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心血管医师应倡导使用新型降糖药物！ACC更新决策路径

2020-08-07 朱朱 文韬 中国循环杂志

降糖药物
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8月5日，美国心脏病学会（ACC）更新专家共识，心血管医师要成为应用新型降糖药物治疗的拥护者和倡导者。

8月5日，美国心脏病学会（ACC）更新专家共识，心血管医师要成为应用新型降糖药物治疗的拥护者和倡导者。
 
共识建议，针对4类人群，心血管医师可应用钠葡萄糖共转运蛋白2（SGLT2）抑制剂或胰高血糖素样肽1（GLP-1）受体激动剂来降低其心血管风险。
 
这4类人群是已有动脉粥样硬化性心血管病、心衰、糖尿病肾病或处于心血管病高风险的2型糖尿病患者。
 
近期，我国葛均波院士、霍勇教授等发表的《改善心血管和肾脏结局的新型抗高血糖药物临床应用中国专家建议》亦指出，临床医师应及早启动并长期维持能够改善心血管和肾脏结局的新型降糖药物治疗。
 
近年来积累的证据表明，SGLT2抑制剂和GLP-1受体激动剂是可直接改善心血管结局的两类降糖药物。
 
上述四类患者均可考虑选择SGLT2抑制剂，有动脉粥样硬化性心血管病或处于心血管病高风险的患者也可考虑选择GLP-1受体激动剂。
 
SGLT2抑制剂尤其适用于合并射血分数降低的心衰（收缩性心衰）的2型糖尿病患者。
 
2型糖尿病患者启用SGLT2抑制剂或GLP-1受体激动剂的机会
1
已合并动脉粥样硬化性心血管病的2型糖尿病患者（SGLT2抑制剂或GLP-1受体激动剂）
2
2型糖尿病患者临床诊断动脉粥样硬化性心血管病（SGLT2抑制剂或GLP-1受体激动剂）、糖尿病肾病和（或）心衰（SGLT2抑制剂）时
3
动脉粥样硬化性心血管病（SGLT2抑制剂或GLP-1受体激动剂）、肾脏病和（或）心衰（SGLT2抑制剂）患者诊断2型糖尿病时
4
因动脉粥样硬化性心血管病（SGLT2抑制剂或GLP-1受体激动剂）或心衰（SGLT2抑制剂）住院患者出院时
5
合并糖尿病肾病的2型糖尿病患者（SGLT2抑制剂，eGFR <30  ml/min/1.73 m2时可用GLP-1受体激动剂替代）
6
动脉粥样硬化性心血管病高风险（SGLT2抑制剂或GLP-1受体激动剂）或心衰高风险（SGLT2抑制剂）患者
 
两类药物均应以在临床试验中应用的最低剂量开始应用，根据患者情况逐渐滴定至最大可耐受剂量。
 
该专家共识强调，在选择应用SGLT2抑制剂或GLP-1受体激动剂之前，临床医生要与患者充分讨论，根据患者的意愿和优先考虑的方面来选择药物。
 
另外，在2型糖尿病患者中应用上述两类新型降糖药物时，必须与其他心血管危险因素管理指南保持一致，包括关于血脂、血压、抗血小板治疗的指南。
 
在该专家共识决策路径中，动脉粥样硬化性心血管病定义为：有急性冠脉综合征或心肌梗死病史、稳定性或不稳定性心绞痛、冠心病（无论是否接受血运重建）、其他动脉血运重建、中风、推测为动脉粥样硬化导致的外周血管疾病。
 
动脉粥样硬化性心血管病高风险是指：有靶器官损害，例如左室肥厚、视网膜病变；或合并多个心血管危险因素，例如年龄较大、高血压、吸烟、血脂代谢异常、肥胖等。
 
如估算肾小球滤过率（eGFR）下降或存在白蛋白尿，或两者同时存在，就可诊断为糖尿病肾病。
 
SGLT2抑制剂
 
随机对照研究表明，在2型糖尿病患者中，SGLT2抑制剂可显著降低主要不良心血管事件发生风险，合并动脉粥样硬化性心血管病和（或）糖尿病肾病的患者获益尤其明显。这类药物还能降低心衰住院风险。
 
