摘要
移植后糖尿病(PTDM)是肾移植后常见的并发症之一,发生率为4%~30%。肾移植PTDM的药物治疗面临诸多挑战,既要考虑药物本身的降糖疗效,也要考虑药物对移植肾功能的影响,同时需关注降糖药物与免疫抑制药的相互作用。胰高血糖素样肽-1受体激动剂(GLP-1RA)已被广泛用于成人2型糖尿病患者的血糖控制,部分GLP-1RA还能够改善患者的肾脏结局和心血管结局,兼具调脂、减轻体质量等多重代谢获益。已有临床研究提示可将GLP-1RA用于肾移植PTDM受者的血糖控制,同时发现其具有减少不良肾脏事件、不良心血管事件发生风险,以及改善代谢等多重获益,且未发现GLP-1RA的应用影响肾移植PTDM受者免疫抑制药血药浓度。鉴于GLP-1RA在肾移植PTDM受者治疗中的良好应用潜力,本文综述GLP-1RA治疗肾移植PTDM的现状及未来前景,分析不同GLP-1RA的作用差异,以及其在肾脏保护、多重代谢获益的可能作用机制,为临床应用提供依据。
Post transplantation diabetes mellitus(PTDM)is one of the common complications after kidney transplantation,with an incidence rate of 4%to 30%.The pharmacological treatment of PTDM after kidney transplantation faces many challenges.It is necessary to consider not only the blood glucose-lowering efficacy of the drugs themselves,but also the impact of the drugs on the function of the transplant kidney.At the same time,the interaction between antihyperglycemic drugs and immunosuppressive agents should be taken into account.Glucagon-like peptide-1 receptor agonist(GLP-1RA)have been widely used for blood glucose control in patients with type 2 diabetes mellitus.Some GLP-1RA can also improve the renal and cardiovascular outcomes of patients,and they have multiple metabolic benefits,such as regulating the lipid and reducing body weight.Clinical studies have suggested that GLP-1RA can be used for blood glucose control in kidney transplant recipients with PTDM,with multiple benefits,including reducing the risk of kidney disease and adverse cardiovascular events,as well as improving metabolism.Moreover,no influence of GLP-1RA application on the blood concentration of immunosuppressive agents in kidney transplant recipients with PTDM has been found.Given the good application potential of GLP-1RA in the treatment of kidney transplant recipients with PTDM,this article reviews the current status and future prospects of GLP-1RA treatment for PTDM,analyzes the differences in effects of different GLP-1RA,and explores their potential mechanisms of action in renal protection and multiple metabolic benefits,providing a basis for clinical application.
作者
许钰
刘洋
李岚
任卫东
申晶
Xu Yu;Liu Yang;Li Lan;Ren Weidong;Shen Jing(Department of Endocrinology,Eighth Medical Center,General Hospital of the People's Liberation Army,Beijing 100091,China;不详)
出处
《器官移植》
北大核心
2025年第5期785-791,共7页
Organ Transplantation
基金
国家卫生健康委医药卫生科技发展研究中心面上项目(WKZX2024CX201208)。
关键词
胰高血糖素样肽-1受体激动剂
肾移植
移植后糖尿病
2型糖尿病
估计肾小球滤过率
尿白蛋白/肌酐比值
体质量
胆固醇
Glucagon-like peptide-1 receptor agonist
Kidney transplantation
Post transplantation diabetes mellitus
Type 2 diabetes mellitus
Estimated glomerular filtration rate
Urinary albumin-to-creatinine ratio
Body weight
Cholesterol
