接受脏移植的糖尿病患者和新的低血糖药物选择
Giulia Bartoli1, Andrea Dello Strologo2,3, Maria Arena4
1Nephrology and Dialysis Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy.
International journal of molecular sciences
|July 12, 2025
概括
较新的糖尿病药物,包括SGLT2抑制剂和GLP-1RA,对移植接受者来说是有前途的. 这些药物可以通过抵消免疫抑制作用和降低心血管风险来改善结果.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 糖尿病 (DM) 在移植接受者 (KTRs) 中很常见,对移植物和患者的生存有负面影响.
- 较新的低血糖药物,包括SGLT2抑制剂 (SGLT2is),GLP-1受体激活剂 (GLP1RAs) 和非类固醇矿物质皮质类受体对抗剂 (ns-MRAs),如芬瑞,已被批准用于慢性病 (CKD) 患者.
- 这些药物在减轻糖尿病CKD患者心血管 (CV) 事件和病进展方面具有显著的益处.
研究的目的:
- 审查SGLT2is,GLP1RAs和ns-MRAs在2型糖尿病或移植后糖尿病 (PTDM) 的KTRs中的使用和潜在益处.
- 分析从观察性研究,元分析和临床试验中获得的文学数据,对KTRs中的这些药物进行分析.
主要方法:
- 对观察性研究,元分析和临床试验的文献评论.
- 分析药物作用机制及其对KTRs的潜在影响.
- 对安全性和有效性数据的评估,包括与免疫抑制疗法的相互作用和排斥风险.
主要成果:
- 在KTRs中,SGLT2is和GLP1RAs通常似乎是安全和有效的.
- 对于SGLT2is和GLP1RAs,没有报告SGLT2is和GLP1RAs的排斥或与免疫抑制药物不良相互作用的风险增加.
- 有限的数据存在于finerenone,有一个正在进行的临床试验;目前没有文献数据可用.
结论:
- SGLT2is和GLP1RAs可以减轻KTRs免疫抑制的负面代谢影响,可能减少PTDM和CV事件.
- 尽管2022年KDIGO指南谨慎,但最近的专家共识鼓励在KTR中使用这些药物.
- 需要进一步的研究,特别是在finerenone,但目前的证据支持在这个人群中使用SGLT2is和GLP1RAs.
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