针对心脏代谢多病症的机制导向药疗:从病理生理学到表型优先治疗
Hezeng Dong1, Liping Chang2, Tenghui Tian2
1Changchun University of Chinese Medicine, Changchun, Jilin, China.
Frontiers in endocrinology
|December 17, 2025
概括
心脏代谢多病症 (CMM) 管理需要新的策略,超越单一疾病的指导方针. 根据患者表型优先考虑SGLT2抑制剂和GLP-1RA等特定药物类别,可以改善复杂心血管和代谢疾病的结果.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 腎臟病學 (nephrology) 是一種醫學.
背景情况:
- 心脏代谢多病症 (CMM) 构成了日益严重的全球健康挑战,往往以零碎的,单一疾病的方法来治疗.
- 目前对CMM管理的指导方针往往是孤立的,导致多药和潜在的冲突治疗.
- 新出现的证据表明,对CMM的基于机制的疗法进行范式转变.
研究的目的:
- 审查用于管理心脏代谢多病症 (CMM) 的药理学药物的证据.
- 要突出降糖剂超出血糖控制的多器官保护作用.
- 为患有并发性心血管和代谢疾病的患者提供关于优化治疗策略的指导.
主要方法:
- 大规模结局试验 (2020-2025) 和转化研究的审查.
- 对药理学剂的机械路径和多器官保护作用的分析.
- 对-葡萄糖共运输体2抑制剂,GLP-1受体激动剂和非类固醇矿物质皮质醇受体对抗剂的证据评估.
主要成果:
- 像SGLT2抑制剂和GLP-1受体激动剂这样的药物表现出显著的心血管和脏保护作用,独立于血糖控制.
- 这些药物在适当组合时显示出附加效益.
- 非类固醇矿物质皮质类受体抗剂对CMM内的慢性病表型有益.
结论:
- 建议在CMM管理中优先考虑基于患者表型的SGLT2抑制剂或GLP-1受体激动剂.
- 门监测协议对于减轻低血糖和高血糖等风险至关重要.
- 基于机制的疗法优化有望改善CMM的结果,未来的研究重点是降级策略.
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