Возможности кардио- и нефропротективного действия препаратов группы ингибиторов SGLT2

В настоящей работе предпринята попытка проанализировать данные о механизмах кардио- и нефропротекции препаратов из группы ингибиторов SGLT2 (Sodium/glucose cotransporter 2 — натрий-глюкозный котранспортер 2-го типа). Показаны данные исследований последних лет, которые свидетельствуют о влиянии препаратов данной группы на показатели центральной гемодинамики, в основном на объем циркулирующей плазмы, что может снижать риск прогрессирования и декомпенсации хронической сердечной недостаточности (ХСН). Продемонстрирована способность эмпаглифлозина уменьшать пульсовое давление, которое является маркером увеличения жесткости сосудистой стенки. Также ингибиторы SGLT2 улучшают энергообеспечение миокарда и почечной ткани путем увеличения концентрации кетоновых тел в крови, которые являются более эффективным энергетическим субстратом, нежели глюкоза и жирные кислоты. Не исключается также благоприятное действие на миокард, улучшение диастолической дисфункции миокарда. Известно, что ингибиторы SGLT2 уменьшают корковую гипоксию, снижают внутриклубочковую гипертензию и увеличивают скорость клубочковой фильтрации, уменьшая вероятность появления нефропатии, ее тяжесть и скорость прогрессирования. В некоторых исследованиях выявлены антиоксидантные, противовоспалительные, антифибротические свойства ингибиторов натрий-глюкозного котранспортера 2-го типа. Применение данной группы препаратов также приводит к снижению массы тела, больше этот эффект выражен в комбинации с другими лекарственными средствами, предназначенными для лечения ожирения. Все это делает ингибиторы SGLT2 перспективной группой лекарственных средств, имеющих большое количество патогенетических точек приложения на развитие кардиоренального синдрома.

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