临床试验对心力衰竭患者危险性的评估及生物学药物治疗的新证据

The evaluation of clinical trial on the risk factor and new clinical evidence of the biological therapy in heart failure

心力衰竭是一个严重的大众健康问题 ,尽管药物治疗取得了进步 ,但是死亡例数一直在稳步增加。临床试验证明 ,年龄较大、收缩压较低、呼吸频率较快、血尿素氮较高、低钠血症是心力衰竭患者的危险因素。临床试验的新证据提示 ,ARB可降低 HF患者的总死亡率、病死率 +病残率联合终点 ,但 ARB并不优于传统治疗药物 ACEI,也不支持在传统治疗药物 ACEI基础上联合使用 ARB。具有 β1 受体、β2 受体和 α受体阻滞作用的非选择性 β受体阻滞剂—卡维地洛能较长时间和较大幅度抑制交感神经张力 ,降低慢性心力衰竭患者的病死率 ,且疗效较选择性β1 受体阻滞剂美托洛尔显著。选择性醛固酮阻滞剂依普利酮在标准治疗基础上可以降低急性心肌梗死后左心室功能不全和

Heart failure (HF) is a severe problem.Although medicine treatment has achieved greatly,the mortality increases obviously.Clinical trial has proved that ageing,low systolic blood pressure,rapid respiratory rate,high blood urea and hyponatremia are risk factors of HF.New clinical evidence suggests that angiotensin receptor blocker (ARB) can lower the total mortality and morbidity of HF patients,but not superior to the traditional angiotensin converting enzyme inhibitors (ACEI).As non selective β receptor blocker,carvedilol can depress sympathetic nerve for a longer time and decrease the death rate of HF patients.Eplerenone,a selective aldosterone blocker may decrease the rate of left ventricular dysfunction of post acute myocardial infarction and the morbidity and mortality of HF patients under basis standard treatment.