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摘要: 近年来，因具有广泛的心血管保护作用，钠葡萄糖共转运体2抑制剂(SGLT2i)获得较大的关注。鉴于其广泛的心血管益处，有人推测SGLT2i可能降低心律失常发生的风险。对近几年有关SGLT2i与心律失常的研究进行总结和分析，发现SGLT2i可能通过对氧化应激、离子通道、自主神经系统及危险因素等方面的影响来减少心律失常的发生。但由于现有证据缺乏，仍然需要进一步的研究来证实。Abstract: In recent years, there has been increasing interest in sodium-dependent glucose transports 2 inhibitors(SGLT2i), mainly due to their broad cardiovascular protective effects. Given the broad cardiovascular benefits of SGLT-2i, it has been hypothesized that SGLT2i may reduce the risk of arrhythmias. Recent studies suggest that SGLT2i may reduce arrhythmias through the effects on oxidative stress, ion channels, the autonomic nervous system, and risk factors, but further studies are needed to confirm this due to the lack of evidence from existing studies.
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Key words:
- arrhythmias /
- oxidative stress /
- ion channels /
- autonomic nervous system /
- risk factors
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表 1 SGLT2i与房性心律失常研究汇总
Table 1. Studies on SGLT2i and atrial arrhythmias
研究 药物 研究对象 研究结论 Effect of dapagliflozin on atrial fibrillation in patients with type 2 diabetes mellitus insights from the DECLARE-TIMI 58 trial 达格列净 T2DM患者 达格列净在随访期间可降低T2DM患者AF/AFL事件风险以及AF/AFL事件的总次数 Sodium-glucose cotransporter 2 inhibitors(SGLT2i)and cardiac arrhythmias：a systematic review and meta-analysis 达格列净
卡格列净
恩格列净
埃格列净T2DM、CKD
或HF患者SGLT2i治疗可使AF风险降低18%，对AFL的风险没有显著影响。当AF和AFL合并作为复合终点时，SGLT2i使AF/AFL风险降低 Protective effects of sodium-glucose transporter 2 inhibitors on atrial fibrillation and atrial flutter：a systematic review and meta-analysis of randomized placebo-controlled trials 达格列净
卡格列净
恩格列净
索格列净
埃格列净高血糖患者 SGLT2i的使用与AF/ AFL风险降低相关。达格列净使用者AF/AFL发作的风险最低，卡格列净其次，恩格列净、索格列净、埃格列净无明显作用 SGLT2 inhibitors and atrial fibrillation in type 2 diabetes：a systematic review with meta-analysis of 16 randomized controlled trials 达格列净
卡格列净
恩格列净T2DM患者 与安慰剂相比，SGLT2i显著降低了AF/AFL事件的发生率。达格列净与AF/AFL显著降低相关，而卡格列净和恩格列净对减少AF/AFL事件无明显作用 Canagliflozin and atrial fibrillation in type 2 diabetesmellitus：A secondary analysis from the CANVAS Programand CREDENCE trial and meta-analysis 卡格列净 T2DM患者 整体队列中，卡格列净治疗对AF/AFL的发生率无明显影响。但卡格列净似乎可降低无AF/AFL史患者的AF/AFL发生率。卡格列净对其他关键心血管和肾脏结局的相对影响不受基线AF/AFL病史的影响 New-onset atrial fibrillation in patients with type 2 diabetes treated with novel glucose lowering therapies 恩格列净
达格列净
卡格列净T2DM患者 与GLP-1RAs相比，使用SGLT2i与较低的新发AF风险相关 The risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors 恩格列净
达格列净
卡格列净T2DM患者 与DPP4i相比，使用SGLT2i与较低的AF发生风险相关 
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表 2 SGLT2i与室性心律失常研究汇总
Table 2. Studies on SGLT2i and ventricular arrhythmias
研究 药物 研究对象 研究结论 Sodium-glucose cotransporter 2 inhibitors(SGLT2i)and cardiac arrhythmias：a systematic review and meta-analysis 达格列净
卡格列净
恩格列净
埃格列净T2DM、CKD
或HF的患者SGLT2i与VT风险降低相关，但对SCA风险无显著影响 Effect of dapagliflozin on ventricular arrhythmias，resuscitated cardiac arrest，or sudden death in DAPA-HF 达格列净 HFrEF患者 达格列净可降低任何“严重”室性心律失常、SCA复苏或猝死的首次发生时间的主要复合终点发生率 Association between sodium-glucose cotransporter-2 inhibitors and risk of sudden cardiac death or ventricular arrhythmias：a meta-analysis of randomized controlled trials. 卡格列净
恩格列净
达格列净T2DM、HF
和(或)
CKD患者SGLT2i治疗与SCD或室性心律失常的总体风险降低无关 Association of SGLT2 inhibitors with arrhythmias and sudden cardiac death in patients with type 2 diabetes or heart failure：A meta-analysis of 34 randomized controlled trials 卡格列净
达格列净
恩格列净
埃格列净T2DM或
HF患者SGLT2i可显著降低房性心律失常和SCD的发生风险，对室性心律失常的风险无明显作用 Empaglifozin protects the heart againstischemia/reperfusion-induced sudden cardiac deathAzam 恩格列净 雄性Sprague
Dawley
大鼠恩格列净可降低大鼠室性心律失常的发生风险，对SCD具有强大的保护作用 Acute dapagliflozin administration exerts cardioprotective effects in rats with cardiac ischemia/reperfusion injury 达格列净 雄性Wistar
大鼠达格列净在预处理组大鼠第1次发生VT/VF的时间显著延长，在缺血和再灌注开始阶段，达格列净组的这些参数与对照组无差异 Anti-arrhythmic and inotropic effects of empagliflozin following myocardial ischemia 恩格列净 Langendorff-
perfused
兔心脏模型恩格列净治疗可使直接电刺激诱发的VF发作时间显著减少，VF诱导率明显降低
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| 引用本文: |
张琪, 李佳. 钠葡萄糖共转运体2抑制剂与心律失常[J]. 临床心血管病杂志, 2023, 39(9): 674-680. doi: 10.13201/j.issn.1001-1439.2023.09.005
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| Citation: |
ZHANG Qi, LI Jia. Sodium-dependent glucose transports 2 inhibitors and cardiac arrhythmias[J]. J Clin Cardiol, 2023, 39(9): 674-680. doi: 10.13201/j.issn.1001-1439.2023.09.005
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