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Novel Insights Into the Genetic Causes of Short Stature in Children. 对儿童身材矮小的遗传原因的新见解。
Pub Date : 2022-06-01 Epub Date: 2022-05-25 DOI: 10.17925/EE.2022.18.1.49
Concetta Mastromauro, Francesco Chiarelli

Short stature is a common reason for consulting a growth specialist during childhood. Normal height is a polygenic trait involving a complex interaction between hormonal, nutritional and psychosocial components. Genetic factors are becoming very important in the understanding of short stature. After exclusion of the most frequent causes of growth failure, clinicians need to evaluate whether a genetic cause might be taken into consideration. In fact, genetic causes of short stature are probably misdiagnosed during clinical practice and the underlying cause of short stature frequently remains unknown, thus classifying children as having idiopathic short stature (ISS). However, over the past decade, novel genetic techniques have led to the discovery of novel genes associated with linear growth and thus to the ability to define new possible aetiologies of short stature. In fact, thanks to the newer genetic advances, it is possible to properly re-classify about 25-40% of children previously diagnosed with ISS. The purpose of this article is to describe the main monogenic causes of short stature, which, thanks to advances in molecular genetics, are assuming an increasingly important role in the clinical approach to short children.

身材矮小是儿童时期咨询生长专家的常见原因。正常身高是一种多基因性状,涉及荷尔蒙、营养和社会心理因素之间复杂的相互作用。遗传因素在理解身材矮小方面变得非常重要。排除生长衰竭最常见的原因后,临床医生需要评估是否考虑遗传原因。事实上,在临床实践中,矮小的遗传原因很可能被误诊,矮小的根本原因经常是未知的,因此将儿童归类为特发性矮小(ISS)。然而,在过去的十年中,新的遗传技术已经导致与线性生长相关的新基因的发现,从而有能力定义新的可能的矮小病因。事实上,由于新的遗传学进展,有可能正确地重新分类大约25-40%以前被诊断为ISS的儿童。本文的目的是描述身材矮小的主要单基因原因,由于分子遗传学的进步,这些原因在矮小儿童的临床治疗中扮演着越来越重要的角色。
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引用次数: 1
Once-weekly 2.4 mg Semaglutide for Weight Management in Obesity: A Game Changer? 每周一次2.4毫克西马鲁肽用于肥胖患者的体重管理:改变游戏规则?
Pub Date : 2022-06-01 Epub Date: 2022-06-15 DOI: 10.17925/EE.2022.18.1.35
Ides M Colin, Katherine M Gérard

The treatment of obesity can no longer be reduced to a simplistic view of weight loss. Metabolic adaptation leads to systematic weight regain following weight-loss efforts, and new obesity treatments should therefore aim to induce long-standing double-digit weight loss, and thus improve and even reverse obesity-associated comorbidities such as type 2 diabetes. Until now, only metabolic surgery has been able to achieve such a goal, but this invasive procedure cannot be offered on a large scale. Among the alternatives, lifestyle interventions and drug therapies have often been disappointing. The recent availability of once-weekly subcutaneous 2.4 mg semaglutide (a glucagon-like peptide-1 receptor agonist; Wegovy™ Novo Nordisk A/S, Bagsværd, Denmark) has changed the scene, and semaglutide is considered a 'game changer' in the treatment of obesity. The results from the phase III STEP (Semaglutide treatment effect in people with obesity) clinical programme have shown that semaglutide provides clinically meaningful and sustained weight loss in ranges much higher than those achieved with previously available pharmacotherapies. These results led to the approval of semaglutide by regulatory authorities as an adjunct to a reduced-calorie diet and increased physical activity in people with obesity or overweight, with at least one weight-related comorbidity. With data from phase II and III clinical trials showing that newer drugs (i.e. the glucagon-like peptide-1 and gastric inhibitory polypeptide dual receptor agonist tirzepatide and the amylin agonist cagrilintide, either alone or combined) produce a greater sustained weight loss than semaglutide, an upstream 'weight-centric' strategy has emerged as a new standard for the treatment of type 2 diabetes.

