第2型鈉－葡萄糖共同轉運蛋白抑制劑的降血壓效應：文獻回顧

The Anti-hypertensive Effect of Sodium-glucose Cotransporter 2 Inhibitors

蘇貞元(Chen-Yuan Su) ； 趙庭興(Ting-Hsing Chao)

《內科學誌》 32卷1期 (2021/02) Pp. 1-7

https://doi.org/10.6314/JIMT.202102_32(1).01

摘要

高血壓以及糖尿病為重要的心血管疾病因子，且近年來盛行率持續爬升。第二型鈉－葡萄糖共同轉運蛋白（sodium glucose cotransporter 2，SGLT2）抑制劑為近年來新發展的口服血糖藥物，此藥物的主要的降血糖機轉是透過抑制SGLT2來增加尿糖的排除，進而降低血糖。因為非透過胰島素作用，故此藥物較不會有低血糖的風險。研究顯示使用SGLT2抑制劑可下降血壓，大型的心血管預後研究也顯示其有心臟與腎臟的保護效果。該藥物降血壓的機轉尚未明確，但目前已知可能透過不同途徑以達降壓效應，包括利尿效果、減重、動脈血管功能的改善以及交感系統的抑制皆扮演重要角色。

關鍵字

糖尿病（Diabetes mellitus） ； 高血壓（Hypertension） ； 第二型鈉－葡萄糖共同轉運蛋白抑制劑（Sodium-glucose cotransporter 2 inhibitor）

並列摘要

Hypertension and diabetes mellitus are important risk factors for cardiovascular disease. The prevalence of both diseases are still increasing. The sodium-glucose cotransporter 2 (SGLT2) inhibitor is a relatively new oral antidiabetic agent. The main mechanism of action for blood glucose lowering with this drug is through glycosuria due to its inhibiting effect on SGLT2 in nephrons. Since the action of the drug is independent from insulin, hypoglycemia is rare with an SGLT2 inhibitor. Many studies had consistently demonstrated blood pressure lowering effect of SGLT2 inhibitors, and large cardiovascular outcome trials also revealed the cardio-renal protection effect of SGLT2 inhibitors. Although the mechanisms of anti-hypertensive effect of SGLT2 inhibitors are not well established, an interplay pathway had been suggested, including diuretic effect, weight loss, improvement of arterial stiffness and endothelial dysfunction, and suppression of sympathetic over-activation.