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肾脏病与透析肾移植杂志 ›› 2025, Vol. 34 ›› Issue (5): 469-474.DOI: 10.3969/j.issn.1006⁃298X.2025.05.014

• 肾脏病临床 • 上一篇    下一篇

钠⁃葡萄糖协同转运蛋白 2 抑制剂改善贫血的研究进展

  

  • 出版日期:2025-10-28 发布日期:2025-10-30

Advances of sodium⁃glucose cotransporter 2 inhibitors in improving anemia

  • Online:2025-10-28 Published:2025-10-30

摘要: 贫血是慢性肾脏病(CKD)的常见并发症,严重影响患者的生活质量并与多种慢性疾病的进程密切相关。钠⁃葡萄糖协同转运蛋白 2 抑制剂(SGLT2i)最初用于改善糖尿病患者的血糖控制,但近年的研究发现,SGLT2i 不仅能延缓 CKD 的进展,还能显著改善贫血。研究表明,SGLT2i 通过减轻近端肾小管缺氧状态,恢复肾间质成纤维细胞样细胞的活力,增加促红细胞生成素(EPO)生成;还可通过调节缺氧诱导因子(HIF)⁃1α 和 HIF⁃2α 的表达,改善肾脏的氧合状态,优化铁代谢,促进红细胞生成。同时,SGLT2i 还可能增加肝脏 EPO 生成来代偿肾脏功能的不足。SGLT2i 通过多方面的机制改善贫血,为肾性贫血治疗提供了新思路。

关键词: 钠?葡萄糖协同转运蛋白 2 抑制剂, 贫血, 促红细胞生成素, 缺氧诱导因子, 铁代谢

Abstract: Anemia is a common complication of chronic kidney disease (CKD), which significantly affects the quality of life of patients and is closely related to the progression of various chronic diseases. Sodium⁃glucose cotransporter 2 inhibitors (SGLT2i) were initially used to improve glycemic control in patients with diabetes. However, in recent years, studies have found that SGLT2i not only delay the progression of CKD, but also show significant effects in improving anemia. Research indicates that SGLT2i alleviate hypoxia in the proximal renal tubules to restore the vitality of fibroblast⁃like cells in the renal interstitium and enhance the production of erythropoietin (EPO), thereby promoting red blood cell generation. Furthermore, SGLT2i enhance renal oxygenation by regulating the expression of hypoxia⁃inducible factor (HIF)⁃1α and HIF⁃2α, while also facilitating erythropoiesis through the optimization of iron metabolism. Moreover, SGLT2i may compensate for renal insufficiency by stimulating hepatic EPO production. Through these multifaceted mechanisms, SGLT2i ameliorate anemia and offer novel therapeutic insights for the treatment of renal anemia.


Key words: sodium?glucose cotransporter 2 inhibitors, anemia, erythropoietin, hypoxia?inducible factor, iron metabolism