【提要】  T2DM的病理生理过程包括复杂的“八重奏”机制，其中肾脏调节作用正逐渐得到关注。肾脏对葡萄糖代谢的调节作用包括糖异生、肾小球滤过和近曲小管重吸收。钠-葡萄糖协同转运蛋白-2（SGLT2）是肾葡萄糖重吸收过程中的关键分子。受T2DM患者SGLT2 mRNA和蛋白水平升高，以及家族性肾性糖尿等遗传代谢病的启示，研究者逐步开发出多种选择性SGLT2抑制剂，这些药物通过减少肾葡萄糖重吸收、降低异常升高的肾糖阈，可降低血糖且不增加低血糖风险。多种SGLT2抑制剂的临床试验或上市后研究显示，该类药物在降糖方面有很好的前景，对体重、血压等有额外保护效应，总体安全性也较好。其作为T2DM标准治疗的可行性仍有待在大样本临床研究中进一步探究。

【关键词】  葡萄糖代谢异常；肾重吸收；钠-葡萄糖协同转运蛋白；糖尿病，2型

 The role of the kidney in regulating blood glucose 

    【Abstract】  The Pathophysiology of type 2 diabetes （T2DM）is complicated and described as “Ominous Octet”. The role of kidney attracts more and more attention. Renal gluconeogenesis, glomerular glucose filtration and tubular glucose reabsorption are the three main ways of renal involvement in glucose homeostasis. Sodium-glucose cotransporter 2(SGLT2) is a key molecular in renal reabsorption of glucose. Inspired by increased SGLT2 and corresponding mRNA level in subjects with T2DM s and family renal glucosuria syndrome, selective SGLT2 inhibitors are gradually developed in the recent years. Such agents reduce glucose reabsorption and renal threshold for glucose therefore reduce blood glucose of T2DM patients  with additional protective effect on bodyweight and blood pressure as well as acceptable safety profile. Clinical data in large and long-term trials is required to identify if SGLT-2 inhibitors can be used as a standard treatment in subjects with T2DM.

    【Key words】 Glucose metabolism disorders; Renal reabsorption; Sodium glucose cotransporters; Diabetes mellitus, type 2