除了降糖，SGLT2抑制剂还有减轻体重、利尿利钠、降压等作用，但其对血脂、血糖、血压等传统危险因素的影响似乎并不是其改善心血管和肾脏结局的关键原因。
 
在SGLT2抑制剂中，恩格列净、卡格列净、达格列净已获得美国FDA批准用来降低成年糖尿病患者的心血管风险，其中达格列净还可用于治疗非糖尿病患者合并的心衰。这三种药物都可改善2型糖尿病患者的肾功能。
 
SGLT2抑制剂的不良反应主要是生殖系统真菌感染，因此感染高风险患者在用药时需要注意监测。其他不良反应包括糖尿病酮症酸中毒、下肢截肢、低血压、血容量不足。
 
GLP-1受体激动剂
 
近年来的随机对照研究显示，GLP-1受体激动剂可显著减少主要不良心血管事件（非致死性心肌梗死、心血管死亡、非致死性中风）发生风险。
 
GLP-1受体激动剂的心血管获益主要见于合并动脉粥样硬化性心血管病的2型糖尿病患者，但度拉糖肽也可用于仅有心血管病危险因素的患者，即可用于心血管病的一级预防。
 
有研究发现，某些GLP-1受体激动剂有一定的肾脏获益，但尚未经随机临床试验证实。
 
除了降糖，GLP-1受体激动剂还有降压、减轻体重、改善炎症和降低甘油三酯水平等作用。
 
GLP-1受体激动剂的主要不良反应为恶心、呕吐，一般为一过性；另外还可能导致胆囊疾病、低血糖、糖尿病视网膜病变、心率增快等。
 
GLP-1受体激动剂包括利拉鲁肽、度拉糖肽、索马鲁肽、阿必鲁肽。
 
来源：
[1]2020 Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol, 5 August 2020
[2]葛均波, 霍勇, 李勇, 等. 改善心血管和肾脏结局的新型抗高血糖药物临床应用中国专家建议. 中国循环杂志, 2020, 35: 231-238.   
DOI:10.3969/j.issn.1000-3614.2020.03.002

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    2021-03-20 1479ea96m27暂无昵称

    学习

    0

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    2021-01-02 ms3000000573963476

    达格列净心内科常用了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=949837, encodeId=5a6094983ecb, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=51705231149, createdName=1479ea96m27暂无昵称, createdTime=Sat Mar 20 23:54:42 CST 2021, time=2021-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913154, encodeId=7f279131546d, content=达格列净心内科常用了, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ac125449497, createdName=ms3000000573963476, createdTime=Sat Jan 02 21:46:18 CST 2021, time=2021-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=898886, encodeId=1b368988865e, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3e95433715, createdName=ms6000001414112870, createdTime=Fri Nov 13 09:23:37 CST 2020, time=2020-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=886086, encodeId=3b27886086bd, content=是一般人用得起的吗?言必称美国批准什么的，中国批准了哪些药，不介绍介绍。, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e7572458878, createdName=12412355m93暂无昵称, createdTime=Thu Sep 17 16:15:51 CST 2020, time=2020-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881869, encodeId=814388186943, content=实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200819/64fbd2072f9a45e4ab1d483ac903cef2/6094007d789849e39a3a1f25435a6f41.jpg, createdBy=72732561091, createdName=杀无敌战神, createdTime=Tue Sep 01 20:58:29 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270919, encodeId=52a912e091901, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326698, encodeId=21ad1326698f8, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390276, encodeId=b8b413902e680, content=<a href='/topic/show?id=355398180af' target=_blank style='color:#2F92EE;'>#降糖药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98180, encryptionId=355398180af, topicName=降糖药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bb182500058, createdName=yuhaisheng_ibp_32061711, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541861, encodeId=c2ca15418619e, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806902, encodeId=956c8069025d, content=实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a63e5409568, createdName=ms1000000689800756, createdTime=Sat Aug 08 10:36:03 CST 2020, time=2020-08-08, status=1, ipAttribution=)]
    2020-11-13 ms6000001414112870

    不错

    0

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    2020-09-17 12412355m93暂无昵称

