新型降糖药与骨折风险关系的研究进展  

Research progress on the relationship between new hypoglycemic drugs and fracture risk

作　　者：彭净[1] 马洁 曹晓孚[1] 刘振[1] 赵艳艳[1] 王辉[1] 陈静 张正军[3] Peng Jing;Ma Jie;Cao Xiaofu;Liu Zhen;Zhao Yany an;Wang Hui;Chen Jing;Zhang Zhengjun(Department of Pharmacy,Affiliated Hospital of Jining Medical University,Shandong Province,Jining 272000,China;Graduate Department,ChinaPharmaceutical University,Nanjing 210009,China;Department of Endocrinology,Affiliated Hospital of Jining Medical University,Shandong Province,Jining 272000,China)

机构地区：[1]济宁医学院附属医院药学部,272000 [2]中国药科大学研究生处,南京210009 [3]济宁医学院附属医院内分泌科,272000

出　　处：《药物不良反应杂志》2019年第6期435-440,共6页Adverse Drug Reactions Journal

基　　金：济宁医学院附属医院“苗圃”科研课题(MP-2017-017)。

摘　　要：糖尿病患者是骨质疏松、骨折的高风险人群,某些降血糖药可能会增加糖尿病患者的骨折风险。目前常用的新型降糖药包括肠促胰岛素类似物及钠-葡萄糖共转运蛋白2(SGLT2)抑制剂,前者又包括二肽基肽酶4(DPP4)抑制剂和胰高血糖素样肽(GLP)1受体激动剂。临床研究中发现,GLP1受体激动剂利拉鲁肽、DPP4抑制剂阿格列汀等可能会减少2型糖尿病患者骨折事件的发生风险,而GLP1受体激动艾塞那肽在日剂量超过22.5μg的情况下可能会增加骨折发生风险。SGLT2抑制剂在抑制肾小管重吸收钠和葡萄糖的同时可导致磷酸盐的重吸收增加。血磷增加可通过间接途径促进骨吸收,导致骨质疏松,增加骨折风险。然而在临床研究中除发现卡格列净可能会增加患者骨折发生风险外,没有证据证明其他SGLT2抑制剂与骨折风险增加相关。Patients with diabetes mellitus are at high risk for osteoporotic and fractures.Some hypoglycemic drugs may increase the risk of fracture in diabetic patients.At present,the commonly used new hypoglycemic agents include incretin mimetic drugs and sodium-glucose co-transporter protein 2(SGLT2)inhibitors.The incretin mimetic drugs include dipeptidyl peptidase 4(DPP4)inhibitors and glucagon-like peptide(GLP)1 receptor agonists.It was found in clinical studies that GLP1 receptor agonist liraglutide and DPP4 inhibitor alogliptin may reduce the risk of fracture events in patients with type 2 diabetes mellitus,while GLP1 receptor agonist exenatide may increase the risk of fracture when its daily dose is more than 22.5μg.SGLT2 inhibitors can inhibit the reabsorption of sodium and glucose in renal tubules and increase the reabsorption of phosphate.The increase of blood phosphorus can indirectly promote bone absorption,which would lead to osteoporosis and increase the risk of fracture.However,there was no evidence in clinical studies that other SGLT2 inhibitors except canagliflozin may be associated with the increase of fracture risk.

关 键 词：降血糖药 肠促胰岛素类 钠-葡萄糖转运蛋白2抑制剂 骨折 药物相关副作用和不良反应 

分 类 号：R6[医药卫生—外科学] R587[医药卫生—临床医学]