钠-葡萄糖共转运蛋白2抑制剂对老年2型糖尿病患者发生肌肉减少症的影响  

Effect of sodium-glucose cotransporter 2 inhibitor on sarcopenia in elderly patients with type 2 diabetes

作　　者：宋宝娜 林萍[2] 王琴[2] SONG Baona;LIN Ping;WANG Qin(The Fourth Clinical Medical College of Zhejiang Chinese Medicine University,Hangzhou,Zhejiang 310053,China;不详)

机构地区：[1]浙江中医药大学第四临床医学院,浙江杭州310053 [2]杭州市第三人民医院老年科,浙江杭州310009

出　　处：《中华全科医学》2023年第6期1016-1020,共5页Chinese Journal of General Practice

基　　金：浙江省杭州市卫生计生科技计划重点项目(2018Z05);浙江省医药卫生科技计划面上项目(2019KY502);杭州市医学重点学科建设项目(杭卫发[2021]21号)。

摘　　要：2型糖尿病是老年人常见的疾病之一,随着年龄的增加发病率增高。肌肉减少症简称肌少症,是一种与增龄相关的临床综合征。研究表明,肌少症在老年2型糖尿病患者中的发病率逐年增高。2型糖尿病合并肌少症的发病机制主要有:胰岛素抵抗、慢性炎症、氧化应激、线粒体功能障碍、周围神经病变及损伤、降糖药物的使用等。多种降糖药物例如双胍类(biguanides)、噻唑烷二酮类(thiazolidinediketones)、二肽激肽酶-4抑制剂(dipeptidyl peptidase-4 inhibitors,DPP-Ⅳ抑制剂)、胰高糖素样肽-1受体激动剂(glucagon-like peptide-1 receptor agonist,GLP-1RA)、钠-葡萄糖共同转运体2抑制剂(sodium-glucose cotransporter-2 inhibitors,SGLT-2i)等均对肌少症的发生有影响。随着SGLT-2i在降糖治疗及心血管疾病治疗中的广泛应用,笔者发现,其对肌少症也有重要影响。SGLT-2i在老年2型糖尿病患者的使用过程中,能够优化人体结构,减少脂肪量但不会影响肌肉含量,不会增加骨折的发生率;可以通过肌肉和脂肪的调节与转录、提高氧化磷酸化及控制炎症等方面延缓肌少症的发生;可通过影响中枢神经系统,使患者的主动摄食量增加,从营养不良层面减少肌少症发生的风险。因此,SGLT-2i应用于老年2型糖尿病患者,不仅能起到降糖、保护心血管的作用,对延缓肌少症的发生也有重要的意义。SGLT-2i的使用对老年2型糖尿病合并肌少症患者的治疗来说,或许可以带来新思路、新靶点。Type 2 diabetes is one of the common diseases of the elderly,and the incidence increases with the increase of age.Sarcopenia,or sarcopenia,is also a clinical syndrome associated with aging.Studies have shown that the incidence of sarcopenia in elderly patients with type 2 diabetes is increasing year by year.The pathogenesis of type 2 diabetes combined with sarcopenia mainly includes insulin resistance,chronic inflammation,oxidative stress,mitochondrial dysfunction,peripheral neuropathy and injury,and the use of hypoglycemic drugs.Many hypoglycemic drugs,such as biguanides,thiazolidinediketones,dipeptidyl peptiase-4 inhibitors(DPP-Ⅳinhibitor),glucagon-like peptide-1 receptor agonist(GLP-1RA),sodium-glucose cotransporter-2 inhibitors(SGLT-2i)and other inhibitors have influence on the occurrence of sarcopenia.With the wide application of SGLT-2i in hypoglycemic treatment and cardiovascular disease treatment,the author found that it also has an important impact on sarcopenia.When used in elderly patients with type 2 diabetes,SGLT-2i can optimize the body structure and reduce fat without affecting muscle content or increasing the incidence of fracture.It can delay the occurrence of sarcopenia through the regulation and transcription of muscle and fat,improve oxidative phosphorylation and control inflammation.By influencing the central nervous system,the active food intake of patients can be increased and the risk of sarcopenia can be reduced from the level of malnutrition.Therefore,the application of SGLT-2i in elderly patients with type 2 diabetes can not only play a role in hypoglycemia and cardiovascular protection,but also has important significance in delaying the occurrence of sarcopenia.The application of SGLT-2i may bring new ideas and targets for the treatment of elderly patients with type 2 diabetes complicated with sarcopenia.

关 键 词：钠-葡萄糖共转运蛋白2抑制剂 老年2型糖尿病 肌肉减少症 

分 类 号：R587.1[医药卫生—内分泌] R592[医药卫生—内科学]