    是一般人用得起的吗?言必称美国批准什么的，中国批准了哪些药，不介绍介绍。

    0

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    2020-09-01 杀无敌战神

    实用

    0

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    2020-08-09 minlingfeng

    #降糖药#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=949837, encodeId=5a6094983ecb, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=51705231149, createdName=1479ea96m27暂无昵称, createdTime=Sat Mar 20 23:54:42 CST 2021, time=2021-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913154, encodeId=7f279131546d, content=达格列净心内科常用了, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ac125449497, createdName=ms3000000573963476, createdTime=Sat Jan 02 21:46:18 CST 2021, time=2021-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=898886, encodeId=1b368988865e, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3e95433715, createdName=ms6000001414112870, createdTime=Fri Nov 13 09:23:37 CST 2020, time=2020-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=886086, encodeId=3b27886086bd, content=是一般人用得起的吗?言必称美国批准什么的，中国批准了哪些药，不介绍介绍。, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e7572458878, createdName=12412355m93暂无昵称, createdTime=Thu Sep 17 16:15:51 CST 2020, time=2020-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881869, encodeId=814388186943, content=实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200819/64fbd2072f9a45e4ab1d483ac903cef2/6094007d789849e39a3a1f25435a6f41.jpg, createdBy=72732561091, createdName=杀无敌战神, createdTime=Tue Sep 01 20:58:29 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270919, encodeId=52a912e091901, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326698, encodeId=21ad1326698f8, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390276, encodeId=b8b413902e680, content=<a href='/topic/show?id=355398180af' target=_blank style='color:#2F92EE;'>#降糖药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98180, encryptionId=355398180af, topicName=降糖药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bb182500058, createdName=yuhaisheng_ibp_32061711, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541861, encodeId=c2ca15418619e, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806902, encodeId=956c8069025d, content=实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a63e5409568, createdName=ms1000000689800756, createdTime=Sat Aug 08 10:36:03 CST 2020, time=2020-08-08, status=1, ipAttribution=)]
    2020-08-09 12498568m50暂无昵称

    #ACC#

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=949837, encodeId=5a6094983ecb, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=51705231149, createdName=1479ea96m27暂无昵称, createdTime=Sat Mar 20 23:54:42 CST 2021, time=2021-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913154, encodeId=7f279131546d, content=达格列净心内科常用了, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ac125449497, createdName=ms3000000573963476, createdTime=Sat Jan 02 21:46:18 CST 2021, time=2021-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=898886, encodeId=1b368988865e, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3e95433715, createdName=ms6000001414112870, createdTime=Fri Nov 13 09:23:37 CST 2020, time=2020-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=886086, encodeId=3b27886086bd, content=是一般人用得起的吗?言必称美国批准什么的，中国批准了哪些药，不介绍介绍。, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e7572458878, createdName=12412355m93暂无昵称, createdTime=Thu Sep 17 16:15:51 CST 2020, time=2020-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881869, encodeId=814388186943, content=实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200819/64fbd2072f9a45e4ab1d483ac903cef2/6094007d789849e39a3a1f25435a6f41.jpg, createdBy=72732561091, createdName=杀无敌战神, createdTime=Tue Sep 01 20:58:29 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270919, encodeId=52a912e091901, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326698, encodeId=21ad1326698f8, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390276, encodeId=b8b413902e680, content=<a href='/topic/show?id=355398180af' target=_blank style='color:#2F92EE;'>#降糖药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98180, encryptionId=355398180af, topicName=降糖药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bb182500058, createdName=yuhaisheng_ibp_32061711, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541861, encodeId=c2ca15418619e, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806902, encodeId=956c8069025d, content=实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a63e5409568, createdName=ms1000000689800756, createdTime=Sat Aug 08 10:36:03 CST 2020, time=2020-08-08, status=1, ipAttribution=)]
    2020-08-09 yuhaisheng_ibp_32061711

    #降糖药物#

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=949837, encodeId=5a6094983ecb, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=51705231149, createdName=1479ea96m27暂无昵称, createdTime=Sat Mar 20 23:54:42 CST 2021, time=2021-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913154, encodeId=7f279131546d, content=达格列净心内科常用了, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ac125449497, createdName=ms3000000573963476, createdTime=Sat Jan 02 21:46:18 CST 2021, time=2021-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=898886, encodeId=1b368988865e, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3e95433715, createdName=ms6000001414112870, createdTime=Fri Nov 13 09:23:37 CST 2020, time=2020-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=886086, encodeId=3b27886086bd, content=是一般人用得起的吗?言必称美国批准什么的，中国批准了哪些药，不介绍介绍。, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e7572458878, createdName=12412355m93暂无昵称, createdTime=Thu Sep 17 16:15:51 CST 2020, time=2020-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881869, encodeId=814388186943, content=实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200819/64fbd2072f9a45e4ab1d483ac903cef2/6094007d789849e39a3a1f25435a6f41.jpg, createdBy=72732561091, createdName=杀无敌战神, createdTime=Tue Sep 01 20:58:29 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270919, encodeId=52a912e091901, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326698, encodeId=21ad1326698f8, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390276, encodeId=b8b413902e680, content=<a href='/topic/show?id=355398180af' target=_blank style='color:#2F92EE;'>#降糖药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98180, encryptionId=355398180af, topicName=降糖药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bb182500058, createdName=yuhaisheng_ibp_32061711, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541861, encodeId=c2ca15418619e, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806902, encodeId=956c8069025d, content=实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a63e5409568, createdName=ms1000000689800756, createdTime=Sat Aug 08 10:36:03 CST 2020, time=2020-08-08, status=1, ipAttribution=)]
    2020-08-09 ms2999106592497887

