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2型糖尿病的精密药物:针对SGLT2抑制剂治疗,以保护脏
Thijs T Jansz1, Katherine G Young2, Rhian Hopkins2
1University of Exeter Medical School, University of Exeter, Exeter, UK. t.jansz@exeter.ac.uk.
Diabetologia
|November 9, 2025
概括
一个新的模型准确地预测了早期CKD的2型糖尿病患者对SGLT2抑制剂的脏保护. 这种方法比目前的白尿症指南更有效地针对治疗,改善治疗结果.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 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:
- 目前的指导方针建议SGLT2抑制剂用于保护CKD (uACR≥3 mg/mmol) 的2型糖尿病 (T2D) 的脏.
- 结局试验不包括正常uACR或低水平albuminuria的个体,在这个人群中对治疗益处产生不确定性.
- 需要一个预测模型来指导SGLT2抑制剂治疗决策的T2D患者早期CKD.
研究的目的:
- 开发和验证一个模型来预测SGLT2抑制剂对早期CKDT2D患者的个体水平脏保护益处.
- 为了比较基于模型的治疗策略的临床效用与当前的白蛋白尿值.
主要方法:
- 使用英国初级保健电子健康记录 (2013-2020) 的观察性队列研究.
- 包括患有T2D,eGFR≥60毫升/分钟/1.73毫米2和uACR<30毫克/毫升的成年人,启动SGLT2抑制剂或DPP4抑制剂/硫氨酸尿素.
- 验证了CKD-PC风险评分,并将其预测与SGLT2抑制剂相对治疗效应相结合,以估计3年绝对风险降低.
主要成果:
- 与DPP4抑制剂/硫尿素相比,SGLT2抑制剂显示病进展的相对风险降低了42% (HR 0.58).
- CKD-PC风险评分显示了良好的校准.
- 该模型预测,在3年内,绝对风险的中位数降低0.37%,通过确定高效益子组,uACR<3 mg/mmol,其临床效用优于albuminuria值.
结论:
- 一个适应的CKD-PC风险评分模型准确地预测了SGLT2抑制剂对没有CKD或早期CKD的T2D患者的个人脏保护益处.
- 这个模型可以指导全球的临床实践,使得治疗的向性比目前的≥3 mg/mmol白尿指南更有效.
- 这些发现支持个性化治疗策略,以保护T2D的脏.
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