射血分数保留型心力衰竭与微血管内皮炎症

Ejection fraction preserved heart failure and microvascular endothelial inflammation

射血分数保留型心力衰竭(HFpEF)是一种以运动耐受减低和组织充血为特征的临床综合征,其原因主要有炎症反应、内皮功能障碍、代谢异常等。临床上还未出现治疗HFpEF的有效药物,其发病机制也尚未明确,目前提出的微血管内皮炎症有望成为重要靶点。HFpEF并发症导致全身炎症反应,随后冠状动脉微血管内皮细胞氧化应激,降低心肌细胞的一氧化氮(NO)生物利用度,导致心肌细胞环磷酸鸟苷(cGMP)-蛋白激酶G(PKG)活性降低,引起心肌顺应性降低和心肌肥厚。本文就此作一综述。

Ejection fraction preserved heart failure(HFpEF)is a clinical syndrome characterized by reduced exercise tolerance and hyperemia,mainly caused by the inflammatory response,endothelial dysfunction,and metabolic abnormalities.Unfortunately,there is no effective drug for the treatment of HFpEF in clinical practice,and the pathogenesis of HFpEF is still unclear.Currently,the proposed microvascular endothelial inflammation is expected to become an important target.Complications of HFpEF lead to systemic inflammation,followed by oxidative stress of coronary microvascular endothelial cells.In addition,microvascular endothelial inflammation can decrease the bioavailability of nitric oxide(NO),and the activity of cGMP-protein kinase G(PKG),resulting in decreased myocardial compliance and hypertrophy.This review will summarize the pathogenesis of systemic inflammation and microvascular endothelial inflammation in HFpEF.