肥胖的治疗不能再被简化为减肥的简单观点。代谢适应导致减肥后的系统性体重恢复,因此新的肥胖治疗应该旨在诱导长期两位数的体重减轻,从而改善甚至逆转肥胖相关的合并症,如2型糖尿病。到目前为止,只有代谢手术能够实现这一目标,但这种侵入性手术无法大规模提供。在替代疗法中,生活方式干预和药物治疗往往令人失望。最近可获得每周一次皮下2.4 mg semaglutide(一种胰高血糖素样肽-1受体激动剂;Wegovy™Novo Nordisk A/S, Bagsværd,丹麦)已经改变了这一场景,semaglutide被认为是肥胖治疗的“游戏规则改变者”。来自III期STEP (Semaglutide治疗肥胖患者的效果)临床项目的结果表明,Semaglutide提供的临床意义和持续的体重减轻范围远远高于以前可用的药物治疗。这些结果导致监管机构批准西马鲁肽作为肥胖或超重人群减少卡路里饮食和增加体力活动的辅助药物,至少有一种与体重相关的合并症。II期和III期临床试验的数据显示,较新的药物(即胰高血糖素样肽-1和胃抑制多肽双受体激动剂tizepatide和amylin激动剂cagrilintide,单独或联合使用)比semaglutide产生更大的持续减肥效果,上游“以体重为中心”的策略已经成为治疗2型糖尿病的新标准。
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引用次数: 1
Glucagon-like Peptide-1 Receptor Analogues for the Treatment of Obesity. 胰高血糖素样肽-1受体类似物治疗肥胖。
Pub Date : 2022-03-01 Epub Date: 2022-03-18 DOI: 10.17925/EE.2022.18.1.43
David M Williams, Matthew Staff, Stephen C Bain, Thinzar Min

There is an increasing prevalence of obesity worldwide, associated with significant morbidity and mortality, which frequently reduces quality of life and life expectancy. Consequently, there is a substantial and growing personal and economic burden necessitating the development of more effective therapies for obesity. Glucagon-like peptide-1 receptor analogues (GLP-1RAs) are licensed for the treatment of type 2 diabetes (T2D), and there is substantial evidence that these drugs not only improve cardiovascular outcomes but also promote weight loss. More recent evidence supports the use of the GLP-1RAs liraglutide and semaglutide in people with obesity without T2D. This article discusses the results of the major cardiovascular outcome trials for GLP-1RAs in people with T2D, the SCALE Obesity and Prediabetes study (Effect of liraglutide on body weight in non-diabetic obese subjects or overweight subjects with co-morbidities: SCALE™ - Obesity and Pre-diabetes; ClinicalTrials.gov identifier: NCT01272219; investigating liraglutide) and the STEP studies (Semaglutide treatment effect in people with obesity; assorted studies; investigating subcutaneous semaglutide). We also highlight the importance of a cost-effective approach to obesity pharmacotherapy. Clinicians should consider the use of GLP-1RAs in people with obesity, especially those with T2D or other obesity-related diseases, such as hypertension and dyslipidaemia. Ongoing trials, as well as clinical and cost-effectiveness appraisals, are anticipated over the next 12 months, and their findings may change the current landscape of obesity pharmacotherapy.

肥胖在世界范围内日益流行,与显著的发病率和死亡率相关,经常降低生活质量和预期寿命。因此,有一个巨大的和不断增长的个人和经济负担,需要发展更有效的治疗肥胖的方法。胰高血糖素样肽-1受体类似物(GLP-1RAs)被批准用于治疗2型糖尿病(T2D),有大量证据表明这些药物不仅可以改善心血管结局,还可以促进体重减轻。最近更多的证据支持GLP-1RAs利拉鲁肽和semaglutide用于无T2D的肥胖患者。本文讨论了GLP-1RAs在T2D患者中的主要心血管结局试验的结果,即SCALE肥胖和前驱糖尿病研究(利拉鲁肽对非糖尿病性肥胖受试者或伴有合并症的超重受试者体重的影响:SCALE™-肥胖和前驱糖尿病;ClinicalTrials.gov识别码:NCT01272219;调查利拉鲁肽)和STEP研究(西玛鲁肽治疗肥胖患者的效果;各种各样的研究;研究皮下semaglutide)。我们还强调了成本效益的方法对肥胖药物治疗的重要性。临床医生应考虑在肥胖患者中使用GLP-1RAs,特别是那些患有T2D或其他肥胖相关疾病的患者,如高血压和血脂异常。正在进行的试验以及临床和成本效益评估预计将在未来12个月内进行,他们的发现可能会改变目前肥胖药物治疗的现状。
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引用次数: 3
Imeglimin: A New Promising and Effective Weapon in the Treatment of Type 2 Diabetes. 伊米霉素:治疗2型糖尿病的有效新武器。
Pub Date : 2021-11-01 Epub Date: 2021-11-10 DOI: 10.17925/EE.2021.17.2.88
John Doupis, Neoklis Baris, Konstantinos Avramidis

