作者
丁 淼,叶 强
文章摘要
替尔泊肽是一种新型的胰高血糖素样肽-1(GLP-1)和葡萄糖依赖性胰岛素促分泌多肽(GIP)双重受体激动剂,其独特的双重激动机制,使其在降糖、减重方面的疗效显著,同时表现出心血管保护作用,为心血管疾病治疗提供了新方向。本文综述替尔泊肽的作用机制、心血管益处,其对血糖、体重、血脂、血压等心血管危险因素的调控作用,以及与心室重构、炎症反应等心血管病理过程的关联,旨在为替尔泊肽在代谢性疾病及心血管疾病中的临床应用与后续研究提供参考。
文章关键词
替尔泊肽;心血管疾病;胰高血糖素样肽-1;葡萄糖依赖性胰岛素促分泌多肽
参考文献
[1] Greenwell A A,Chahade J J,Ussher J R.Cardiovascular biology of the GIP receptor[J].Peptides,2020,125:170228.
[2] Jones B.The therapeutic potential of GLP-1 receptor biased agonism[J].Br J Pharmacol,2022,179(4):492-510.
[3] Nowak M,Nowak W,Grzeszczak W.Tirzepatide-a dual GIP/GLP-1 receptor agonist-a new antidiabetic drug with potential metabolic activity in the treatment of type 2 diabetes[J].Endokrynol Pol,2022,73(4):745-55.
[4] Holst J J.GLP-1 physiology in obesity and development of incretin-based drugs for chronic weight management[J].Nat Metab, 2024,6(10):1866-85.
[5] Patoulias D,Papadopoulos C,Fragakis N,et al.Updated Meta-Analysis Assessing the Cardiovascular Efficacy of Tirzepatide[J].Am J Cardiol,2022,181:139-40.
[6] Galli M,Benenati S,Laudani C,et al.Cardiovascular Effects and Tolerability of GLP-1 Receptor Agonists:A Systematic Review and Meta-Analysis of 99,599 Patients[J].J Am Coll Cardiol,2025,86(20):1805-19.
[7] Wu J Y,Tseng K J,Kao C L,et al.Tirzepatide and the Prevention of Heart Failure in Obesity:A Multi-Center Cohort Study Using the TriNetX Database[J].Eur J Prev Cardiol,2025.
[8] Hankosky E R,Wang H,Neff L M,et al.Tirzepatide reduces the predicted risk of atherosclerotic cardiovascular disease and improves cardiometabolic risk factors in adults with obesity or overweight:SURMOUNT-1 post hoc analysis[J].Diabetes Obes Metab,2024, 26(1):319-28.
[9] Nauck M A,D'alessio D A.Tirzepatide,a dual GIP/GLP-1 receptor co-agonist for the treatment of type 2 diabetes with unmatched effectiveness regrading glycaemic control and body weight reduction[J].Cardiovasc Diabetol,2022,21(1):169.
[10] Taktaz F,Scisciola L,Fontanella R A,et al.Evidence that tirzepatide protects against diabetes-related cardiac damages[J].Cardiovasc Diabetol,2024,23(1):112.
[11] Packer M,Zile M R,Kramer C M,et al.Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity[J].N Engl J Med, 2025,392(5):427-37.
[12] Nicholls S J,Bhatt D L,Buse J B,et al.Comparison of tirzepatide and dulaglutide on major adverse cardiovascular events in participants with type 2 diabetes and atherosclerotic cardiovascular disease:SURPASS-CVOT design and baseline characteristics[J].Am Heart J,2024, 267:1-11.
[13] Mcguire D K,D'alessio D,Nicholls S J,et al.Transitioning to active-controlled trials to evaluate cardiovascular safety and efficacy of medications for type 2 diabetes[J].Cardiovasc Diabetol,2022,21(1):163.
[14] Nicholls S J,Pavo I,Bhatt D L,et al.Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes[J].N Engl J Med,2025,393(24):2409-20.
