研究对糖尿病中新型降血糖药物的影响以及心肌缺血/再灌注损伤的影响
Research progress on the effects of novel hypoglycemic drugs in diabetes combined with myocardial ischemia/reperfusion injury
影响因子:12.40000
分区:医学1区 Top / 老年医学1区 细胞生物学2区
发表日期:2023 Apr
作者:
Tiangui Yang, Daqing Zhang
摘要
急性心肌梗死（AMI）再灌注与缺血/再灌注（I/R）损伤有关，这会导致心肌梗死的大小扩大，梗塞心肌治愈不良，梗塞心肌的治愈不佳，左心室重塑不良，从而增加了严重心血管疾病的风险。糖尿病会增加对I/R损伤的心肌敏感性，降低对心脏保护策略的心肌反应性，加剧心肌I/R损伤，并扩大AMI的梗塞大小，从而增加恶性心律失常的发生率。当前，缺乏有关糖尿病与AMI和I/R损伤的糖尿病药理干预措施的证据。传统的降血糖药物在预防和治疗I/R损伤的预防和治疗中起作用有限。目前的证据表明，新型的低血糖药物可能对糖尿病以及心肌I/R损伤产生预防作用梗塞大小，抑制缺血性心脏的结构和功能重塑，改善心脏功能，并通过机制减少与AMI结合的糖尿病患者的MAS发生，例如减少炎症反应，抑制氧化应激的抑制作用，并改善血管内皮功能。本文将系统地阐述GLP-1 RA和SGLT2I在糖尿病中的保护作用和分子机制，结合心肌I/R损伤，旨在提供临床辅助。
Abstract
Acute myocardial infarction (AMI) reperfusion is associated with ischemia/reperfusion (I/R) injury, which leads to enlarged myocardial infarction size, poor healing of the infarcted myocardium, and poor left ventricular remodeling, thus increasing the risk of major adverse cardiovascular events (MACEs). Diabetes increases myocardial susceptibility to I/R injury, decreases myocardial responsiveness to cardioprotective strategies, exacerbates myocardial I/R injury, and expands the infarct size of AMI, thereby increasing the incidence of malignant arrhythmias and heart failure. Currently, evidence regarding pharmacological interventions for diabetes combined with AMI and I/R injury is lacking. Traditional hypoglycemic drugs have a limited role in the prevention and treatment of diabetes combined with I/R injury. Current evidence suggests that novel hypoglycemic drugs may exert a preventive effect on diabetes combined with myocardial I/R injury, especially glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-dependent glucose transporter protein 2 inhibitors (SGLT2i), which may increase coronary blood flow, reduce acute thrombosis, attenuate I/R injury, decrease myocardial infarction size, inhibit structural and functional remodeling of the ischemic heart, improve cardiac function, and reduce the occurrence of MACEs of diabetes patients combined with AMI via mechanisms such as reduction of inflammatory response, inhibition of oxidative stress, and improvement of vascular endothelial function. This paper will systematically elaborate the protective role and molecular mechanisms of GLP-1 RA and SGLT2i in diabetes combined with myocardial I/R injury, aiming to provide clinical assistance.