School of Life and Health Sciences, Aston University, Birmingham, UK.
Diabetes Obes Metab. 2019 Jun;21(6):1291-1298. doi: 10.1111/dom.13670. Epub 2019 Mar 15.
Sodium/glucose co-transporter-2 (SGLT2) inhibitors, which lower blood glucose by increasing renal glucose elimination, have been shown to reduce the risk of adverse cardiovascular (CV) and renal events in type 2 diabetes. This has been ascribed, in part, to haemodynamic changes, body weight reduction and several possible effects on myocardial, endothelial and tubulo-glomerular functions, as well as to reduced glucotoxicity. This review evaluates evidence that an effect of SGLT2 inhibitors to lower uric acid may also contribute to reduced cardio-renal risk. Chronically elevated circulating uric acid concentrations are associated with increased risk of hypertension, CV disease and chronic kidney disease (CKD). The extent to which uric acid contributes to these conditions, either as a cause or an aggravating factor, remains unclear, but interventions that reduce urate production or increase urate excretion in hyperuricaemic patients have consistently improved cardio-renal prognoses. Uric acid concentrations are often elevated in type 2 diabetes, contributing to the "metabolic syndrome" of CV risk. Treating type 2 diabetes with an SGLT2 inhibitor increases uric acid excretion, reduces circulating uric acid and improves parameters of CV and renal function. This raises the possibility that the lowering of uric acid by SGLT2 inhibition may assist in reducing adverse CV events and slowing progression of CKD in type 2 diabetes. SGLT2 inhibition might also be useful in the treatment of gout and gouty arthritis, especially when co-existent with diabetes.
钠-葡萄糖协同转运蛋白 2(SGLT2)抑制剂通过增加肾脏葡萄糖排泄来降低血糖,已被证明可降低 2 型糖尿病患者不良心血管(CV)和肾脏事件的风险。这部分归因于血流动力学变化、体重减轻以及对心肌、内皮和肾小管-肾小球功能的多种可能影响,以及降低糖毒性。这篇综述评估了 SGLT2 抑制剂降低尿酸的作用可能有助于降低心肾风险的证据。慢性高循环尿酸浓度与高血压、CV 疾病和慢性肾脏病(CKD)的风险增加有关。尿酸在这些疾病中的作用程度,无论是作为病因还是加重因素,尚不清楚,但在高尿酸血症患者中减少尿酸生成或增加尿酸排泄的干预措施始终改善了 CV 和肾脏预后。2 型糖尿病患者的尿酸浓度通常升高,导致 CV 风险的“代谢综合征”。用 SGLT2 抑制剂治疗 2 型糖尿病可增加尿酸排泄,降低循环尿酸并改善 CV 和肾功能参数。这增加了 SGLT2 抑制降低尿酸可能有助于降低 2 型糖尿病不良 CV 事件和减缓 CKD 进展的可能性。SGLT2 抑制也可能对痛风和痛风性关节炎的治疗有用,尤其是当与糖尿病共存时。
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