Imeglimin is a novel molecule currently under development for the treatment of type 2 diabetes mellitus, and is the first agent of the 'glimin' class of glucose-lowering medication. It has a unique mechanism of action that targets the three main pathophysiologic components of type 2 diabetes: impaired glucose uptake by muscle tissue, excess hepatic gluconeogenesis and increased β-cell apoptosis. To date, imeglimin has been evaluated in many preclinical and clinical trials and has shown to have notable antihyperglycaemic effects, such as statistically significant reductions in glycated haemoglobin, fasting plasma glucose and other glycaemic parameters. The encouraging tolerability profile, combined with its efficacy, could make it suitable as a monotherapy or in combination with other classes of antidiabetic agents, hopefully in the near future.

依米明是一种新型分子,目前正在开发用于治疗2型糖尿病,是“格米明”类降血糖药物的第一种药物。它具有独特的作用机制,针对2型糖尿病的三个主要病理生理成分:肌肉组织葡萄糖摄取受损,肝脏糖异生过度和β细胞凋亡增加。迄今为止,伊米明已经在许多临床前和临床试验中进行了评估,并显示出显著的抗高血糖作用,例如在统计学上显著降低糖化血红蛋白、空腹血糖和其他血糖参数。令人鼓舞的耐受性,结合其疗效,可能使其适合作为单一治疗或与其他类型的抗糖尿病药物联合使用,希望在不久的将来。
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引用次数: 3
Medical Therapy for Craniopharyngiomas. 颅咽管瘤的药物治疗
Pub Date : 2021-11-01 Epub Date: 2021-11-08 DOI: 10.17925/EE.2021.17.2.121
Krystallenia I Alexandraki, Paraskevi Xekouki

Craniopharyngiomas are rare benign neoplasms presenting in two different types, adamantinomatous (ACP) or papillary (PCP), which are molecularly and clinically distinct. Traditional treatment includes surgical resection and radiotherapy, which are accompanied by a number of debilitating complications because of the tumours' proximity to important brain structures. Recent advances in the understanding of molecular pathogenesis of craniopharyngiomas have opened horizons to medical therapeutic options. ACPs are mainly characterized by mutations of β-catenin, which activate Wingless/Int (Wnt), and alter the mitogen extracellular kinase (MEK)/extracellular signal-regulated kinase (ERK) pathway, as well as inflammatory, cellular senescence, programmed cell death and sonic hedgehog (SHH) pathways. PCPs are mainly characterized by Ras/Raf/MEK/ERK pathway activation secondary to BRAF-V600E mutations. MEK inhibitors, such as binimetinib, or anti-inflammatory mediators, such as tocilizumab or interferon, have been administered to patients with ACP and the efficacy is mostly favourable. On the other hand, BRAF inhibitors, such as dabrafenib or vemurafenib, either alone or in combination with the MEK inhibitors trametinib and cobimetinib, have been administered to patients with PCP resulting in favourable responses. A number of ongoing trials will shed light on schemes, doses, combined treatments and safety issues of the new molecular-targeted treatments, changing the management of patients with craniopharyngiomas by launching the era of personalized medicine in these rare neoplasms. We conducted a systematic review to identify case series or case reports with patients currently treated with systemic medical therapy.

