许加伟　何劲松

[关键词] 糖尿病肾病;新型降糖药;降糖作用;肾脏保护作用

[中图分类号] R587.2          [文献标识码] A          [文章编号] 1673-9701（2021）23-0189-04

Application of new hypoglycemic agents in the treatment of diabetic nephropathy

XU Jiawei1   HE Jinsong2

1.Graduate School，Nanjing University of Chinese Medicine，Nanjing   210000，China; 2.Department of Nephrology，Nanjing Drum Tower Hospital，The Affiliated Hospital of Nanjing University Medical School， Nanjing   210008，China

[Abstract] Diabetic nephropathy （DN） is one of the most important complications of diabetic patients. With the increasing number of diabetic patients，the prevalence of DN showed a rising trend simultaneously. If DN continues to progress，it will easily develop into end-stage renal disease （ESRD）. Because of the complex metabolic disorder of DN，the treatment will be more difficult once faced with the ESRD.There are limitations in blindly controlling blood glucose in DN，and more attention should be paid to the damage of target organs. In recent years，with the advent of new hypoglycemic agents （dipeptidyl peptidase-4 inhibitors，glucagon-like peptide-1 receptor agonists，and sodium-glucose transporter-2 inhibitors）， the protection effect of kidney has been better solved while controlling blood glucose. The hypoglycemic effect，renal protection effect and related study progress of new hypoglycemic agents will be reviewed in this paper.

[Key words] Diabetic nephropathy; New hypoglycemic agents; Hypoglycemic effect; Renal protection effect

隨着人类生活水平的提高、人口老龄化的加剧，糖尿病患者的数量逐年上升。据统计到2045年，全球糖尿病患者数量将增至6.93亿[1]。糖尿病患者中大约有30%～40%可发展为糖尿病肾病。糖尿病肾病的发病机制较为复杂，危险因素较多，其中最关键的就是高血糖。高血糖可以通过多种作用机制对肾脏的结构及功能产生损伤。首先，肾素-血管紧张素-醛固酮系统（Renin-angiotensin-aldosterone system，RAAS）激活，使得血管紧张素II生成增多，肾小球动脉、毛细血管压力以及肾小球滤过率也随之增加，从而形成高滤过、高灌注，促使肾小球损伤。其次，多种炎性介质以及炎性因子的产生、细胞氧化防御机制的失衡，都能促使肾小球逐渐硬化、肾间质纤维化、肾小管的萎缩，从而逐渐推进糖尿病肾病的发展，最终形成终末期肾脏病。

目前糖尿病肾病已成为终末期肾脏病的第二位原因，仅次于各种肾小球肾炎。针对糖尿病肾病患者，在监测血糖变化、防止血糖水平紊乱发生的同时，积极治疗并发症、保护肾脏功能、防止糖尿病肾病进一步发展，也成为了重中之重。传统的降糖药，例如：二甲双胍、磺酰脲类、胰岛素被证实在降低血糖的同时能降低并发症发生的风险，但二甲双胍、磺酰脲类药物引起的低血糖事件、胰岛素引起的体重增加等副作用也不容忽视。近几年来，新型降糖药的逐步面世让2型糖尿病、糖尿病肾病的治疗更加全面[2]。……