降血糖药对脂质代谢影响的机制研究进展

doi:10.3969/j.issn.1674-8115.2026.05.015

摘要/Abstract

摘要：

降血糖药包括双胍类（biguanides）、α-糖苷酶抑制剂（α-glucosidase inhibitor，AGI）、噻唑烷二酮类（thiazolidinediones，TZDs）、胰岛素、二肽基肽酶-Ⅳ（dipeptidyl peptidase-Ⅳ，DPP-4）抑制剂、钠-葡萄糖协同转运蛋白2（sodium-glucose cotransporter 2，SGLT-2）抑制剂、胰高血糖素样肽-1受体激动剂（glucagon-like peptide-1 receptor agonist，GLP-1RA）、葡萄糖激酶激活剂（glucokinase activator，GKA）和过氧化物酶体增殖物激活受体（peroxisome proliferator-activated receptor，PPAR）泛激动剂等，前4种属于传统降血糖药，后5种属于新型降血糖药。研究表明，这些药物不仅能有效降低血糖，还在改善脂质代谢方面展现出一定潜力，然而其具体作用机制尚需深入探究。2型糖尿病（type 2 diabetes mellitus，T2DM）患者长期慢性高血糖状态会通过多种病理生理途径干扰脂质代谢平衡，因此纠正脂质代谢紊乱已成为T2DM管理的关键目标之一。但T2DM合并脂质代谢紊乱的患者，在疾病早期阶段，难以精准选择合适的降血糖药进行治疗。基于此，该文综述不同降血糖药对脂质代谢影响的机制研究新进展，并深入探讨其对脂质代谢的作用，为临床医师选择降血糖药时提供参考，帮助T2DM伴脂质代谢紊乱的患者获得长期临床收益。

关键词: 降血糖药, 2型糖尿病, 脂质代谢

Abstract:

Antihyperglycemic agents include biguanides, α-glucosidase inhibitors (AGIs), thiazolidinediones (TZDs), insulin, dipeptidyl peptidase-Ⅳ (DPP-4) inhibitors, sodium-glucose cotransporter 2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), glucokinase activators (GKAs) and peroxisome proliferator-activated receptor (PPAR) pan-agonists. Among them, the former four categories are traditional antihyperglycemic agents, while the latter five are novel antihyperglycemic agents. Studies have demonstrated that these agents not only exert effective glucose-lowering effects, but also exhibit potential in improving lipid metabolism, although their precise mechanisms remain to be further elucidated. Long-term chronic hyperglycemia in patients with type 2 diabetes mellitus (T2DM) disrupts lipid metabolic homeostasis via multiple pathophysiological pathways. Therefore, correcting lipid metabolism disorders has become one of the key objectives of T2DM management. However, in patients with T2DM complicated by lipid metabolism disorders, it is difficult to accurately select appropriate antihyperglycemic agents for treatment at the early stage of the disease. Based on this, this article reviews recent progress in the mechanism of the effects of different antihyperglycemic agents on lipid metabolism, and further explores their effects on lipid metabolism, so as to provide a reference for clinicians in selecting antihyperglycemic agents and help T2DM patients with lipid metabolism disorders achieve long-term clinical benefits.

Key words: antihyperglycemic agent, type 2 diabetes mellitus (T2DM), lipid metabolism

中图分类号:

R587.1

王丽, 宋康. 降血糖药对脂质代谢影响的机制研究进展[J]. 上海交通大学学报（医学版）, 2026, 46(5): 680-687.

Wang Li, Song Kang. Progress in the mechanism of the effects of antihyperglycemic agents on lipid metabolism[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(5): 680-687.

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