[15] Rosenstock J,Wysham C,Frías J P,et al.Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes(SURPASS-1):a double-blind,randomised,phase 3 trial[J].Lancet,2021,398(10295):143-55.
[16] Singh M.In type 2 diabetes with increased CV risk,tirzepatide reduced HbA(1c)vs.glargine at 52 wk[J].Ann Intern Med,2022,175(3):Jc34.
[17] Frías J P,Davies M J,Rosenstock J,et al.Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes[J].N Engl J Med, 2021,385(6):503-15.
[18] Ludvik B,Giorgino F,Jódar E,et al.Once-weekly tirzepatide versus once-daily insulin degludec as add-on to metformin with or without SGLT2 inhibitors in patients with type 2 diabetes(SURPASS-3):a randomised,open-label,parallel-group,phase 3 trial[J].Lancet,2021, 398(10300):583-98.
[19] Del Prato S,Kahn S E,Pavo I,et al.Tirzepatide versus insulin glargine in type 2 diabetes and increased cardiovascular risk (SURPASS-4):a randomised,open-label,parallel-group,multicentre,phase 3 trial[J].Lancet,2021,398(10313):1811-24.
[20] Su X,Peng D.Emerging functions of adipokines in linking the development of obesity and cardiovascular diseases[J].Mol Biol Rep, 2020,47(10):7991-8006.
[21] Preda A,Carbone F,Tirandi A,et al.Obesity phenotypes and cardiovascular risk:From pathophysiology to clinical management[J].Rev Endocr Metab Disord,2023,24(5):901-19.
[22] Li M,Cui M,Li G,et al.The Pathophysiological Associations Between Obesity,NAFLD,and Atherosclerotic Cardiovascular Diseases[J]. Horm Metab Res,2024,56(10):683-96.
[23] Ansari H U H,Qazi S U,Sajid F,et al.Efficacy and Safety of Glucagon-Like Peptide-1 Receptor Agonists on Body Weight and Cardiometabolic Parameters in Individuals With Obesity and Without Diabetes:A Systematic Review and Meta-Analysis[J].Endocr Pract,2024,30(2):160-71.
[24] Aronne L J,Horn D B,Le Roux C W,et al.Tirzepatide as Compared with Semaglutide for the Treatment of Obesity[J].N Engl J Med,2025,393(1):26-36.
[25] Müllertz A L O,Sandsdal R M,Jensen S B K,et al.Potent incretin-based therapy for obesity:A systematic review and meta-analysis of the efficacy of semaglutide and tirzepatide on body weight and waist circumference,and safety[J].Obes Rev,2024,25(5):e13717.
[26] Iacobellis G.Epicardial adipose tissue in contemporary cardiology[J].Nat Rev Cardiol,2022,19(9):593-606.
[27] Malavazos A E,Iacobellis G,Dozio E,et al.Human epicardial adipose tissue expresses glucose-dependent insulinotropic polypeptide,glucagon,and glucagon-like peptide-1 receptors as potential targets of pleiotropic therapies[J].Eur J Prev Cardiol,2023, 30(8):680-93.
[28] Kramer C M,Borlaug B A,Zile M R,et al.Tirzepatide Reduces LV Mass and Paracardiac Adipose Tissue in Obesity-Related Heart Failure:SUMMIT CMR Substudy[J].J Am Coll Cardiol,2025,85(7):699-706.
[29] Yu D,Shen S,Zhang J,et al.Effect of the Dual Glucose‐Dependent Insulinotropic Peptide/Gulcagon‐like Peptide 1 Receptor Agonist Tirzepatide on Lipid Profile and Waist Circumference:A Systematic Review and Meta‐analysis[J].Clin Ther,2023,45(8):787-96.
[30] Mahar M U,Mahmud O,Ahmed S,et al.The Effects of Tirzepatide on Lipid Profile:A Systematic Review and Meta-Analysis of Randomized Controlled Trials[J].J Obes Metab Syndr,2024,33(4):348-59.
