陈运凡,刘家乐,方臻飞

• 1:中南大学湘雅二医院心血管内科

摘要(Abstract)：

主动脉瓣狭窄（AS）是老年人最常见的瓣膜性心脏病之一。尽管主动脉瓣置换术，尤其是经导管主动脉瓣置换术（TAVR），显著改善了重度AS患者的症状和生存，但目前仍缺乏能够延缓AS自然进展的有效药物治疗；与此同时，TAVR术后患者仍面临心力衰竭再恶化、左心室逆重构不充分、急性肾损伤及生物瓣功能障碍等残余风险。近年来，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）在心力衰竭和慢性肾脏病领域显示出稳定的心肾保护作用，其研究范围亦逐步扩展至AS及TAVR术后人群。现有基础与转化研究提示，SGLT2i可能通过改善容量状态、减轻炎症与氧化应激以及调节心肌重构发挥潜在疾病修饰作用。临床证据方面，观察性研究提示SGLT2i可能与非重度AS进展减缓、TAVR术后心肌逆重构改善、急性肾损伤风险降低及生物瓣相关结局改善有关；DapaTAVI随机对照研究显示，达格列净可降低全因死亡或心力衰竭恶化复合终点的发生风险，且主要获益来源于心力衰竭事件减少。总体而言，达格列净在TAVR术后高风险患者中的心力衰竭事件预防价值已获得随机证据支持，但SGLT2i对原生AS进展、全因死亡及生物瓣耐久性的影响仍需进一步验证。

关键词(KeyWords)： 主动脉瓣狭窄;经导管主动脉瓣置换术;钠-葡萄糖协同转运蛋白2抑制剂;心力衰竭;心肌重构;生物瓣耐久性

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 陈运凡,刘家乐,方臻飞

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