颅咽管瘤是一种罕见的良性肿瘤,表现为两种不同的类型,金刚腺瘤(ACP)和乳头状瘤(PCP),它们在分子和临床上是不同的。传统的治疗方法包括手术切除和放射治疗,由于肿瘤靠近重要的大脑结构,这伴随着许多使人衰弱的并发症。颅咽管瘤分子发病机制的最新进展为医学治疗选择开辟了视野。acp的主要特征是β-catenin突变,其激活无翼/Int (Wnt),改变丝裂原细胞外激酶(MEK)/细胞外信号调节激酶(ERK)通路,以及炎症、细胞衰老、细胞程序性死亡和sonic hedgehog (SHH)通路。pcp主要以BRAF-V600E突变继发的Ras/Raf/MEK/ERK通路激活为特征。MEK抑制剂(如binimetinib)或抗炎介质(如tocilizumab或干扰素)已被用于ACP患者,且大多数疗效良好。另一方面,BRAF抑制剂,如dabrafenib或vemurafenib,单独使用或与MEK抑制剂trametinib和cobimetinib联合使用,已被用于PCP患者,并产生良好的反应。一些正在进行的试验将揭示新的分子靶向治疗的方案、剂量、联合治疗和安全性问题,通过启动这些罕见肿瘤的个性化医疗时代,改变颅咽管瘤患者的管理。我们进行了一项系统综述,以确定目前接受全身药物治疗的患者的病例系列或病例报告。
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引用次数: 5
Non-alcoholic Steatohepatitis: From Pathophysiology to Clinical Practice. 非酒精性脂肪性肝炎:从病理生理学到临床实践。
Pub Date : 2021-11-01 Epub Date: 2021-09-14 DOI: 10.17925/EE.2021.17.2.112
Sherwyn Schwartz, Jean Lucas, Mark H DeLegge

Non-alcoholic steatohepatitis (NASH) is becoming a global disease with significant associated comorbidities. To date, there are no commercialized drugs to treat NASH, outside of India; however, there is an abundance of new molecular entities which are in clinical development, some in phase III trials. Many of these trials have created an especially heavy demand for USA-based subjects. Hepatologists currently play a major role in the diagnosis, treatment and clinical-trial enrolment of patients with NASH. However, NASH has a strong metabolic component, with patients often carrying comorbid diseases, such as type 2 diabetes mellitus, obesity, hyperlipidaemia, hypothyroidism and sex steroid disorders. The primary care physician, internist and endocrinologist stand at a pivotal position in the NASH healthcare delivery system, as many of the diseases they commonly encounter are associated with a higher risk of developing NASH. Specialty society practice guidelines are evolving regarding the identification and care of patients with NASH. This review of the literature, and assessment of IQVIA's proprietary patient claims database of diagnosis codes, patient encounters and treatments, substantiates the importance of the primary care provider and endocrinologist in the clinical care and clinical research of patients with NASH.

非酒精性脂肪性肝炎(NASH)正在成为一种具有显著相关合并症的全球性疾病。到目前为止,在印度以外,还没有商业化的治疗NASH的药物;然而,有大量新的分子实体正在临床开发中,其中一些正在进行III期试验。其中许多试验对美国受试者产生了特别大的需求。肝病学家目前在NASH患者的诊断、治疗和临床试验登记方面发挥着重要作用。然而,NASH具有很强的代谢成分,患者经常携带合并症,如2型糖尿病、肥胖、高脂血症、甲状腺功能减退和性类固醇疾病。初级保健医生、内科医生和内分泌学家在NASH医疗保健系统中处于关键地位,因为他们经常遇到的许多疾病都与患NASH的风险较高有关。关于NASH患者的识别和护理,专业协会的实践指南正在不断发展。这篇文献综述,以及对IQVIA专有的诊断代码、患者遭遇和治疗患者索赔数据库的评估,证实了初级保健提供者和内分泌学家在NASH患者的临床护理和临床研究中的重要性。
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引用次数: 0
Changing the Concept: From the Traditional Glucose-centric to the New Cardiorenal-metabolic Approach for the Treatment of Type 2 Diabetes. 改变观念:从传统的以血糖为中心到新的心肾代谢法治疗 2 型糖尿病。
Pub Date : 2021-11-01 Epub Date: 2021-11-17 DOI: 10.17925/EE.2021.17.2.92
Dimitrios G Chatzis, Konstantinos Kolokathis, Kalliopi Magounaki, Stefanos Chatzidakis, Konstantinos Avramidis, Marianna Leopoulou, Theodoros P Angelopoulos, John Doupis

Type 2 diabetes mellitus (T2DM) is a chronic disease with a constantly increasing prevalence worldwide. It is well established that T2DM affects both the macro- and microvasculature, and its presence is associated with a high risk of acute and chronic cardiovascular events. Traditionally, the management of T2DM has been mainly focused on the optimization of blood glucose levels with the use of antidiabetic medications. During recent years, however, an impressive accumulation of evidence has arisen from studies designed to explore the plausible effects of new antidiabetic drugs on cardiovascular outcomes in patients with diabetes. This review article aims to emphasize the findings of these studies and to highlight the substantial role of the newer classes of antidiabetic drugs in treating T2DM in a holistic, cardiorenal-metabolic approach, thus shifting the paradigm from the traditional, simplistic, glucose-lowering approach.

