胍或新型药物（如GLP-1激动剂和SGLT2抑制剂）进行比较的研究表明，心血管事件存在差异，但这可能是后者有益作用的结果。将磺脲类药物与其他药物进行比较的研究结果令人安心。由于其卓越的价值，磺脲类药物仍然是2型糖尿病患者常用的治疗选择。它们能有效降低血糖，从而有助于预防微血管并发症。体重增加和低血糖是其主要副作用，不过与胰岛素治疗相比不太严重。由于缺乏确凿数据，其心血管安全性仍将是一个有争议的话题，但没有确凿证据表明第二代药物有害。