    #决策#

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=949837, encodeId=5a6094983ecb, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=51705231149, createdName=1479ea96m27暂无昵称, createdTime=Sat Mar 20 23:54:42 CST 2021, time=2021-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913154, encodeId=7f279131546d, content=达格列净心内科常用了, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ac125449497, createdName=ms3000000573963476, createdTime=Sat Jan 02 21:46:18 CST 2021, time=2021-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=898886, encodeId=1b368988865e, content=不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3e95433715, createdName=ms6000001414112870, createdTime=Fri Nov 13 09:23:37 CST 2020, time=2020-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=886086, encodeId=3b27886086bd, content=是一般人用得起的吗?言必称美国批准什么的，中国批准了哪些药，不介绍介绍。, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e7572458878, createdName=12412355m93暂无昵称, createdTime=Thu Sep 17 16:15:51 CST 2020, time=2020-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=881869, encodeId=814388186943, content=实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200819/64fbd2072f9a45e4ab1d483ac903cef2/6094007d789849e39a3a1f25435a6f41.jpg, createdBy=72732561091, createdName=杀无敌战神, createdTime=Tue Sep 01 20:58:29 CST 2020, time=2020-09-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270919, encodeId=52a912e091901, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326698, encodeId=21ad1326698f8, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390276, encodeId=b8b413902e680, content=<a href='/topic/show?id=355398180af' target=_blank style='color:#2F92EE;'>#降糖药物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=120, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98180, encryptionId=355398180af, topicName=降糖药物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bb182500058, createdName=yuhaisheng_ibp_32061711, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541861, encodeId=c2ca15418619e, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Sun Aug 09 04:55:04 CST 2020, time=2020-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=806902, encodeId=956c8069025d, content=实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=114, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a63e5409568, createdName=ms1000000689800756, createdTime=Sat Aug 08 10:36:03 CST 2020, time=2020-08-08, status=1, ipAttribution=)]
    2020-08-08 ms1000000689800756

    实用

    0

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2017年10月，韩国糖尿病协会(KDA)发布了降糖药物治疗成人2型糖尿病的立场声明，本文主要内容是关于成人非妊娠2型糖尿病患者的药物治疗，主要建议内容包括口服降糖药和胰高血糖素样蛋白-1受体激动剂（GLP-1RAs）治疗2型糖尿病，注射药物治疗2型糖尿病，包括胰岛素和GLP-1RAs。

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糖尿病肾脏疾病（DKD）是糖尿病主要的微血管并发症之一，良好的血糖控制会明显减少微血管并发症的发生。过去20年虽然我们在大血管并发症的预防和治疗方面取得了长足的进步，但遗憾的是，在微血管并发症防治方面一直停滞不前。尽管目前有多种降糖药物和治疗策略来控制血糖，但是终末期肾病的发病风险仍未降低。因此，临床上迫切需要具有肾脏保护作用的降糖药物。

Diabetes Obes Metab：2型糖尿病：降糖药物与糖尿病视网膜病变的“恩怨纠葛”

降糖药物（GLDs）的使用与糖尿病视网膜病变（DR）的相关性尚未得到很好阐述。近来临床研究表明：降糖药物可增加DR的风险。2018年5月，发表在《Diabetes Obes Metab》的一项网络荟萃分析调查了GLDs对2型糖尿病（T2DM）患者DR风险的相对影响。

Int J Cardiol：新型降糖药物的心血管预后分析！

由此可见，SGLT-2抑制剂和GLP-1 Ras可降低全因死亡率和MACE，但是DPP-4抑制剂无此效应。SGLT-2抑制剂对全因死亡率的影响最大。DPP-4抑制剂没有展示出具有心血管益处，并且在预防死亡方面不如其他两种药物。

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