2 型糖尿病(T2DM)是一种慢性疾病,在全球的发病率不断上升。T2DM 对大血管和微血管都有影响,而且与发生急性和慢性心血管事件的高风险相关,这一点已得到公认。传统上,T2DM 的治疗主要侧重于通过使用抗糖尿病药物来优化血糖水平。然而,近年来,旨在探索新型抗糖尿病药物对糖尿病患者心血管预后的合理影响的研究积累了大量证据,令人印象深刻。这篇综述文章旨在强调这些研究的结果,并突出新型抗糖尿病药物在以心肾代谢综合方法治疗 T2DM 方面的重要作用,从而改变传统、简单的降糖方法。
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引用次数: 0
Controversies in Gestational Diabetes. 妊娠期糖尿病的争议。
Pub Date : 2021-11-01 Epub Date: 2021-08-04 DOI: 10.17925/EE.2021.17.2.102
Chloe A Zera, Ellen W Seely

Gestational diabetes mellitus (GDM) complicates approximately 7% of pregnancies in the USA. Despite recognition of the benefits of diagnosing and treating GDM, there are several areas of controversy that remain unresolved. There is debate as to whether to screen for GDM with the one-step versus the two-step approach. While the former identifies more pregnancies with potential adverse outcomes, data are lacking as to whether treatment of these pregnancies will improve outcomes, while increasing costs by diagnosing more women. Though it is well established that the diagnosis of even mild GDM, and treatment with lifestyle recommendations and insulin, improves pregnancy outcomes, it is controversial as to which type and regimen of insulin is optimal, and whether oral agents can be used safely and effectively to control glucose levels. Finally, it is recommended that women with GDM get tested for type 2 diabetes within several months of delivery; however, many women do not undergo this testing and alternative approaches are needed. These controversies are discussed with data from both sides of the debate to enable clinicians to make patient-centered decisions until more definitive data are available.

在美国,妊娠期糖尿病(GDM)并发症约占妊娠的7%。尽管认识到诊断和治疗GDM的好处,但仍有几个争议领域尚未解决。关于是用一步法还是两步法筛查GDM存在争议。虽然前者确定了更多有潜在不良后果的怀孕,但缺乏数据表明,对这些怀孕的治疗是否会改善结果,同时因诊断出更多的妇女而增加了成本。虽然已经确定,即使是轻度GDM的诊断,以及生活方式建议和胰岛素治疗,都可以改善妊娠结局,但哪种类型和方案的胰岛素是最佳的,以及口服药物是否可以安全有效地控制血糖水平,这些都是有争议的。最后,建议患有GDM的妇女在分娩后几个月内进行2型糖尿病检测;然而,许多妇女不接受这种检查,需要其他方法。这些争议讨论与数据从辩论双方,使临床医生做出以患者为中心的决定,直到更明确的数据可用。
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引用次数: 0
Contemporary Non-hormonal Therapies for the Management of Vasomotor Symptoms Associated with Menopause: A Literature Review. 当代非激素疗法治疗与更年期相关的血管舒缩症状:文献综述
Pub Date : 2021-11-01 Epub Date: 2021-10-13 DOI: 10.17925/EE.2021.17.2.133
Sabrina Sahni, Angie Lobo-Romero, Taryn Smith
Nearly 75% of all menopausal women experience bothersome vasomotor symptoms including hot flushes and night sweats. Yet vasomotor symptoms continue to be an undertreated and underdiagnosed symptom of menopause which can negatively affect a woman's overall quality of life. While hormone therapy has been widely utilized to ameliorate hot flushes, not all women are candidates for use, especially those with increased risk of cardiovascular disease, thromboembolic disease, and/or women at an increased risk of certain hormone-dependent cancers. The current literature provides strong evidence for non-hormonal therapies in women who experience vasomotor symptoms. This article reviews the evidence for the use of non-hormonal pharmacologic therapies for the treatment of menopausal symptoms including antidepressants, gabapentinoids, clonidine and anticholinergics. We also review data on emerging therapies including the latest evidence on neurokinin-1 and -3 antagonists. These therapies should be considered when hormonal options are contraindicated and/or not preferred by the patient. While there are many options available, clinicians should individualize therapy based on the patient's needs and goals while mitigating bothersome side effects.
近75%的绝经期妇女经历了令人烦恼的血管舒缩症状,包括潮热和盗汗。然而,血管舒缩症状仍然是一种未得到充分治疗和诊断的更年期症状,它会对女性的整体生活质量产生负面影响。虽然激素疗法已被广泛用于改善潮热,但并非所有妇女都适合使用,特别是那些心血管疾病、血栓栓塞性疾病风险增加的妇女,和/或某些激素依赖性癌症风险增加的妇女。目前的文献为经历血管舒缩症状的女性提供了非激素治疗的有力证据。本文综述了使用非激素药物治疗更年期症状的证据,包括抗抑郁药、加巴喷丁类药物、可乐定和抗胆碱能药物。我们还回顾了新兴疗法的数据,包括神经激肽-1和-3拮抗剂的最新证据。当患者有激素治疗禁忌和/或不喜欢激素治疗时,应考虑使用这些治疗方法。虽然有很多选择,临床医生应该根据病人的需要和目标来个性化治疗,同时减轻恼人的副作用。
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引用次数: 5
Finerenone: A Potential Treatment for Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus. 非格列酮慢性肾病和 2 型糖尿病患者的潜在治疗方法。
Pub Date : 2021-11-01 Epub Date: 2021-11-10 DOI: 10.17925/EE.2021.17.2.84
Luis D'Marco, María Jesús Puchades, Lorena Gandía, Claudia Forquet, Elena Giménez-Civera, Nayara Panizo, Javier Reque, Isabel Juan-García, Valmore Bermúdez, José Luis Gorriz

