王贺平 连续

[摘要] 糖尿病肾病（DKD）是糖尿病常见的微血管病变，其发病的影响因素与糖尿病患病时间的长短、血糖、血压、血脂的水平有关。这个疾病的发生机制复杂，在临床上的治疗难度较大。DKD在终末期肾脏疾病（ESRD）的各种发病原因中占据着不容小觑的影响。近几年钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂的出现及应用，给DKD患者的治疗带来了新的曙光，也是延缓病情的关键一步。本文就SGLT-2抑制剂的肾保护作用、血管紧张素转化酶抑制剂（ACEI）類药物的肾保护机制、SGLT-2抑制剂联合ACEI类药物的肾保护机制，SGLT-2抑制剂不良反应、局限性及总结展望等方面的研究进展进行综述。

[关键词] 糖尿病肾病;钠-葡萄糖协同转运蛋白2抑制剂;血管紧张素转化酶抑制剂;终末期肾脏疾病

[中图分类号] R587.2;R692.9          [文献标识码] A          [文章编号] 1673-9701（2021）36-0189-04

Research progress of SGLT-2 inhibitor in treating diabetic kidney disease

WANG Heping   LIAN Xu

Department of Endocrinology，Hongqi Hospital Affiliated to Mudanjiang Medical University，Mudanjiang   157011，China

[Abstract] Diabetic kidney disease（DKD）is a common microangiopathy in diabetes mellitus. The influencing factors of DKD onset are related to the duration of diabetes mellitus，the levels of blood sugar，blood pressure and blood lipid. The pathogenesis of this disease is complex and its clinical treatment is tough. DKD plays an important role in the pathogenesis of end stage renal disease. In recent years，the emergence and application of sodium-glucose cotransporter 2（SGLT-2）inhibitor have brought new dawn to the treatment of DKD patients and are also a key step to delay the disease. In this article，the overview was done concerning the research progress in renal protection of SGLT-2 inhibitors，renal protection mechanism of angiotensin converting enzyme inhibitors（ACEI），renal protection mechanism of SGLT-2 inhibitors combined with ACEI drugs，adverse reactions，limitations and prospects of SGLT-2 inhibitors.

[Key words] Diabetic kidney disease;Sodium-glucose cotransporter 2 inhibitor;Angiotensin converting enzyme inhibitor;End-stage renal disease

糖尿病肾病（Diabetic kidney disease，DKD）的治疗以改善血糖、血压、血脂、尿蛋白及生活方式等危险因素延缓终末期肾脏疾病（End stage renal disease，ESRD）的进程，但仍有40%以上通过接受正规治疗的患者面临着进展为ESRD的风险[1]。T2DM患者对肾脏疾病的认知很低，特别是在疾病一般无症状的早期阶段，只有40%～50%的患者知道自身的情况。DKD患者的早期检查尿常规也可无明显异常，但实际肾脏功能可能已经出现病理改变[2]，可表现为系膜细胞增生、基质增多等肾小球的早期病理变化。所以糖尿病患者要3个月筛查眼底，半年检查肾功能，及早发现病情，及早干预，改善糖尿病患者的预后及生活质量，延缓糖尿病肾病的进程。

1 糖尿病肾病流行病学