[31] Gastaldelli A,Cusi K,Fernández LandóL,et al.Effect of tirzepatide versus insulin degludec on liver fat content and abdominal adipose tissue in people with type 2 diabetes(SURPASS-3 MRI):a substudy of the randomised,open-label,parallel-group,phase 3 SURPASS-3 trial[J].Lancet Diabetes Endocrinol,2022,10(6):393-406.
[32] Elsayed N A,Aleppo G,Aroda V R,et al.10.Cardiovascular Disease and Risk Management:Standards of Care in Diabetes-2023[J]. Diabetes Care,2023,46(Suppl 1):S158-s90.
[33] Krumholz H M,De Lemos J A,Sattar N,et al.Tirzepatide and blood pressure reduction:stratified analyses of the SURMOUNT-1 randomised controlled trial[J].Heart,2024,110(19):1165-71.
[34] Kanbay M,Copur S,Siriopol D,et al.Effect of tirzepatide on blood pressure and lipids:A meta-analysis of randomized controlled trials[J].Diabetes Obes Metab,2023,25(12):3766-78.
[35] Wilson J M,Lin Y,Luo M J,et al.The dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist tirzepatide improves cardiovascular risk biomarkers in patients with type 2 diabetes:A post hoc analysis[J].Diabetes Obes Metab,2022, 24(1):148-53.
[36] Liu Q,Zhu J,Kong B,et al.Tirzepatide attenuates lipopolysaccharide-induced left ventricular remodeling and dysfunction by inhibiting the TLR4/NF-kB/NLRP3 pathway[J].Int Immunopharmacol,2023,120:110311.
[37] Chen M,Zhao N,Shi W,et al.Glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor agonist tirzepatide promotes branched chain amino acid catabolism to prevent myocardial infarction in non-diabetic mice[J].Cardiovasc Res,2025, 121(3):454-67.
[38] Chen L,Chen X,Ruan B,et al.Tirzepatide protects against doxorubicin-induced cardiotoxicity by inhibiting oxidative stress and inflammation via PI3K/Akt signaling[J].Peptides,2024,178:171245.
[39] Yang D,Chen Y H,Chen Y K,et al.Tirzepatide alleviates doxorubicin-induced cardiotoxicity via inhibiting HRD1-mediated Nrf2 ubiquitination[J].Cardiovasc Res,2025,121(12):1865-82.
[40] Maringwa J,Sardu M L,Hang Y,et al.Characterizing Effects of Antidiabetic Drugs on Heart Rate,Systolic and Diastolic Blood Pressure[J].Clin Pharmacol Ther,2021,109(6):1583-92.
[41] Yang Y,He L,Liu P,et al.Impact of a dual glucose-dependent insulinotropic peptide/glucagon-like peptide-1 receptor agonist tirzepatide on heart rate among patients with type 2 diabetes:A systematic review and pairwise and network meta-analysis[J].Diabetes Obes Metab, 2024,26(2):548-56.
[42] Baggio L L,Yusta B,Mulvihill E E,et al.GLP-1 Receptor Expression Within the Human Heart[J].Endocrinology,2018,159(4):1570-84.
[43] Zaïmia N,Obeid J,Varrault A,et al.GLP-1 and GIP receptors signal through distinctβ-arrestin 2-dependent pathways to regulate pancreaticβcell function[J].Cell Rep,2023,42(11):113326.
[44] Baser O,Samayoa G,Rodchenko K,et al.The association between weight loss medications and cardiovascular complications[J]. Obesity(Silver Spring),2024,32(7):1401-9.
[45] Wu J Y,Tseng K J,Kao C L,et al.Clinical effectiveness of tirzepatide for patients with atrial fibrillation and type 2 diabetes:A retrospective cohort study[J].Diabetes Res Clin Pract,2025,225:112279.
[46] Tan M C,Yee M F,Vignarajah A,et al.Exploring the cardiopulmonary effects of tirzepatide in atrial fibrillation and comorbid chronic obstructive pulmonary disease[J].Am J Med,2026,139(1):108-13.
Full Text:
DOI