Type 2 diabetes mellitus (T2DM) affects an estimated 463 million people worldwide, equivalent to 1 in 11 adults. Moreover, the rapid growth of this disease has resulted in a high incidence of diabetic kidney disease (DKD), which, together with hypertension, is the main cause of chronic kidney disease (CKD). Hyperglycaemia, low-grade inflammation, altered lipid metabolism and hyperactivation of the renin-angiotensin-aldosterone system (RAAS) seem to be interrelated mechanisms contributing to both T2DM and microvascular complications. The introduction of drugs such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists has improved the ability to slow the progression of DKD, and has also demonstrated benefits in cardiovascular disease. Beyond the effects of these novel antidiabetic drugs, a body of evidence suggests that the overactivation of the mineralocorticoid receptor also contributes to CKD progression. Moreover, new and ongoing trials have demonstrated that the selective nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone improves the risk of CKD progression and cardiovascular events in patients with CKD and T2DM and optimized RAAS blockade. We review the rationale for the development and use of MRA drugs to slow CKD progression in patients with DKD, as well as other pleiotropic effects, and highlight the warnings associated with these agents.

全世界约有 4.63 亿人患有 2 型糖尿病(T2DM),相当于每 11 个成年人中就有 1 人。此外,这种疾病的快速增长导致糖尿病肾病(DKD)的高发病率,而糖尿病肾病与高血压一起,是慢性肾病(CKD)的主要病因。高血糖、低度炎症、脂质代谢改变和肾素-血管紧张素-醛固酮系统(RAAS)亢进似乎是导致 T2DM 和微血管并发症的相互关联的机制。钠-葡萄糖共转运体 2 抑制剂和胰高血糖素样肽 1 受体激动剂等药物的问世,提高了延缓 DKD 病程进展的能力,也显示出对心血管疾病的益处。除了这些新型抗糖尿病药物的作用外,大量证据表明,矿物质皮质激素受体的过度激活也是导致慢性肾脏病进展的原因之一。此外,新的和正在进行的试验表明,选择性非甾体类矿化皮质激素受体拮抗剂(MRA)非那西酮可改善慢性肾功能衰竭和 T2DM 患者的慢性肾功能衰竭进展风险和心血管事件,并优化 RAAS 阻断。我们回顾了开发和使用 MRA 药物以延缓 DKD 患者 CKD 病程进展的理论依据以及其他多生物效应,并强调了与这些药物相关的警告。
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引用次数: 0
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TouchREVIEWS in endocrinology
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