急性心肌梗塞（AMI）再灌注与缺血/再灌注（I/R）损伤相关，导致心肌梗塞面积增大、梗死心肌愈合不良、左心室重构不良，从而增加主要不良心血管事件（MACEs）的风险。糖尿病增加心肌对I/R损伤的敏感性，降低心肌对心脏保护策略的反应性，加剧心肌I/R损伤，扩大AMI的梗塞面积，从而增加恶性心律失常和心力衰竭的发生率。目前，有关糖尿病加上AMI和I/R损伤的药物干预的证据不足。传统的降糖药物在预防和治疗糖尿病并发I/R损伤方面的作用有限。目前的证据表明，新型降糖药物可能对糖尿病伴发心肌I/R损伤起到预防作用，特别是胰高血糖素样肽-1受体激动剂（GLP-1 RA）和钠依赖性葡萄糖转运蛋白2抑制剂（SGLT2i），它们可能通过减少炎症反应、抑制氧化应激和改善血管内皮功能等机制，增加冠状动脉血流，减少急性血栓形成，减轻I/R损伤，减少心肌梗塞面积，抑制缺血心脏的结构和功能重构，改善心功能，降低糖尿病患者AMI的发生率。本文将系统阐述GLP-1 RA和SGLT2i在糖尿病伴发心肌I/R损伤中的保护作用和分子机制，旨在为临床提供帮助。版权所有©2023 Elsevier B.V.

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.Copyright © 2023 Elsevier B.V. All rights reserved.